What is the best thing I can do for my lower back pain?


child-swim-lesson


Answer: Exercise!!



This may initially seem strange to you but in this blog entry we will review the question that has been debated for many years by medical professionals.

Before the 1990’s bed rest was prescribed by GP’s for anyone suffering from lower back pain. However since then there has been a complete change in thought for the management of lower back pain. In the late 80’s and early 90’s many medical studies were undertaken to find if exercise or bed rest was most effective for treating lower back pain. Exercise strongly prevailed as the best of the two treatments, so ever since all medical guidelines now recommend exercising and staying active. Below is an example exercise sheet produced by us at PhysioQinetics to help our patients suffering from back pain.


Leaflet2


The National Institute for Health and Care Excellence also recommend manual therapy, acupuncture and anti-inflammatories as well as exercise for lower back pain. They also promote Physiotherapy over the other manual therapies (Chiropractors and Osteopaths). This is due to a physiotherapist being someone who can “help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice." Watch one of our our physios demonstrating core exercise techniques below:-





With thanks to:

http://www.nice.org.uk/guidance/cg88/chapter/1-guidance#physical-activity-and-exercise


http://www.csp.org.uk/your-health/what-physiotherapy


http://www.nhs.uk/Livewell/Backpain/Pages/Backexercises.aspx





How to treat patella tendonopathy


With rugby Six Nations in full swing and England beating Italy on the pitch on Valentine's Day, PQ blog this week will discuss a common problem of the knee not only commonly seen in rugby players but also in runners and cyclists - patella tendonopathy.


But before we dive any deeper in with this blog lets have a look at the anatomy. A tendon is a fibrous connective tissue that joins muscles to bone. It is made mainly from collagen fibres and has a fairly poor blood supply compared with muscles, hence it may take longer to heal when injured. The patella tendon is a tendon for the large quadriceps muscles at the knee joint. This tendon also slightly differs from most as it holds the patella (knee cap) in place.



Pasted Graphic


Patella tendonitis is an acute inflammation around the tendon but in more long-term cases it may be classed as patella tendonopathy which can be described as inflammatory or non-inflammatory degeneration of the tendon.


Symptoms of patella tendonitis may include, pain just below the knee cap, swelling, heat. There are many potential causes for patella tendonopathy, these may include increase in training (running, jumping, cycling), over stretching, tight quadriceps, or altered bodies’ biomechanics after trauma.


Treatment for this condition may include: massage, taping, strengthening exercises, ice.


The type of strengthening exercise recommended for tendonopathies is eccentric strengthening. This is when a muscle is being loaded but rather than shortening as we would expect a muscle to do (concentric) the muscle instead is controlling the movement by lengthening.


A good example of eccentric strengthening for patella tendonopathy is the lowering action in a squat. Such as in this video below:-







Reference:
A Study of the Circulation in Normal Tendons and Healing Grafts. E Peacock http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1450994/?page=10
British Journal of Sports Medicine. What is the most appropriate treatment for Patellar Tendinopathy? J cook, K Khan

I have back pain - do I need a scan? (Part II)

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This is a follow on post so we would recommend reading Part I first (click HERE to read Part I)

It has come to our attention that many Chiropractors are still commonly using X-rays as part of their routine lower back pain diagnosis procedure. Looking through current research it is difficult to determine how frequently X-rays are used by Chiropractors in the UK. However a study in Australia of 274 Chiropractors estimated that 68% of these would take an X-ray where an X-ray is not indicated. This is a worrying figure considering the unwarranted radiation exposure to the patients. (see Part I for more details)

An X-ray is only indicated if a tumour or fracture is suspected and this is documented in many Chiropractic guidelines. However, many Chiropractors are still using X-rays to determine if any spinal ‘subluxation’ has occurred. The word "subluxation" means partial dislocation of a joint. The contentious issue here is that there is simply no clinical evidence to suggest spinal subluxation either (1) exist in any clinical meaningful sense or (2) has any clinical relevance to low back pain.

In fact, the limited clinical evidence shows that spinal subluxation, if it at all exists, is very rarely clinically relevant as a cause of pain; however this is a frequent Chiropractic diagnosis based from findings on an X-ray. The only problem with this is (as mentioned in part 1) that on imaging for the back a visible abnormality may not be the cause for the back pain. As we all have anatomical differences and for the majority these do not cause pain.

So our final thought is, if you have back pain and are offered a scan, question the health care professionals. ‘Why do I need one and what are you looking for?’

As a general rule in PhysioQinetics, we only refer for plain x-ray or MRI scan if we have sufficient clinical suspicion of an anatomical pathology and if we are considering referral to specialist orthopaedic surgeons for surgical intervention.


With thanks
• Why do Chiropractors order so many Xrays? Published in 2010
• Chiropractic diagnostic imaging from the Chiropractic board of Australia
• Management of people with acute low-back pain: a survey of Australian Chiropractors published in Chiropractic and Manual Therapies.