Having been to BODY WORLDS Vital myself in Berlin 2015, and being a musculoskeletal physiotherapist and assistant professor at the Physical Therapy bachelor program at Norwegian University of Science and Technology (NTNU), I felt proud that NTNU Vitenskapsmuseet in Trondheim got this exhibition to town for four months this summer. First time in Norway too. Awesome. Body Worlds is an fascinating, wonderful, enlightening and amazing exhibition. It’s primary goals is health education and to convey that every human being is unique and with anatomical individuality. It is therefor with utter SHOCK I find this one piece of truly outdated and misunderstood information about “save your spine” within this amazing adventure that is BODY WORLDS Vital:
What?
The paradox is astounding as it is a gust of causation and structural-postural-biomechanical based thinking from decades ago and conflicts directly with both the BODY WORLDS Vital’s own primary goals and the health professions (e.g. Physical Therapy) focus of reversing these myths and common beliefs for decades. An updated understanding of the complexity of pain and the body’s capability to adapt specifically to imposed demands, should make it crystal clear that such claims about lifting, bending and pore posture is counter-intuitive and wrong. At the very very best it is extremely oversimplified and without nuance.
The paradox is even more reinforced by the accumulating knowledge that psycho-social factors both contribute to the onset, the severity and the prognoses of back pain. And that one such factor is back beliefs and attitudes, e.g. beliefs that the back is fragile, that bending and lifting are dangerous and that your body posture is an important risk factor for back pain. These factors lead to fear avoidance behavior and maladaptive and unhelpful movement strategies, and are the opposite of what evidence-based knowledge states and advocates. Furthermore, the beliefs that poor posture (as it is stated here) causes back pain is emphatically denied by scientific evidence. In fact to the degree that it is strange this myth isn’t put firmly to rest in all health information/professions. It is very plausible that the consequences of this type of information causes harm via iatrogenic effects and it directly counteract against modern health education. Messages like “bending and lifting is dangerous, and poor posture is a risk factor” only serve to nurture and keep alive unhealthy and unhelpful beliefs in society. And as a poster in a popular and renowned exhibition under the logo of NTNU it directly undermines and degrade the competence and authority of the health profession educations. (My own for instance, and it is unbearable and embarrassing).
Perspective
To put this in perspective; This message is comparable to saying to people with lifestyle diseases, such as diabetes 2, that physical activity and exercise is dangerous and may make their disease worse. I also find this comparable, in principle, to the smoking adverts in the 1940s: “More doctors smoke Camel than any other cigarettes – the doctors choice is America’s choice”. The posters of “save your spine” could very well belong in a museum with the Camel adverts, but not today in a museum of science, and certainly not under the logo of a respectable University of Science and Technology with faculties/institutes for medicine and health science, movement science and social and educational science. Or at any other of the museums BODY WORLDS Vital has exhibitions around the world. Or anywhere else for that matter.
Prevalence
According to the Global Burden of Disease study 2015, back pain is the number two cause of disability-adjusted life-years in rich nations, and number 4 in all nations. Up to 84 pc of people worldwide will experience back pain at some point. Amongst children and adolescent the prevalence is rising with age being almost at adult-level in late adolescent. It is important that every aspect of health care and health education/information understands and advocates evidence-based knowledge. Myths may not be a big factor in causing this back pain phenomenon on a grand scale, but it is acknowledged as an important factor that works as a barrier to both reducing the extreme use of health care resources because of back pain and both for individual and community dealing with and consequences of back pain.
Cause
We do not know what really causes most back pain but it is widely understood that it is, or may be, multifactorial. You can strain you back picking up the mail or picking up something heavy, or stretching one morning or dancing in the evening, with bended or straight knees. You can experience back pain when doing every activity of daily activities, e.g. when sitting, sleeping, walking, standing, exercising, at work or home cleaning your house. To accuse normal and natural movements of the human body to be dangerous is counterproductive and counter-intuitive. And to continue to advocate this single cause fallacy is ignorant. The back is designed for bending and lifting, and variations in movements, positions and loads. One of the consequences for people with back pain is that they alter behavior that do not allow the spine to move normally, and thus create a negative spiral of unhelpful strategies. Because as we now know with great certainty is that one of the most important factors for good back health is that the back should be moved, used and loaded. No activity or exercise is superior or inferior in this regard, and for the latter certainly not bending or lifting activities. More movement is medicine – negative beliefs are unhelpful.
A communicable disease?
Many has pointed to clear trends in society that the consequences of back pain is a socio-cultural construct and phenomenon. Beliefs spreads through society and back pain is a massive socioeconomic burden. Myths, and the beliefs in them, about back pain has infected society in a way that still affect the consequences of having back pain at a frustrating high level. We in health care professions are desperately trying to clean our own house from the old dogmas, but our work in educating patients and communities is constantly pushed back by old myths held alive or brought to the surface by stubborn faith advocates and media. BODY WORLDS Vital is no small player in this regard.
There is considerable evidence that the beliefs and attitudes of people with back pain can greatly influence their management and prognosis. For example, how disabled a person is by their back pain is actually more closely related to their back pain beliefs and behaviours than the actual intensity of their pain. In addition, back pain subjects with poorer back pain beliefs and greater fear about physical activity are more disabled by their back pain. Furthermore, modifying the beliefs and attitudes of people with LBP appears to be effective and reduces disability.
Norway as an example
Camilla Ihlebæk et al. did several studies in the early 2000’s on the Norwegian population based on Richard Deyo’s 7 myths about back pain from 1998 (!!). Many studies worldwide have been designed around these myths and they all show about the same. Two of the myths are for instance “most back pain is caused by injuries or heavy lifting” and “bed rest is the mainstay of therapy”: The myths are still heavily alive and influential within communities worldwide. Ihlebæk concluded in a study from 2004 that the results signals the need for public health campaigns that can reach the general public with accurate messages about backs. She was by far the first to express this concern and advocate a shift of paradigm of back pain understanding, and certainly not the last as the evidence rising since has been overwhelming and the advocates for this revolution in updated back information have been steadily increasing over the last decades.
Neglect
Anyone working in health care or with health education have had to been living under a rock….at the bottom of the ocean….on another planet, to not have absorbed some of the information, knowledge and evidence that debunks these myths and states their unhelpfulness and iatrogenic consequences. At least to the extent that such information like «save your spine» should seem too controversial to push on people in general.
I will leave just one reference (since the evidence is so otherwise overwhelming against the «save your spine» information) and I both urge, and sincerely hope, that BODY WORLDS Vital would consider removing the “save your spine” myth from the otherwise unique and wonderful exhibition.
And to all the visitors of BODY WORLDS Vital (which i highly recommend): Enjoy the exhibition but ignore the «save your spine» information, and read this:
The Irish society of chartred physiotherapists published in 2011 a campaign; «Challenging back pain myths» that was, and still is, supported by World Confederation for Physical Therapy http://www.wcpt.org/sites/wcpt.org/files/files/Publicity_materials-ISCP-Booklet.pdf
Save your own spine of credibility by taking these myths down and out, BODY WORLDS Vital.
FYI: I’ve been in contact with the museum requesting that this information should be taken down. How this information slipped under the radar and through the work with translation and quality check, is not for me to speculate. There are rules for exhibitions I don’t know and exclusive rights for its use and distribution that grants the creator of an original work exclusive rights that makes this far from straight forward. But I will say that NTNU Vitenskapsmusemet have been very cool towards my complaints and have taken my arguments both serious and to heart. They have acknowledged my request and understood the paradox in this information. They have consulted other experts within the University and St. Olavs Hospital that seemingly have confirmed my arguments, and to my understanding also looked into possibilities for taking it down. But as of now their hands are somewhat tied in regard to the posters that is a part of the exhibition.
This blog and opinions are entirely my own. I must say that a resent tweet from Peter O’Sullivan partly inspired me to write this. He said about back pain myths that «We need to be relentless calling out the nonsense – it does harm!». I agree. And I also think this is a perfect proof of how deeply infected society are with back pain myths, on all levels.
Main picture of the archer is taken by myself at Menchen Museum in Berlin 2015.
Fysio Neuralyzer 