Tag Archives: back pain

Is Acne bacteria connected to back pain?

The paper by  Hanne B. Albert et al “Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy throws up a fascinating possibility. That some back pain and sciatica is  caused by a pathogen and as such, can be treated by antibiotics .

The pathogen that could be causing this is Propionibacterium acnes.

If you think you recognise the “acne” bit. You’d be correct. The stuff that ruins your teenage years and gives you acne!

As Dr long in his article  “The Murky world of Mordic Changes” . says “there will always be a proportion of our patients who simply don’t respond to our care…….Could there be something far more ‘pathological’ that might perpetuate lower back pain”

To understand this issue you need to  vaguely understand “mordic changes”. These are changes in the bones marrow of the vertebral body either side of a damaged disc. In stage 1 changes these areas have increased levels of pro inflammatory cytokines and increased levels of innervation

“Propionibacterium acnes bacteria secrete propionic acid, which has the capacity to dissolve fatty bone marrow and bone. We hypothesize that diffusion of propionic acid from the disc into the vertebrae causes the Modic changes. Similarly, as increased TNF-alpha and the growth of PGP-5 unmyelinated nerve fibres have been reported in Type 1 Modic changes, with the inherent slowness of these pathological processes perhaps explaining the delayed onset of improvement observed in this study”.(Albert et al)

Needless to say, shooting up clients with lots of antibiotics has drawbacks!

“High-dose long-term antibiotics should not be prescribed without due consideration. Clearly in a condition as chronic lower back pain there is a potential community as well as individual hazard if used indiscriminately. However, as many patients, as in this trial, are on sick leave, at risk of losing their jobs and have a high analgesic intake, we suggest that antibiotics, when applied along the lines of this MAST protocol may be appropriate in this subgroup, i.e. chronic lower back pain with Modic Type 1 changes. We do not support the proposition that all patients with lumbar pain should have a trial course of antibiotics. The criteria in this study were very clear: chronic lower back for more than 6 months, Modic Type 1 changes in the adjacent vertebrae following a previous disc herniation. As we do with other drugs, we rely on our fellow colleagues to use clear evidence-based criteria and to avoid excessive antibiotic use.”

However antibiotic issues to one side, this treatment is mired in controversy .  Lars Bråten authored a report totally failing to find any beneficial effect.

“Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial” (click here for report ) tested patients with chronic low back pain and Modic changes at the level of a previous disc herniation. For three months they were treated  with amoxicillin. It  did not provide a clinically important benefit. These  results do not support the use of antibiotic treatment for chronic low back pain and Modic changes

I note though that that Albert experiment (Pro) used amoxicillin–clavulanate and the Braten report (Anti) used Amoxicillin. Im not clever enough to state whether this would have made any difference.

So, keep an eye on that research!

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The big warning.
Some back pain is really serious: check your RED FLAGS by clicking here 

 

 

Understand your pain

Underpinning every psychological approach to back pain is education.

It’s seen as crucial that you understand the mechanisms of pain within your body. So here is a super simple introduction to the basics of pain. I started teaching in our kitchen:

We have that basic banana approach. We can now build up to a bit more of a technical  overview. You’ll see, I got kicked out of the kitchen, into the bathroom!

Helping you understand how pain works  is certainly  the approach used by  Dr Sarno in his TMS (Tension Myositis Syndrome)programme  and  Dr Schubiner in his MBS  ( Mind Body Syndrome) programme. I  just think our educational process is a bit funnier!

The Backaholic course should be ready in late August/early September, so if you want to fix your back pain, do sign up for our newsletter so you know when its available! Obviously we will send out lots of handy hints and tips between then and now.

The big warning.
Some back pain is really serious: check your RED FLAGS by clicking here 

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.

 

The big warning.
Some back pain is really serious: check your RED FLAGS by clicking here 

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

The big warning.
Some back pain is really serious: check your RED FLAGS by clicking here 

There is a lot to be said for losing weight!

The body mass index is a little clunky as a measure, but for those with knee and back problem, it should  be your 1st port of call.  Do you have  a healthy Body mass index?

click here and check

If not and you are  active, think on this. “Active” normally means 10,000 steps a day. If you are 10kg over weight  thats  10 x10,0000 that 100,000 kilos extra than your body  expected  . Weightlifters brace and prepare!

If you are inactive and slumping in your chair thats a lot of deadweight pressing on knackered  back and bum muscles.

“Dude, loose some weight!”

If you  have an ok weight, well thats ok. Go you. Thats not the problem!

i

Sit on your Ischial Tuberosities

When sitting, you can sit on your  Coccyx, or your Ischial Tuberosities. After all, it’s your ass!

sit on you ischial tuberosities

BUT…..sitting on your coccyx  ( right picture above: Boo. Bad) is the same as bending over badly and slumping (bad): the abdomen protrudes (bad) , the chest sinks ( bad), and breathing is inhibited. (cannot be good) It also indicates  fatigue (yawn) , and lack of support (Boo). In this position you can  try and make the client  (or yourself) sit up, but it will only last a short time before slumping back (sob) into your Backaholic patterns

Sitting on your Ischial Tuberosities ( a good place to sit, on the left above) , causes a more upright position (good), which elongates the spine (good)  and reduces excessive curvature (good; high five) .  Maintaining  this natural spine is easier as it is seen as a natural position (good. Fist bump). Each minute of wrong sitting can be compared to doing  the wrong exercise. if you sit poorly for 8 hours a day, thats a lot of bad exercise.  you are not a runner or a body builder or a crossfitter, you are a “bad back maker”

Of course, you should never sit  for that long, but if you must sit, sit on your Ischial Tuberosities!!

To get into correct “sit”, once you have sat down, lean to one side (imagine you are  trying to break wind!)  and gently lift your “lifted” buttock up with your hand,  scoop it back then sit down, then do the other side.

This said, you still  have  to fight your slumping habit. You must learn to sit tall and relaxed, but with an appropriate amount of abdominal tone. Say No to being a Backaholic!!

The shoulder bridge: gluteal engagement

Lie on the floor with your knees flexed (feet on the floor) and stick your fingers into the meat of your ass.

Squeeze your ass cheeks together as your method of engaging them  and not by trying to over extend your hips or play with your pelvis; keep that neutral.

Once that is mastered,  bridge the torso off the floor. At this stage, you , a friend or your trainer needs to feel your hamstrings. People who are “hamstring dominant and gluteal deficient will engage the hamstrings prior to moving” (McGill: page 195 Ultimate back Fitness).

This is the wrong pattern. The glutes should drive this action. To help  we can put our foot against your toes, and whilst asking you to squeeze your ass, we  can help your quads engage by lightly cueing from the knees ( so either a finger hook under the knee to gently pull them up, or if you know each other, a quad stroke ( to encourage the hamstrings to switch off) ).

Once you get  your  ass  engaging, “Boom” your back gets  a bit more resilient  and your squat gets better!

shoulder bridge

Help your back find its way: tape it up!

If you struggle to maintain  a neutral spine when deadlifting or squatting, or sitting for that matter, a “bit of gaffer tape” either side of your lumbar spine can give some very useful feedback. Set your neutral back, and get someone to stick tape either side of your spine ( the boney bit in the middle): when you stoop it pulls, and reminds you to maintain a better back position (  but don’t tape into a hyper- lordotic position!!)

backtape1

Obvious point, but make sure you are not allergic to the tape you are going to use! This can really help you save your back and cut down your  pack pain. Essentially it tells the body where your back is. Often back pain sufferer’s have no idea what their back is doing.