Magpie Therapy for Low Back Pain
Evidence based Magpie Therapy for Non-Specific Low Back Pain
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I’ve had my fair share of magpie attacks, I have PTSD (post traumatic swoop disorder). In “magpie season”, every magpie is a suspected swoop-terrorist. I fear them. I stress about them. It takes the enjoyment out of my walks/runs/rides. I avoid cycling at this time. Yet, sometimes I can go years without being swooped, and I’ve never been seriously hurt. And this got me thinking…….
In Australia, swooping magpies are a problem.
People can get hurt.
It is a very stressful experience.
After a long and cold winter there’s nothing better than going for a ride in Spring when the sun is out, the bees are buzzing and the birds are….mating.
Magpie season takes place anywhere from late August to November each year in Australia.
Many of us (especially those of us in the ‘stack hat’ era, aka Big Magpie Target) grew up with the Spring threat of magpie attacks.
Swooping magpies can be a stressful experience.
For some, swooping magpies can be a very stressful experience, and sometimes cause injury, and occasionally even death, but it’s not the magpie that causes death, rather the action of the human it swoops.
A stressful experience with a swooping magpie can stop someone from cycling ever again. Especially if they don’t understand the Science behind them. They might even assume the magpie hates them, swoops every time and is trying to kill them.
The good news is, magpies can’t directly kill people, they might draw blood, but humans weigh 200x more than these little light creatures, we’ll survive.
The majority of bad injuries (and death) have happened from people taking unnecessary evasive action, or watching it then running into a stationary object. That bird is way more agile than you, so protect yourself, keep calm, keep moving. Very rarely do magpies actually cause direct harm. Some do, but mostly not. You can look up a map where people tell you about them: https://www.magpiealert.com/
Yes, sometimes years can pass without it happening
and people can happily cycle/walk around without a squawking-hassle, but it does happen, the main thing to know is that it will stop, once mating season is over so is the swooping. For someone who is having this stressful swooping experience, it’s good and reassuring to understand this:
it is normal and it will stop.
Spikes on your helmet, eyes on the back of your head… there are many things you can try to wear on your head when you go through a magpies territory, but if it’s going to swoop it’s going to swoop.
Be careful of confirmation bias however, just because you wore eyes on your helmet or spikes on your head that one year and you didn’t get swooped, it doesn’t mean that they worked! Maybe Mr Maggie was just bored that day.
Be careful about what you read on the internet, you can never be sure about the quality of information from unknown sources.
Australian Scientists have studied the magpies behaviour and they roughly say this:
- It’s a normal thing for a Magpie protecting its territory during mating season.
- It’s better keep calm and keep moving, quickly moving through their territory.
- It’s nothing wrong with you, it’ll swoop whoever is riding (and sometimes walking) through their territory).
- It will eventually settle and stop swooping once you have moved through its territory.
- Perhaps temporarily modify your activities to avoid the magpies territory and then gradually return once the mating season is over.
Some people see a black and white big bird and
avoid it because it could cause injury,
but sometimes it’s not a magpie, it’s a currawong… it’s not going to swoop and people can
unnecessarily stress out and avoid enjoying the things they like.
If people aren’t sure of the difference they should
consult a good source of information
to see the difference between a magpie and a currawong.
Once fearful thinking patterns set in it’s difficult to get out of them.
However, once people who have been swooped can understand the behaviour of a nearby Magpie they might notice that it’s not paying attention to the walker/rider/cyclist, it’s sitting on a branch scratching its nose on the tree or fluffing its feathers… and
“Hang On A Sec! It’s no longer mating season anyway! So let’s gradually go back through that area, calmly and feeling safe with the knowledge that that bird isn’t going to kill me, and it’s ok if it swoops, I’ll remain calm, keep moving and enjoy being outside in nature!”
Non-specific low back pain (NS-LBP) is a fancy term that is a little misunderstood. To a patient it may sound like
“you have back pain and we have no idea why you have it”.
But it’s actually
“you have back pain, and there’s no way we’ll know exactly what’s causing the pain but we’ve ruled out: medical causes (such as renal, aortic dissection), neurological causes (such as radiculopathy, spinal canal stenosis, cauda equina syndrome), nasty causes (such as tumours, infections, fractures) and inflammatory diseases (such as spondyloarhtirits)”
…. See what I mean… it’s just easier saying “you have non-specific back pain.”
It’s very common, it represents a large chunk of the low back pain cases we (registered healthcare professionals) see in the clinic.
Low back pain for patients can be….
Yes, it does suck, all pain sucks however the key thing is that people with (NS-LBP) see a healthcare professional to rule out anything sinister and tell them it isn’t going to kill them (same as the swooping magpie) and let the patient know that:
Yes, sometimes years can pass without it happening
(just like a swooping magpie) and patients can be happily active without a hassle, but back pain often does happen, sometimes for no reason, it’s good and reassuring to understand this:
it is normal and it will stop.
Once NS-LBP patients have had the significant stuff ruled out, they can try things they’ve seen or heard about they can get rubbed (aka massage) poked, cracked, zapped, cupped, stretches… you name it, they can try it, as long as they are careful of confirmation bias, just because they have had some acupuncture with scented candles and their back got better doesn’t mean that it worked, maybe they just got better. A wise man once said:
Here’s what Science says about low back pain in a nutshell:
- It’s a normal thing to get intermittent pain with an insidious onset (out of nowhere).
- It’s better to keep calm and keep moving, once a healthcare professional has ruled out anything serious.
- It’s usually nothing wrong with you, it happens to everyone, it doesn’t mean you’re broken or something serious has happened, hurt doesn’t = harm.
- It will eventually settle, with appropriate adjuncts such as anti-inflammatories and appropriate activity modification.
- Perhaps temporarily modify your activities to keep active in other ways then gradually return once your pain settles.
NS-LBP patients should try not to worry about it too much, there’s usually no need for xrays, MRIs and CT Scans. Diagnostic imaging in non-specific low back pain is not often diagnostic and most of the time results comes out with the “the kisses of time”, which radiologists call “degeneration”, a fancy term for “you’re no longer 19years old”, the rest of healthcare call them “age-related changes on imaging that are unrelated to your pain”.
Just like focusing on a magpie and having an accident, focusing on imaging results can result in a patient becoming a VOMIT.
NS-LBP patients shouldn’t obsess about their “core” or their “posture”, it may cause more harm than good if they walk around “sucking in their belly” or sitting up straight all day because someone suggested that if they slump in any way their posture will cause them to get crippling back pain or if they don’t use their core their spine will be “unstable”.
Often this “well meaning” advice is found on the internet or social media, or from relatives who’ve been told it sometime 20 years ago.
Be careful about what you read on the internet, you can never be sure about the quality of information from unknown sources,
and people should avoid getting their healthcare advice from blanket statements on social media.
Some people stop before doing a normal safe activity because they have a slight feeling near their lower back, and
avoid it because it could cause injury,
but sometimes it’s not even the lower back causing it, it could be something else nearby (eg: hip/pelvis) causing people thinking they have back pain, then
unnecessarily stress out and avoid enjoying the things they like.
If people aren’t sure of the difference they should
consult a good source of information
such as a (registered and regulated) healthcare professional who can sit down with them and listen, take a full history, conduct a full and thorough physical examination, take the time to fully explain the patients condition in a way they can understand, refer externally for any other necessary adjunct healthcare services, offer any treatment that could help, provide a home program including activity modification advice and any exercises if required, and sending them a follow up email following that session summarising all of the main points, make themselves available for follow-up questions and follow up at an appropriate time to progress their program (which is supposed to be what a good Physiotherapist does). Not all Physiotherapists do this, just the good ones, but all of this also falls into the best practice guidelines for managing not only low back pain but many complex injuries (Almeida, Saragiotto, Richards, & Maher, 2018; Maher, Underwood, & Buchbinder, 2017; Oliveira et al., 2018).
Sometimes the low back pain does go away but some small trigger in the future makes the patient think:
Once fearful thinking patterns set in it’s difficult to get out of them.
Some people who’ve had low back pain once (particularly those who had poor quality healthcare experiences) can stress about any small sign of tightness, stiffness or niggle becoming something much worse. But patients can
learn to see when the (symptom) behaviour is different,
and then stress less and move on with life. Patients don’t have to fly solo however (see what I did there?), they always have a safety net, the good physiotherapist who they saw the first time it happened can help translate their feelings to them so they can learn what’s normal and what’s worth investigating and learn to manage this sort of condition in the long-term for themselves, improving their self-efficacy, reducing healthcare burden and blah blah blah… job done, high fives, we all go home and feel warm and fuzzy and sip some Pinot Noir.
Summary
Having an episode of low back pain is like getting swooped by a magpie.
Magpie Therapy … or the use of the metaphor of swooping magpies can be helpful for people with non-specific low back pain. Sometimes it happens. Rarely is it bad. It does go away. Just keep an eye on it and calmly keep moving. You can temporarily avoid getting into certain situations but most of the time you will be able to get back to your normal life.
To Patients, don’t be a Galah, Seek guidance from a registered and regulated healthcare professional (in Australia, they will be a university qualified AHPRA registered professional) if you need access to a high-quality source of information. Every management plan is different depending on each patient, avoid self-diagnosing and self-managing from the University of YouTube.
Metaphors are powerful, often when combined with a good narrative they can form their own therapy, so I hope you’ve enjoyed this, Evidence Based Magpie Therapy for Non-Specific Low Back Pain (yes, I know, it’s misleading, but it’s the internet, no one reads anything unless it has a crazy headline). It IS a little silly, but for the right patient it’ll be a magpie on a stackhat (… it’ll hit the mark).
Did you enjoy this blog or learn something new that will help you with your clinical practise?
Are you a patient and has this helped you in some way?
‘Buy Me A Coffee’ to say thanks and help me continue to be motivated to share everything I’ve learned in the clinic with the world for free.
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References
Almeida, M., Saragiotto, B., Richards, B., & Maher, C. G. (2018). Primary care management of non‐specific low back pain: key messages from recent clinical guidelines. Medical Journal of Australia, 208(6), 272–275.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747.
Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C.-W. C., Chenot, J.-F., . . . Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, 27(11), 2791–2803.
