Extract: ‘Good posture’ — and other back myths
An excerpt from Walkley-winning journalist Liam Mannix’s new book Back Up
In 1997 WorkCover, Victoria’s workers’ safety regulator, launched ‘Back Pain — Don’t Take It Lying Down’, a multi-million-dollar experiment in the power of belief. WorkCover got interested because, then as now, back pain makes up an enormous amount of workers’ injury claims; nearly 50 per cent of all claim payouts were for back pain in 1997. Those costs had tripled over the last decade, and the agency was at a loss as to how to stop them.
Watching the ads now, they’re of their time — grainy, the men in ill-fitting suits — but the messages still resonate. ‘The human spine is surprisingly difficult to damage,’ says a spine surgeon. ‘It’s very unlikely you’ll ever need spinal surgery.’ The surgeon’s message is powerful and important.
It’s an ad that even I can remember from watching TV as a nine year old.
It stars Merv Hughes, one of Australia’s most iconic cricketers, a wonderful fast bowler, heavy drinker, and owner of a giant horseshoe moustache. Hughes was also well known, like many fast bowlers, as a sufferer of back pain. The ad starts with Hughes in full cricket gear, wearing a wide-brimmed hat while fielding close to the boundary. He stretches his back side to side and, tickled, the entire crowd behind him mimics the strange movement.
‘People used to think I was fooling around out there with those exercises,’ Hughes says. ‘What they didn’t realise was, I’ve got a disc bulge that gives me a lot of pain. And it would give me a lot more pain if I didn’t give it a lot of exercise. So, if you’ve got back pain, give exercise a go,’ says Hughes, and then flings down a ball, slicing through a hapless batsman’s wicket.
The ads ran during prime time, often during breaks from the football or cricket, along with radio and print ads, billboards, posters and workplace visits. The core messages were simple: stay active, keep going to work, don’t lie in bed.
‘That was about really trying to get at the fundamental misconceptions people have: that physical activity will make it worse, that you should rest, that it would inevitably get worse, that you won’t be able to work. We know being active and working is actually better for you,’ Rachelle Buchbinder, who was deeply involved in the ads’ formulation, tells me. ‘We primed people. So when they got an episode of back pain, they knew it was going to get better.’
Surveys run after the campaign suggested it was working. Nearly everyone could remember the ad, and 89 per cent understood the core message: if your back hurts, keep moving and stay active. To measure how well the ad campaign worked, Buchbinder’s team measured the beliefs around back pain in Victoria and then compared them to people in New South Wales, where the ad did not air. Their study showed big changes in Victorians’ belief about back pain, and no changes in New South Wales at all. Perhaps more importantly, Buchbinder found her ads changed how doctors and back pain specialists thought about and treated back pain.
And what about the result? Did claims for back pain drop? Yes — and dramatically. Compensation claims for back pain dropped 15 per cent, time off work fell, and WorkCover recorded an overall 20 per cent cut in their compensation costs.
‘And now for the kicker,’ writes Buchbinder in the book she wrote with surgeon Ian Harris, Hippocrasy. ‘One group of people wasn’t affected by the campaign at all.’
The doctors who said they knew the most about back pain. The specialists. The people who, Buchbinder found, were often giving out the worst treatment for back pain, encouraging people to stay in bed, ordering expensive scans. They ‘did not shift their beliefs in the slightest’, she writes. ‘The bottom line? If you have low back pain, avoid seeing doctors who declare a special interest in it.’
The evidence suggests people saw the back pain ads, changed their beliefs, and that led to a drop in the number of people struggling with chronic back pain.
This is an edited extract from Back Up: Why back pain treatments aren’t working and the new science offering hope by Liam Mannix, published by New South Books.
Liam Mannix is a multi-award-winning national science reporter for The Age and the Sydney Morning Herald, as well as Nine’s other stable of mastheads. He won the 2022 Press Club Quill Award for Excellence in Science, Medical and Health Reporting, the 2020 Walkley Award for Short Feature Writing, the 2019 Eureka Prize for Science Journalism, the 2019 Barry Williams Award for Skeptical Journalism and has twice won the Walkley Young Journalist of the Year (Innovation) award. He lives in Melbourne.
