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My Back Recovery: Recovering from Chronic Low Back Pain

In every episode we share valuable insights from systematic research and clinical guidelines, as well as advice from experts dedicated to helping people recover from chronic low back pain. My Back Recovery promotes evidence based treatment options, safe training and expert strategies to help you make smart decisions about your rehabilitation process.
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Now displaying: October, 2016
Oct 17, 2016

Movement control not only helps you control your posture and position whilst exercising but can also help you adjust exercises to your own personal needs by controlling stress and strain on the spine.

This episodes guides you through impaired movement control, lists exercises to improve your ability to control movement and talks about the resulting benefits in your experience of pain and everyday activity.

 

Movement-Control – a Basis for Healthy Training

 

Therapists and trainers have always highlighted the value of good posture and position, and now science also backs up the importance of movement control for people recovering from chronic low back pain.

 

Traditionally movement control is taught by therapists and trainers in order to gain control over the position of your spine as a basis to:

  • exercise in a healthy way
  • adjust exercises to your own needs
  • control stress and strain on your spine in your everyday activities

 

Your brain adapts according to your needs

There is scientific evidence to promote movement control as a therapy approach. Today it is widely accepted that chronic LBP is often not caused by a single structure at fault in the back. At least this is the case with 80-95 %, which is why this group is called non specific low back pain.1,2,3,4,5,6,

Recent research points out that there is growing evidence of changes in the brain with people with chronic pain.7

 

Chronic pain patients sometimes have a decreased cortical representation of the affected body parts8,9 - which in the case of LBP is also shown by diminished movement control.10

This means that when you want to make a movement without moving your back you are unable to do so, and instead you still move your back because you can’t control it. This movement sometimes happens without you even noticing it.

 

Practicing movement control can lead to a better representation of your different body parts in your sensual cortex , which is a section in your brain that makes you feel your body surface.

Imagine a musician, they will have much better cortical representation of their hands than someone who has not acquired this coordinative skill. Your brain adapts to how you are using your body.

What some research suggests is: The better your body is represented in this part of your brain (and you can train this through movement control) the less pain you will experience if you are suffering from chronic pain.11,10,12,

 

Basic Anatomy for practicing movement control:

Your pelvis is connected to your thigh-bones as well as your spine. Therefore when you tilt your pelvis up or down, the position of your spine changes too.

It’s also necessary to understand that the neutral position of your lower spine is a curved line (looking at it from the side). Keeping your lower back slightly curved during different exercises without moving it is often a goal in movement control.

A good way to start practicing movement control is to learn how to tilt your pelvis in different positions and become conscious of the resulting movement in your lower back.

Listen to the podcast, episode 05, “Movement Control" at www.mybackrecovery.com to learn more about movement control for people recovering from low back pain.

 

Videos:

find all the resources at: http://mybackrecovery.com/resources.page

watch the clip

  • quadruped - position
  • supine
  • side lying position
  • seated
  • standing position
  • lean forward from a seated position without moving your back as a movement control exercise. If you do it correctly your back will not change its curvature while leaning forward, therefore the movement is coming from your hips.

Literature:

  1. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-68. doi:10.1007/s00586-006-1070-3.
  2. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012.
  3. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012.
  4. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5.
  5. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250.
  6. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-91. doi:10.1007/s00586-006-1071-2.
  7. Wand BM, O’Connell NE, Di Pietro F, Bulsara M. Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants. Phys Ther. 2011;91(4):535-546. doi:10.2522/ptj.20100150.
  8. Catley MJ, O’Connell NE, Berryman C, et al. Is tactile acuity altered in people with chronic pain? A systematic review and meta-analysis. J Pain. 2014;15(10):985-1000. doi:10.1016/j.jpain.2014.06.009.
  9. Moseley GL. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain. 2008;140(1):239-243. doi:10.1016/j.pain.2008.08.001.
  10. Gutknecht M, Mannig A, Waldvogel A, et al. The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. J Bodyw Mov Ther. 2015;19(4):722-731. doi:10.1016/j.jbmt.2014.12.003.
  11. Daffada PJ, Walsh N, McCabe CS, Palmer S. The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review. Physiotherapy. 2015;101(1):25-33. doi:10.1016/j.physio.2014.07.002.
  12. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Improvement in low back movement control, decreased pain and disability, resulting from specific exercise intervention. Sports Med Arthrosc Rehabil Ther Technol. 2010;2(Mc):11. doi:10.1186/1758-2555-2-11.

 

Oct 3, 2016

This episode presents the different groups within low back pain and looks at where statistics come from. This information helps you battle fear associated with the condition and validate your experience of pain.

Facts about Low Back Pain (LBP)

LBP is defined as pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain.1

LBP is categorized into acute LBP and chronic LBP, which is LBP lasting for longer than 12 weeks.2,3,4,5,6

LBP is the most common form of chronic pain,7 a leading cause of disability in people younger than 45 years old8 and has a lifetime prevalence of 70 % in industrialised countries9.

LBP is among the top ten causes of long-term disability in every country and number one cause in 86 countries.10 LBP is the fifth most common reason for all doctor’s visits in the United States11 and the third most common diagnosis in German prevention and rehabilitation facilities.12

One year after a first episode of back pain 62% of people will still experience pain while 16% of those initially unable to work are still not working.13

What Back Pain do You Have?

  • 80-95 % non-specific LBP
  • 5% radicular syndrome
  • 1 % serious spinal pathology

What is Non-Specific LBP?

Today it is widely accepted that the biggest group of LBP is non-specific-LBP. Non-specific LBP means that no anatomic structure can be identified that is at fault. You might be surprised to learn that this is the case with 80-95% of all people with

LBP. 9,12,4,5,14,15

How Should it be Diagnosed?

Almost all guidelines16,17,6 recommend that people presenting with an acute episode of LBP should be screened for:

  1. potential serious pathology (e.g. cancer, fractures, infections of the spine, cauda equina syndrome, systemic disease) that could cause pain in the back
  2. radicular syndrome (that means pain arises from the nerve roots in your spine)

Potential serious pathologies for LBP are very rare (0,01% spinal infections, 0,7% cancer) and together with neurological impairment make up for approximately 1-5% of all LPB-Incidents.18

Nerve root pain (pain caused by the nerves in your spine) is considered to be present if there is pain radiating down the leg, together with a positive neurological examination (muscle strength, sensibility and deep tendon reflexes should be assessed). The neurological examination is positive when there is a palsy/weakness of a muscle in your leg that wasn´t there before, or if you experience incontinence or urinary retention that wasn´t there previous to your back pain, or if parts of your skin are numb. 

If you have no confirmed serious disease and no radicular symptoms you have non-specific LBP.

For LBP with substantial neurologic involvement (1-5 %), guidelines generally do not recommend conducting any further assessment until appropriate conservative management (which is rarely defined) has failed, after which MRI or CT (imaging of your spine) is generally recommended.6

Find out more: www.mybackrecovery.com

Sources:

  1. Duthey BB, Ph D. Priority Medicines for Europe and the World “ A Public Health Approach to Innovation ” Update on 2004 Background Paper Background Paper 6 . 24 Low back pain. (March 2013).
  2. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2(November 2004):192-300. doi:10.1007/s00586-006-1072-1.
  3. Savigny P Watson P, Underwood M, Ritchie G , Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough,C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. KS. Low Back Pain: early management of persistent non-specific low back pain. London Natl Collab Cent Prim Care R Coll Gen Pract. 2009;(May):1-235.
  4. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012.
  5. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5.
  6. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. doi:10.1016/j.spinee.2010.03.032.
  7. Froud R, Patterson S, Eldridge S, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15:50. doi:10.1186/1471-2474-15-50.
  8. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283-298. doi:10.1007/s00586-006-0143-7.
  9. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-S168. doi:10.1007/s00586-006-1070-3.
  10. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;6736(15):1990-2013. doi:10.1016/S0140-6736(15)60692-4.
  11. Cowan P. Consumer Guidelines for Low Back Pain. (Kelly N, Chou R, eds.).; 2008. http://theacpa.org/condition/back-pain.
  12. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012.
  13. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-165. doi:10.1007/s00586-002-0508-5.
  14. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250.
  15. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-S191. doi:10.1007/s00586-006-1071-2.
  16. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176-185. doi:10.1016/j.jbspin.2011.03.019.
  17. Koes BW, van Tulder M, Lin C-WC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-2094. doi:10.1007/s00586-010-1502-y.
  18. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586-597. doi:10.7326/0003-4819-137-7-200210010-00010.

 

 

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