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Post 72

Not all press-ups are created equal
 
“Low back pain (LBP) is a common medical condition that affects p to 80% of the population and can have a profound impact on a person’s everyday life”

 
This statistic gets used so often that it should be common knowledge at this point that 8 out of 10 people will experience back pain at some point in his/her life. It is almost as common as the cold and it has overtaken respiratory issues for reasons to seek health care.
 
“LBP was ranked the greatest contributor to global disability and sixth for overall daily burden…in 57% to 89% of people with LBP, no specific etiology can be identified”.

 
This is huge! Think about this way, LBP is the biggest reason for people to become disabled, but only in about 10% of the cases, can a medical professional tell you the cause of your problem. Might as well play spin the bottle with ten different options. The likelihood of your doctor coming up with the cause of your back pain is as likely as the bottle landing on the cause of your back pain. This is not the doctor’s fault though because not all back pain is the same. If it is not all the same, then it should not all be treated the same. It should be classified, either in a sophisticated manner such as with Mechanical Diagnosis and Therapy or in an unsophisticated manner such as your “core is weak”.
 
“…subjects with LBP moved more in the lumbar spine during the early phases of forward bending, and that the lumbar spine and hips contributed equally during midranges, similar to controls…when rising from a forward bend, subjects with LBP moved more in the lumbar spine during the first 25% of the movement”

 
This is getting nit-picky. The easy way to say this is that people with back pain move from the spine in a different way than those without back pain. Depending on which school of thought you listen to, the lumbar spine should remain stable and all of the movement should happen at the hips. If this is the case, then any movement at the lumbar spine would be unacceptable. I don’t fall into this school of thought…but sometimes they are right, especially under load such as a 500# bar or a bag of dog food. Whatever best resembles your lifestyle.
 
“Three of the more common approaches include the Movement System Impairment (MSI) classification system, the McKenzie approach, and the treatment-based classification system (TBC), with associated clinical prediction rules (CPRs)”

 
I have a problem with this right off the bat. The Mckenzie approach is formally described as Mechanical Diagnosis and Therapy (MDT). There has been stigma against this approach due to the man that started the approach by “accident” and through careful observation and experimentation the approach has been validated time and again in the hands of those that are qualified. The fact that the authors call it the lay term “McKenzie Method” instead of the official MDT makes it hard for me to not comment.
The TBC is based on clinical prediction rules that have yet to be validated, this is of course aside from the manipulation category. We all know, by now, that manipulations are a powerful tool for all PT’s and Chiro’s to use with patients.
 
“…the LBP group displayed significantly less lower lumbar extension than did the control group”

 
If your PT notices this…kudos. What I tend to see is that the upper lumbar spine will extend and then the patient’s pelvis will come off of the table. This has been called “end-range” in some circles, as the lumbar spine has no room left to move and therefore the additional movement happens at the hip. What’s interesting is that I have seen this improve within a session, so the concept of reaching end-range because the pelvis has left the table doesn’t sit well with me. This could be the result of nuclear migration within the annulus, soft tissue accommodation based on the principle of creep or motor learning. I’m sure that there are other possibilities; I just don’t have them at the tip of my tongue (or fingers). Be that as it may, the extension mobility can clear up relatively quickly.
 
The take home message is that those with back pain don’t move the same way as those without back pain. It sounds like common sense, but it is only common sense when it is proven by people that get paid to tell us…DUH!
 
Excepts taken from:
 
Mazzone B, Wood R, Gombatto S. Spine Kinematics During Prone Extension in People With and Among Classification-Specific Low Back Pain Subgroups. JOSPT 2016;46(7):571-579.
 
 

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Categories: Physical therapy

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