Tag Archives: back pain

Specific Causes of Back pain

Specific causes of back pain: some ideas from European Guidelines for the management of Chronic non specific back pain (2004)

There is  little relationship  between  low back pain symptoms, pathology  and radiological findings.

In 85% of people (Deyo 1988), pain has no relationship  to any time of physical abnormality.

*4% of people seen with low back pain in primary care have compression fractures

*1% have a neoplasm (Deyo et al 1992).

*5% develop at least one vertebral fracture in 4 years (Kado et al 2003).

Spondylarthropathies have been reported to occur at a rate of 0.8 to 1.9% of the general population (Saraux et al 1999).

Spinal infections are rare, and chronic spinal infections are particularly rare. Infectious diseases of the spine should be considered if the patient has fever, has had previous surgery, has a compromised immune system, or is a drug addict.

Spondylolysis and spondylolisthesis are often classified as non-specific low back pain because a considerable proportion of patients with such anatomic abnormalities are asymptomatic (Soler and Calderon 2000)

Back and leg pain after surgery represent a major problem addressed at specific conferences for failed back surgery.

Failure rates range from 5-50%. Based on a failure rate of 15%, it was estimated that 37500 new patients with failed back surgery syndrome would be generated annually in the US (Follet and Dirks 1993).

One of the causes that is consistently reported in the literature includes poor patient selection (Goupille 1996, Van Goethem et al 1997).

“This means that patients with non-specific back pain are operated on for radiologically diagnosed disc bulging, herniation or degeneration, which turn out not to be responsible for their pain.”

  • References
    1. Andersson HI, Ejlertsson G, Leden I, Rosenberg C (1993) Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain, 9(3): 174-82.
    2. Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J, 8(6): 429-38.
    3. Barash HL, Galante JO, Lambert CN, Ray RD (1970) Spondylolisthesis and tight hamstrings. J Bone Joint Surg Am, 52(7): 1319-28.
    4. Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly. A systematic review of the literature. Spine, 24(17): 1813-9.
    5. Cassidy JD, Carroll LJ, Cote P (1998) The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine, 23(17): 1860-6; discussion 7.
    6. Deyo RA (1988) Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil, 69(12): 1044-53.
    7. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? Jama, 268(6): 760-5.
    8. Dickson RA, Stamper P, Sharp AM, Harker P (1980) School screening for scoliosis: cohort study of clinical course. Br Med J, 281(6235): 265-7.
    9. Ebbehoj NE, Hansen FR, Harreby MS, Lassen CF (2002) [Low back pain in children and adolescents. Prevalence, risk factors and prevention]. Ugeskr Laeger, 164(6): 755-8.
    10. Follet KA, Dirks BA (1993) Etiology and evaluation of the failed back surgery syndrome. Neurosurgery Quarterly, 3: 40-59.
    11. Goupille P (1996) Causes of failed back surgery syndrome. Rev Rhum Engl Ed, 63(4): 235-9.
    12. Hestbaek L, Leboeuf-Yde C, Manniche C (2003) Low back pain: what is the long- term course? A review of studies of general patient populations. Eur Spine J, 12(2): 149-65.

Experiment with Bracing?

One of the biggest confusions in “back pain” is the role of  abdominal muscles.

For years hard working doctors and researchers have attempted to assess the role and value and ideal type of abdominal engagement and training methodology. At the same time fraudsters and  charlatans have always sought to promote  and mystify the actions of an obscure muscle

There are 3 things you can do with your abs if you are standing up in a neutral position ( we need to talk about this concept too!)

1) You  can suck them in
2) You can “tighten” them where they are
3) You can “bear out”

Ill discuss these ideas in painful depth else where.

and now the research begins

Im actually very good at fixing backs. I look at them as a back pain sufferer, a fitness instructor, a massage therapist, a sports person , a hypnotist and an avid student of the many techniques and idea  published  both  in hard copies and on the internet.

However, when ever I fall in love with a theorist, like other practitioners, I go wrong. Of course all practitioners will claim that they assess what they see. I doubt this. We tend to view the world through lenses, and sometimes assume that identifying a problem, precludes the existence of other problems.Otherwise what the point of having a belief. Which Fan of Stuart McGill doesn’t go looking for a flexion based problem?

So, anyway, I was working with a client,and we began the process of fixing by looking at his life style , what he was doing, etc, and basically concluded that his issue was a flexion issue: certainly be benefitted from evaluating his squat form,  developing his hip and shoulder flexibility , grinding out some scare tissue , and building up his core strength and endurance, and realising how much he used his back.

Nevertheless as we came to the 3rd session we realised there was another factor at play. Strangely, like me,  he accepted that he stooped, but we traced his actual injury down to an over extension fault in the squat: he had attempted a squat with his torso bolt up right,  and obtained the extra flexibility the position demanded by over extending, and collapsing at his lumbar curve at the bottom:

so a couple of extra observation, based on his feed back and mine.

1) if you have back issues, the chances are that your perception of your back position if wrong: you simply dont know what the feedback means

2) Is it  possible to tweak your back by over extending and  flexing at the bottom. Yep, you can have both.

So, I started photographing lumbar curves in a toes touching position and noted that quite a lot of people have immobile lumbar areas in flexion: they  flatten, they don”t collapse ( see the montage).  is there a relation hip between the depth and quality of an overhead squat and the position of the lumbar curve in the toe touching position? If you don’t flex your lumbar spin, isn’t coaching you to make a big chest running the risk of an over extension injury. Do we now have a potential easy to do screen.

Im off to photograph lots of overhead squats and toe touches to see if there is some sort of correlation

Breathing:

if you have back pain you need to learn how to stabilise your spine . One of the hall marks of good stabilisation is the ability to both contract the abdominal wall and breath at the same time. Poor spine stabilisers, in effect, switch between bracing their spines or breathing. In short can you brace your abs ( not suck in!!) and continue to breath?

If not,  train yourself to breath freely while maintaining an isometric  contraction in the abdominal wall.

RED FLAG: Is your back pain “serious”

In many cases, careful management deals with back pain. There is however a species of back pain that  Ill flag up to you now. The items listed below are “RED FLAG” symptoms which means see your doctor or A & E NOW;  go in and say , “I have back pain symptoms that  I think are Red Flag symptoms”

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain from which there is no position of  ease
  • Chest pain
  • leg pain
  •  a change in toilet patterns
  • numbness or tingling  around your bottom and privates.
  • pain that is worse at night

These are known as ‘red flag symptoms’ and could be a sign of something more serious.

Is sitting a lethal activity? [Research]

A reflection by Crossfit trainer Steven<
Post image for Is sitting a lethal activity? [Research]

Cracking article in the New York Times on research into inactivity, especially related to ‘chair & desk’ culture.

I have been considering for quite a while the idea of a stand up desk, at least at home. My miserable seated posture and the back and neck pain I experience from sitting for hours a day should have been enough to spur me into action. And then I read this:

This is your body on chairs: Electrical activity in the muscles drops — “the muscles go as silent as those of a dead horse,” Hamilton says — leading to a cascade of harmful metabolic effects. Your calorie-burning rate immediately plunges to about one per minute, a third of what it would be if you got up and walked.

Oh dear. Dead horses?

‘Is sitting a lethal activity’, New York Times, 14 April 2011

Edit: There is also an earlier article with moar science in it: ‘Stand up while you read this!’, New York Times, 23 Feb 2010