Today, low back pain is a problem that affects a very large number of people. However, it is a condition that specialists still have difficulty understanding and treating effectively.

When you suffer from a chronic pain like back pain and you have difficulty getting rid of it, it can be very difficult to live with on a daily basis.

When I met Remi and he told me about his interest and vision of the profession in treating this type of disorder, I thought it would be interesting to share what he taught me.

So here is a physiotherapist’s experience that can help you if you suffer from this type of pain yourself, or if you know someone who does.

Can you quickly introduce yourself: who you are, your background and where you are today?

My name is Rémi Gamont, I am 27 years old and I am a physiotherapist. I studied in Lyon, and since I graduated I have practiced in London and Paris. Last year I also did a master’s degree in musculoskeletal disorders in Amsterdam.

Today I work in Paris in a practice, mainly with patients who suffer from back and shoulder problems. At the same time I do collective interventions in companies to educate, prevent and empower people in relation to back problems which are more and more common.

Why did you become a physiotherapist?

I have always been attracted to the health professions because I think it is important to know one’s body and how it functions. That’s why I first wanted to go to medical school but as I didn’t pass the exam, I studied the other possibilities that were open to me. I finally chose to go into physiotherapy because it was a discipline that allowed me to discover this subject that is the body and that interests me so much.

Why did you choose to be particularly interested in back pain? And all the more so in an educational dimension?

I happened to have personal back problems as a teenager and during my studies, and what I learned at university didn’t really help me at first.

During our university career, we are mostly taught the treatment of mechanical, articular and muscular disorders. However, in my professional experience over the past few years, I have discovered that there are other factors that come into play, especially with regard to back pain.

I therefore decided after my studies to look for ways to solve my own problem. Indeed, I considered that in order to have credibility, I had to solve my own back pain first, and then I could bring my experience to my patients. This was really important for me to believe in what I was doing. From then on, I pushed my research on mechanical back disorders, and I quickly realized that there were limits: when you don’t find a problem directly linked to the spine or the lumbar region, you expand beyond that, to other parts of the body, and quickly you arrive at the psychological dimensions, the beliefs and the habits of the patient.

I am not saying that all patients suffer from back pain because of psychological factors or bad beliefs. However, it is a factor to be taken into account in some people and I think that it is an axis to be developed in physiotherapy because it is probably not taken into account enough today. That’s why I’m particularly interested in it.

What do you think about the management of back problems by physical therapy today ?

The first thing that comes to my mind is that the ways in which professionals do things are very heterogeneous. To sum it up quickly, we can say that there are two main approaches to the problem: “hands on” and “hands off” (which means the approach by massage and manipulation, versus the approach by exercises). For the moment, there is no irrefutable proof that puts one of the two approaches above the other, but there is an increasing tendency to promote active rather than passive management (physical activity against low back pain) among the population.

However, patients are still very much in demand of massage and manipulation, because they believe that it is the concrete intervention (manipulation) of a professional that will help them get better. And in my opinion, many physiotherapists continue to hold this belief because they have been trained in this way. Things are slowly starting to change.

We still have a very local way of treating pain, i.e. we concentrate on the painful area. However, science leads us to believe that a global treatment would be more effective.

How do you think this care could be improved? What is “global” care?

First of all, I think that there should be a certain homogenization of approaches by professionals. This would make our discourse more coherent.

Secondly, adopting a more global approach to care means: taking into account the patient’s globality, and more precisely taking into account the BIO-PSYCHO-SOCIAL context. But I will detail these three levels:

Biological context: it is the functioning of the body as a whole, it takes into account the musculoskeletal field, the mechanical aspect, the structural lesions, the muscular, bone, patho-anatomical problems… This is essential to start a treatment for several reasons; first of all, it is always what is going to be the most important thing in the patient’s mind, so we MUST be interested in the reason why he comes to see us To gain their trust.

Then it is important for us, physiotherapists, to check the most obvious causes of pain, because if there is a structural defect, we must first repair this structure. On the other hand, if no major structural defect is found (which could be the cause of the pain), or if a structural defect is found which is difficult to treat, we continue the investigation.

Social context: family, work, finances… The objective is to determine the patient’s involvement and desire to get better. If we realize that the patient is already fighting on other fronts, we can choose to relieve him/her for the moment and advise him/her to come back later to focus more specifically on the healing of his/her pathology.

Psychological context: what interests us in psychology as a physiotherapist is to study the patient’s beliefs.

The idea is to understand how the patient functions in relation to his disorder. What do they think are the causes of their pain? Why does he think he has pain? Why does he think the pain is coming back?… We can really get surprising answers like “my back hurts because of my car”, “it’s the fault of my office chair”, “it’s when I go to work, it always gives me back pain”…

It’s very important for us to know the patient’s beliefs because, if as a caregiver we don’t address what the patient thinks is the cause, we will have little effectiveness.

If we massage him and make him do exercises, but he continues to drive his car every day, convinced that this is the origin of his problem, he will continue to have pain. Our role is therefore, within the care, to break the false beliefs, and the harmful adaptation behaviors! To educate and make the patient understand that some of his beliefs may not be true or may be only partially true.

In my opinion, the therapist must guide his patient and help him to understand certain contradictions in his reasoning. Patients often tend to make “cause and effect” associations, and these associations have more emotional than logical components.

In order to work on beliefs and behaviors with the patient, we need to call upon a logical dimension but also an emotional dimension that allows us to consolidate the thought patterns.

Do you think that physiotherapists would benefit from working with psychologists?

It could be useful for some patients with chronic pain. But most of all I think that physiotherapists should have a psychological training during their studies.

What advice would you give to people with chronic back problems?

I would advise them to go to a physical therapist, but to choose a professional who has an educational and empowering approach. Self-assessment and self-treatment, with an educational component on pain and body mechanics, is in my opinion the best way to manage a recurring condition.

The therapist’s goal is to teach the patient to take charge of his or her own pathology. This avoids a possible dependence on certain passive treatments such as massage and/or manipulation by the physiotherapist. The goal of chronic pain management is to make the patient independent in the management of his pain.

The patient can very quickly make an association “pain reduction – therapist’s manipulation” which with time can be very complicated to undo.

In a chronic pathology, the main objective is to teach the patient to manage the recurrence of his troubles in an autonomous way.

The goal is not to eradicate the pain or to cure the local pathology, the goal is to educate the patient about his body, his pain, and the fact that he can manage himself. By taking this direction the therapist breaks the psychological patterns of vigilance, apprehension of pain, avoidance of certain movements, anxiety and fear. This helps the patient to know themselves and to feel in control.

I think we would all benefit from trying to get patients active!

Would you like to add one last thing?

I think everything has been said. I hope it helps patients as well as professionals.