The top 5 things that keep you in pain

Once you have tweaked your back a few times, you stand a good chance of dragging yourself down into a pain cycle. Here are the 5 things people who suffer from pain do.

THEY STOP PHYSICAL ACTIVITY

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If you become sedentary it will start a cascade of bad stuff: your sleep will suffer, you’ll weaken your muscles meaning you’ll slide towards a boring disabled lifestyle, with a loss of control over your daily life. The more you sit and do nothing, the more you focus on your pain. The worse it becomes

THEY FALL INTO THE OVER ACTIVITY TRAP

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taking advantage of any easing of pain to work yourself to exhaustion, or into pain. This means you need to collapse until you recover. When you have recovered a bit, you slog through loads of work until you are exhausted or in pain. This leads to worse pain and declining physical fitness

ABANDONING WORK AND FUN FOR BOREDOM

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once you have taken time off work, and given up your hobbies, you get bored. Your pain will expand to fill the day

STRESS

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Stress. is the ultimate multi-tasking sensation: it can make you avoid activity, avoid friends , edge out loved ones: it can make you feel helpless and hopeless. It can lay the foundations for arguments and anger, and given time will deliver you mental health issue such as anxiety and depression

WAITING FOR A CURE, or HOPING THAT THE PAIN WILL GO AWAY

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Rather than simply doing the basic combination of stretches, smashes, movement education and strengthening that I can show you, You start obsessing about a “cure”. You chase your doctor for a magical MRI or a spinal fusion , even if you know that only 1 out of 250 MRI’s show anything remotely useful, and normally leads to a recommendation to stretch and build your core.

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Needless treatments: spinal fusion surgery for lower back pain is costly and there’s little evidence it’ll work

This article is republished under a Creative Commons license. Read the original article here. It was written by Gustavo Machado, Christine Lin and Ian Harris.

From time to time, we hear or read about medical procedures that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such needless treatments or procedures individually and explains why they could cause more harm than good in particular circumstances.

Back pain affects one in four Australians. It’s so common, nearly all of us (about 85%) will have at least one episode at some stage of our lives. It’s one of the most common reasons to visit a GP and the main health condition forcing older Australians to retire prematurely from the workforce.

Treatment costs for back pain in Australia total almost A$5 billion every year. A great proportion of this is spent on spinal surgical procedures. Recently, Choosing Wisely, the campaign to educate medical professionals and the public about tests, treatments and procedures that have little benefit, or lead to harm, added spinal fusion for lower back pain to its list.

This is because, despite rates of the procedure being on the rise, current evidence doesn’t support spinal fusion for back pain. Randomised trials (regarded as studies providing the highest-quality evidence) suggest spinal fusion has little advantage over a well-structured rehabilitation program, or psychological interventions, for back pain.
What is spinal fusion?

Spinal surgery is most commonly performed to remove pressure on nerves that causes pain and other nerve symptoms in the legs. This surgery is called decompression. The next most common procedure is spinal fusion, where two or more vertebrae are joined together (using such methods as transplanted bone from the patient, a donor or artificial bone substitutes) to stop them moving on each other and make one solid bone.

Spinal fusion may be performed for fractures, dislocations and tumours, and is commonly performed in conjunction with decompression. For back pain, it’s performed when the origin of the pain is thought to be related to abnormal or painful movement between the vertebrae (from degenerative joints and discs, for example).

Rates of spinal fusions have been rising and continue to increase, outstripping other surgical procedures for back pain. In the United States, rates of spinal fusion more than doubled from 2000 to 2009. In Australia, rates increased by 167% in the private sector between 1997 and 2006, despite almost no increase in the public sector.

Spinal fusion rates differ significantly between regions of Australia, with the highest being in Tasmania and the lowest in South Australia: a seven-fold variation. Significant variations are also seen between countries. For instance, spinal fusion rates in the United States are eight times those in the United Kingdom.

The greatest increase in the use of spinal fusion has been in older Australians, often in conjunction with decompression surgery for spinal stenosis – a condition that causes narrowing of the spinal canal (the cavity that runs through the spinal cord).

Differences in clinical training, professional opinion, and local practices are likely to play a role in such variations.
Evidence for spinal surgery

There is little high-quality evidence to support the use of spinal fusion for most back-related conditions, including spinal stenosis. And there is disagreement between surgeons on when spinal fusion surgery should be performed, not only for back pain but also for more acute conditions such as tumours and spine fractures.

There have also been no studies comparing spinal fusion to a placebo procedure. Most research to date compares one fusion technique to another technique or to a form of non-surgical treatment, so we still don’t know whether spine fusion is effective against placebo.

We also know that spine fusion surgery is expensive and associated with more complications than decompression surgery. And the surgery often fails. Around one in five patients who undergo spine fusion will have revision surgery within ten years.

Research also shows most patients having spine fusion surgery under workers’ compensation won’t return to the usual job, will still be having physiotherapy and be on opioid medication two years after surgery.

So why are rates going up?

There are several factors, including an ageing population, that may contribute to the rapid increase in spinal fusion despite the lack of evidence supporting its use. Financial incentives might also explain the differences in rates between private and public sectors in Australia and between the United Kingdom and the United States.

We don’t have high-quality evidence on the benefits and harms of spinal fusion. This means there is uncertainty, which allows practitioners to continue doing the procedures they were trained to do unchallenged. This then leads to overtreatment, particularly where reimbursement rates are high, such as in the workers’ compensation setting.

Uncertainty about the appropriateness of spine fusion results in practice variation, wastes scarce health care resources and leads to worse patient outcomes.

We need better research in this area. This means research efforts should shift from studies looking at different ways of performing the surgery and focus on investigating whether or not it works better than non-operative treatments or a placebo, and, if so, whether the benefits outweigh the harms.

In the absence of such evidence, patients can consider other evidence-based and less costly treatments, such as exercise, cognitive behavioural therapy and physiotherapy.

Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?

“Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?: A Longitudinal Case-Crossover Feasibility Study”. Is a useful report as we continue to make the connection between, excessive sitting  and back pain.

The big question was this: whether physical activities trigger flare-ups of pain during the course of acute low back pain (LBP).

The conclusion:

Among participants with acute LBP, prolonged sitting (>6 hours) and stress or depression triggered LBP flare-ups. PT was a deterrent of flare-ups.

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But what if your back pain is extension based

Too many of us are obsessed with  flexion driven back disorders. Which  is fair because most cases of back pain  are flexion based.  However, not all of them are. Some are because you are over extended, and frankly, you need some  careful flexion in your life, and back.

Until I produce a good guide, here are some useful thoughts  from

https://tonygentilcore.com/2014/01/extension-based-back-pain-b/

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Piriformis Syndrome

There is a sneaky little muscle in your bum that often makes your back , or legs hurt.

It’s sneaky as, whether or not you have a booty or a skinny ass,  its a muscle that hides underneath the big ( or skinny?) obvious bits.

It creates a lot of mischief. So Voila, the piriformis is the muscle to blame. Its this muscle that I’ll often try and find and “trigger point” if I see you acting  or moving in one of many ways. If you are going to have back pain,  you might as well understand the anatomy

So this is where it lives.

piriformis location

When I’ve found it, here is where I’ll try and press

Piriformis points

I’ll often press or rub each point with my thumb about 10 times. Often I’ll try and teach you how to find these points with a Lacross or massage ball.

Obviously, there are other muscles in this area that I’ll identify and treat, but this is often the cause of a lot of back pain

Well, thats why Ive probably shoved my thumb in your bum!

If you have back pain, do get in contact and I’ll see what I can do to help.

I do a lot of work with the Backaholic programme at Crossfit London in E2 , and I help people cure there back pain. Strangely Im just a massage therapist, but as I teach people to olympic lift,  clamber over objects and do lots of cool  gymnastic stuff, Ive been forced to deal with the bad backs my clients bring to their sessions

Is your back pain “psoas Syndrome”

Read more here.

According to the abstract

“Psoas syndrome is an easily missed diagnosis. However, it is important to consider this condition as part of the differential diagnosis for patients presenting with low back pain—particularly for osteopathic physicians, because patients may view these practitioners as experts in musculoskeletal conditions. The authors describe the case of a 48-year-old man with a 6-month history of low back pain that had been attributed to “weak core muscles.” The diagnosis of psoas syndrome was initially overlooked in this patient. After the correct diagnosis was made, he was treated by an osteopathic physician using osteopathic manipulative treatment, in conjunction with at-home stretches between office treatments. At his 1-month follow-up appointment, he demonstrated continued improvement of symptoms and a desire for further osteopathic manipulative treatment.”
Frankly, the stretches recommended in this report are quite standard. The diagnosis of ” weak core” in itself should always be challenged as being too simplistic,  there will almost always be glute, postural,  limb flexibility, manipulation issues to be taken into account