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.
 
 

Author: Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions. MISSION STATEMENT: My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life. I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment. I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.

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