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The Usefulness of Reflection

back pain back pain advice causality critical thinking reflection Dec 13, 2022
Sitting and thinking about back pain in a reflective manner

We feel that reflection is incredibly important. Sure, part of that is because, as medical professionals, we have it drilled into us. But really, the benefits are such that it should be encouraged for everyone, of all ages.

Sadly, reflection is all too often perceived as a ponderous navel-gazing exercise in self-flagellation. But it doesn't need to be arduous, although it does need to be honest.

The end of each year, when most of us get the opportunity to wind down to some extent, is a great time to reflect on what has gone before.


Did things go as we expected?

I'm not a big fan of predictions and forecasts. I'm not saying that they shouldn't be made, but I feel that they should take as little time as possible. I think it's a more valuable use of our time to reflect on events relative to predictions, as we then have the opportunity to learn and, hopefully, make better, more efficient predictions for the future.

That patient I saw. I thought they would be better in a few weeks, but in fact, it took several months. Why was my prediction off the mark? What factors contributed to the difference between prediction and event? Did we have incomplete information for making our prediction? Did other factors come into play between prediction and result?


Could things have been better?

When events turn out not quite as we hoped, we should allow ourselves the time and space to ask "why not?"

In examining these events, we can sometimes simply accept that things unfolded differently from what we expected.

Alternatively, is it worth investing time and energy in a more forensic exploration of cause and effect? It can sometimes yield great insight but it doesn't always make for comfortable reading.

The Stoic's prayer is perhaps useful: 

“God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”


Back pain can't always be explained

All too often in clinic, patients and/or clinicians seek to blame single events for causing back pain. That heavy box, the awkward furniture, stumbling on a country walk.  

Not only is this reductionist - too simplistic, it betrays a lack of reflection. Many other factors can contribute to back pain developing, and the events we blame might be just the final straw, or perhaps just associated with the time the pain was first noticed. This can cause a dangerous, and negative train of thought. 

I hurt my back when I lifted a heavy box, so lifting a heavy box again will hurt my back again. I will avoid lifting heavy boxes from now on, and in a few years' time, I will not have lifted any heavy boxes, and then I will feel weak. My therapist will tell me that my continued back pain is because my back is weak, but I will fear that lifting heavy weights will hurt my back, so I don't know how to strengthen it.

This cycle of blame and fear traps many people, and all because we can jump to conclusions about what causes events to happen.

Causality is a fascinating subject. If a glass drops to the floor and smashes, why did it smash? Because it's made of glass? Or because the floor is made of concrete? Because it fell far enough to break, or because someone threw it to the ground? Not so simple! We need to know more.

As an alternative to blaming an event that immediately precedes another, we should encourage our patients to reflect on a wider spread of factors that were in place before lifting that heavy box.

We should reflect on the presence of any stress at work, or tension at home. Were we feeling under the weather or not sleeping well? Were we running late or did we skip a meal? And were these factors all in play before we lifted that box...


Living the good life?

Christmas is often a time when many people indulge in all their favourite treats. And there's nothing overtly wrong with that. A little hedonism is nice, but would you really want it all the time?

Picture the person who tells you they are living "the good life". What do you imagine? Parties? Champagne and caviar? Foreign travels and spa treatments?

Imagine instead what it might mean to "live life well". This is a distinction that echoes back to Greek philosophy, and there will be eternal debates. I would beseech my patients to try to "live life well".

By this, I mean that we have to cover all our bases:

  • Most of us need to work and we should strive to do our work well - well enough at least to please our masters or customers.
  • We should look after those around us, family and friends. But we shouldn't sacrifice our own health, since then, we will render ourselves unable to help others.
  • We must have some enjoyment in life and make time for it. We should indulge our desires, but not to the detriment of our work or caring responsibilities.

How do we keep this delicate balance? We should reflect on how well we've done, and how close we have come to living life well.

Stuff happens. Some events we can control, and others we can't. When things don't feel right, we should examine cause and effect where appropriate and if necessary, plot a better course. At other times when things aren't to our liking, we're perhaps better off shrugging our shoulders and reinforcing the message that it was beyond our control.

Back pain is often a barometer of a life that is not going completely to plan. It is a nebulous event in many cases, so perhaps let's look at the life we live, and within, we will devise tactics for improvement. Better that than wasting money on the latest gadget to stretch, distort or shine red light on us. These can only be distractions from the need to reflect.

Good health, and a good life, well-lived to everyone.


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