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classification of back pain:

Thanks to Norton et al for “Classification of patients with incident nonspecific low back pain: implications for research” that appears in “spine”

Four distinct groups of patients were identified and validated. One group (53.4%) of patients recovered immediately. One third of patients (31.7%) may appear to recover over six months, but maintain a 37-48% likelihood of receiving care for low back pain in every subsequent quarter, implying frequent relapse. Two remaining groups of patients each maintain very high probabilities of receiving care in every quarter (65-78% and 84-90%), predominantly utilizing therapeutic services and pain medication, respectively. Probabilistic grouping relative to alternatives was very high (89.6-99.3%). Grouping was not related to demographic or clinical characteristics.

Conclusions
The four distinct sets of patient experiences have clear implications for research. Inclusion criteria should specify incident or recurrent cases. A six-month clean period may not be sufficiently long to assess incidence. Reporting should specify the proportion recovering immediately to prevent mean recovery rates from masking between-group differences. Continuous measurement of pain or disability may be more reliable than measuring outcomes at distinct endpoints.

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Meniscoid Entrapment theory

If a therapist, like me,  jumps on your back to give it a crack, it may be that they are acting out a  “meniscoid entrapment theory” moment. This  means, they are speculating that vertebral joints have small menisci  (synovial folds) that gets trapped within the joint. This entrapment causes  guarding  and preventing movements ( that group of facet joints lock).

The idea of using a manipulative techniques  is, so some think, is to  change the pressure within the joint , pushing the synovial  folds back out.

Originally proposed by Kos and Wolf. elaborated by Bogdvk And Jull.

Frankly, I think my theory that your back is invaded by evil demons, makes far more sense!

My achilles

Three elements helped my achilles

1) effective stretch and strengthening regime for my achilles tendon.

2) An understanding of the POSE running technique

3) Going barefoot.

This article is how to sort your Tendinosis in 8 weeks

I began  using ice and , stretching,

Here are my two favourite stretches

but I  also employed  “eccentric loading exercises” ( the lowering part of  a calf raise, for you body building type)

  • Get the balls of your foot on a block or a step
  • and use  both feet  (handsupport) to get you above the block.
  • then lower down with the weight on the injured side.
  • I found being on a staircase with a handrail helped me control the load.

Here is a handy “You Tube” clip

After that, it was  3 sets of 10 reps . How awful the pain is suggests the amount of load you can work with in the early stages.

This was inspired by some ideas from crossfitter Philip Holbrook ( and his physio) and this report….

Eccentric calf muscle training for the treatment of chronic achilles tendinosis

by Toros Tsermakian, Ioannis Mitsakis, Christos Lyrtzis, Ioannis Tsartsapakis,  Menelaos Mitsakis, Christos Papadopoulos,  and Georgios Nousios,  who sort of observed/discovered the following

  • Overuse injuries involving the Achilles tendon are common, especially among runners.
  • The majority of Achilles tendon overuse injuries occur in men,
  • higher rate in middle-aged athletes than do most other overuse injuries.

So,  they studied the effect of eccentric calf muscle training in 18 athletes with chronic Achilles Tendinosis with a long duration of symptoms despite conventional nonsurgical treatment. Calf strength and the amount of pain during running was  measured before and after the study.

At the start of the trail,  all patients had Achilles tendon pain so sever that they could  not run. There was also   significantly lower  calf muscle strength on the injured side.

At the end of the study. Almost everyone was cured. It bloody well worked for me.

for a fuller report visit here http://www.jssm.org/suppls/11/posterpresentations.pdf

  • In the early stages i used ice after the exercise to help with the swelling.

Achilles pain

Whilst my research focus is mainly on back pain, I have  a lot of clients with  Achilles tendinopathy, i though i might as well add a few  articles with advice on remedial treatment for sore achilles.

If you are going to a party and want to show off, you simply must drop the name  Silbernagel into the conversation. He is quite famous in coming up a type of training to help with Achilles Pain. He was part of the team  who researched “A Randomized Controlled Study Continued Sports Activity, Using a Pain-Monitoring Model, During Rehabilitation in Patients With achillies tendonosis” published in Am. J. Sports Med. 2007

That team tried this protocol:

Phase 1: Weeks 1-2 Patient status: Pain and difficulty with all activities, difficulty performing ten 1-legged toe raises

Goal: Start to exercise, gain understanding of their injury and of pain-monitoring model Treatment program: Perform exercises every day

  • Pain-monitoring model information and advice on exercise activity
  • Circulation exercises (moving foot up/down)
  • 2-legged toe raises standing on the floor (3 sets × 10-15 repetitions/set)
  •  1-legged toe raises standing on the floor (3 × 10)
  • Sitting toe raises (3 × 10)
  • Eccentric toe raises standing on the floor (3 × 10)

Phase 2: Weeks 2-5 Patient status: Pain with exercise, morning stiffness, pain when performing toe raises

Goal: Start strengthening Treatment program: Perform exercises every day

  • 2-legged toe raises standing on edge of stair (3 × 15)
  • 1-legged toe raises standing on edge of stair (3 × 15)
  • Sitting toe raises (3 × 15)
  • Eccentric toe raises standing on edge of stair (3 × 15)
  • Quick-rebounding toe raises (3 × 20)

Phase 3: Weeks 3–12 (longer if needed) Patient status: Handled the phase 2 exercise program, no pain distally in tendon insertion, possibly decreased or increased morning stiffness

Goal: Heavier strength training, increase or start running and/or jumping activity Treatment program:

Perform exercises every day and with heavier load 2-3 times/week

  • 1-legged toe raises standing on edge of stair with added weight (3 × 15) • Sitting toe raises (3 × 15)
  • Eccentric toe raises standing on edge of stair with added weight (3 × 15) • Quick-rebounding toe raises (3 × 20)
  • Plyometric training :Phase 4 Week 12–6 months (longer if needed)

Patient status: Minimal symptoms, morning stiffness not every day, can participate in sports without difficulty

Goal: Maintenance exercise, no symptoms Treatment program: Perform exercises 2-3 times/week

Lumo lift

Am i a fan of http://www.lumobodytech.com/ ?

Hmm, I need to think about this.

The proposition seems logical. A system that “knows” when you are holding  a static “correct posture”and holds you to it.

I think my only reservation is the idea that there is a correct  static posture. Certainly you need a stiff core, but your position when seated,  is best often  changed  ( see some of the observations by McGill).

But, if it  reduced your slouching by  say  15 minutes a day , and encouraged you to learn a bit more about your posture, and improved your general back hygiene,  the £80 seems totally worth it.

But, It could fall into the Standing desk error. There are very few safe static postures!  if you work at a desk, rotate between kneeling, sitting, sitting side on, standing ,holding a lunge.

I suspect , having tested a similar system ( the computer’s camera kept your head in a frame) that its  possible to get a “good reading” in as much as you haven’t “tipped” the sensor, but, you have  actually collapsed your back.

Ill try and test that out with this product.

Pelvic tilting

I thought this was a very interesting reflection by bret Contreras on the issue of pelvic tilting in certain exercises

Click here

the only thing id add is that i feel the  Mcgill and Verkoshansky V  Mel Siff . is   a bit contrived. I think they deal with different types of people with different out puts.

“The pelvis plays a vital role in the ability of the athlete to produce strength efficiently and safely, because it is the major link between the spinal column and the lower extremities… a neutral pelvic tilt offers the least stressful position for sitting, standing and walking. It is only when a load (or bodymass) is lifted or resisted that other types of pelvic tilt become necessary. Even then, only sufficient tilt is used to prevent excessive spinal flexion or extension… The posterior pelvic tilt is the appropriate pelvic rotation for sit-ups or lifting objects above waist level. Conversely… the anterior pelvic tilt is the correct pelvic rotation for squatting [and] lifting heavy loads off the floor. – Supertraining 2009 (Hat tip to Pavel Tsatsouline for finding this quote)”

Bret believes this: “I’ve learned much of my spinal biomechanics knowledge from Stu and highly respect him. In this case, I feel that some slight pelvic tilt can help buttress the spine by creating torque in the necessary direction in order to help stabilize the spine and prevent buckling. However, the pelvic tilt isn’t to end-range so it doesn’t dramatically impact spinal posture, but rather keeps it in check”

The difference in the opinion is probably a matter of perspective  and  objective. McGills observation ( and I’m a Mcgill fan) is that bad backs are correlated with poor back control and use. back pain is the result of years of systematic abuse. His battle is to get clients to learn or relearn back positions.

Verkoshansky and Mel Siff are not trying to cure your bad back, they are trying to get you to lift more. For  advanced athletes who do not suffer back pain, their approach is great.

For people who do suffer back pain, getting an effective general purpose  healthy motor pattern is far more important.