“I could 100% see myself getting hurt if I did it wrong”: a qualitative exploration of exercise perceptions in people with chronic low back pain

Traditionally, a specific “core” exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. All participants (<i>n</i> = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. “Core” exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts. Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative.‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous.Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health.Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain. Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative. ‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous. Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health. Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain.

传统上，针对慢性腰痛（chronic low back pain, CLBP）的干预更青睐特定的“核心”训练聚焦模式，这与整体化运动疗法路径形成鲜明对比。本研究旨在探索慢性腰痛患者对运动疗法的认知，以及在无临床叙事的前提下，运动本身能否传递有关其在慢性腰痛管理中应用的隐性信息。研究人员通过线上半结构化访谈，向参与者询问了其慢性腰痛病史、对慢性腰痛相关运动疗法的看法，以及当前的运动行为习惯。随后，参与者观看访谈者演示硬拉（deadlift）、杰斐逊卷体（Jefferson curl）与鸟狗式（bird dog）这三项运动，并被要求逐一判断每项运动是否对慢性腰痛有益，并阐述理由。研究采用反身主题分析法（reflexive thematic analysis），以批判实在论（critical realism）与社会建构主义（social constructivism）为理论视角开展数据分析。所有参与者（n = 16）均认为所有运动对健康与疼痛缓解均有益处，但感知到的疗效存在差异。“核心”训练被视为缓解慢性腰痛的关键手段，而脊柱屈曲动作与外部负重运动则常被认为存在潜在损伤风险。对医疗从业者的不信任同样影响了参与者对运动疗法的认知。慢性腰痛患者对不同运动的认知存在分化，部分运动被认为可缓解疼痛，而另一些则被认为可改善健康状况。医疗从业者可对患者的运动认知产生影响，这凸显了在临床场景中考量患者运动认知的必要性。即便没有配套的临床叙事，运动本身也可向慢性腰痛患者传递隐性信息。“核心”训练被认为具有获益性，而涉及脊柱屈曲或负重的运动则可能被视为危险动作。用于缓解疼痛的运动，与健身房相关运动或其他用于改善健康的运动，在患者认知中存在显著差异。医疗从业者在将运动作为慢性腰痛的干预手段时，必须考量患者的运动认知水平。即便没有配套的临床叙事，运动本身也可向慢性腰痛患者传递隐性信息。“核心”训练被认为具有获益性，而涉及脊柱屈曲或负重的运动则可能被视为危险动作。用于缓解疼痛的运动，与健身房相关运动或其他用于改善健康的运动，在患者认知中存在显著差异。医疗从业者在将运动作为慢性腰痛的干预手段时，必须考量患者的运动认知水平。