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The Facts About Backs

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By Michael Hall

Of all musculoskeletal injuries, low back pain invokes the greatest images of pain and incapacity. And rightly so, the incidence of low back pain is alarming. 80% of people will suffer a major bout of low back pain at some time in their lives. It is second only to the common cold as the cause of absenteeism in the Western world and increasing at a rate 14 times more than the population growth. And yet prescreening testing, back strengthening and teaching people to lift with bent knees and straight back appear to have had little effect in arresting its growth. Why? Even diagnosing the source of low back pain is difficult with at least 40% of CT scans and MRI scans, showing false positives. How can our best diagnostic equipment and treatment be so inaccurate and so ineffective? Perhaps, if we are to be more effective, we need to change the way that we think about low back pain and develop a new model for its diagnosis and treatment.

Background

Of all the incidences of low back pain that present, the great majority are said to have come on for “no apparent reason”. Stories such as “I bent over to pick up a pen” or “I reached forward to get something” are not uncommon, and yet it is often assumed that such easy tasks are the causes of the injury and that through back strengthening further recurrences will be prevented. It is clear however, that in many cases lack of strength and/or lack of flexibility have little to do with the onset of these injuries as they represent such low levels of our overall physical capacity. Consequently, there must be other factors at work and there are! The fact that low back pain often comes on “for no apparent reason” suggests that lifestyle or the way that we live might have something to do with its onset. And because life involves postures, movements and activities, then it is reasonable that these will have an effect on both our physical and psychological health.

The Problem of Diagnosis

As up to 40% of MRI’s and CT Scans can reveal false positives, the question is where is the pain coming from? In the case of the lumbar spine, it may come from the discs, facet joints, bones, ligaments, muscles and nerves- all structures which are intimately involved and in close proximity. Complicating this further, is the fact that many structures produce similar signs and symptoms making differential diagnosis difficult. Our psyche can then influence the amount of pain that we perceive. We like precise diagnosis, because it gives us certainty, however in the case of the body we may simplify things too much. As the body is made up of systems, it makes sense that if one structure is damaged that this will influence the functioning of other structures which in turn will influence the functioning of the whole body. For example, a facet joint strain, may in turn cause muscle spasm, which will then stress other structures and eventually lead to further pain. If just the original damaged structure is treated in isolation without taking into account the change that has taken place in other structures and the body as a whole, then not only will it take longer for healing to take place, but complete resolution may never be achieved.

Predisposition to Low Back Pain

• Poor posture
• Poor movement patterns
• Poor core muscle tone and control
• Regimented, sedentary, stressful lifestyle
• Lack of aerobic fitness, flexibility and strength

Classifying back pain can be confusing!

Various researchers and clinicians including Robin McKenzie, Peter O’Sullivan and Shirley Sahrmann have developed classification systems based upon what movements cause the pain. These movement systems can then easily be related to lower back pathology and specific programs can be developed to best treat these conditions.

Treatment

As with any treatment plan, the most effective and beneficial treatment must coincide with the assessment findings and also each person’s goals. It is essential that treatment take into account the stage of healing and be guided by the injury’s irritability. In the acute stage (48-72 hours) this means reducing inflammation by avoiding aggravating movements and applying cold packs for 20 minutes at least 6 times each day. Electrotherapy and “hands on” techniques may also be used to reduce pain and taping or bracing may be applied to give increased support and awareness.

As pain decreases, healing is then promoted through the use of heat and massage. Various manual techniques may then be combined synergistically with exercises to begin restoring optimal joint mobility, soft tissue length and neuromuscular control. These exercises often begin with isolating particular joints, muscles etc. but then must be integrated into function if people are to achieve, sustained long-term relief. This last point is especially important. It is the author’s experience that people often leave treatment before they are ready. Yet research has shown that there is an 80% recurrence rate within one year for people who have suffered an incident of low back pain. Recent research has indicated that the reason for this may lie in the loss of feed-forward muscular bracing that occurs around the spine within 24 hours of an episode of low back pain. It has been found that this bracing does not return even if a person’s pain completely resolves. This means that if the spine is again to receive the protection of automatic muscular bracing and the possibility of further episodes of back pain be minimised, the spinal muscles must be specifically trained and integrated back into everyday functional activities. Once this bracing has been established, it then forms a base on which further back and abdominal strengthening can take place.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Arthritis – Your action plan

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By Michael Hall

If you suffer from aches, pains, tightness, clicking, grating and joint stiffness, the chances are that you have arthritis, especially if these signs and symptoms worsen during inclement weather. This is because arthritis ranks as the second most prevalent medical problem in Australia. In fact, it is the major cause of disability and chronic pain in Australia, with 3.85million Australians affected at a cost to our economy of more than $23.9 billion each year in medical care and indirect costs such as loss of earnings and lost production.

And as the population ages, the number of people with arthritis is growing. According to leading researcher Access Economics, current trends suggest that, by 2050, 7 million Australians will suffer from some form of arthritis.

So what is arthritis?

Arthritis is often referred to as a single disease but in fact, it is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically the joints where two or more bones meet.

Specifically, arthritis refers to inflammation of the joints and the surrounding tissue. Inflammation is an immune body response and the immune system is the body’s system for defending itself against foreign bodies, viruses, bacteria and so on. But the immune system also has another role and that is to act like a demolition company, clearing an area of debris and damaged tissue following injury, so that new tissue (construction) can be laid down. The immune system is activated when cells are damaged through excessive or abnormal stresses and the problem occurs when the immune system either acts too much or for too long, and continues to break down healthy tissue disrupting the repair of the area. In the case of arthritis, the immune system breaks down the covering on the end of bones (hyaline cartilage) leading to joint stiffness, pain and instability as well as muscle weakness, making it difficult to perform even the most basic daily tasks such as getting out of bed, dressing and walking.

While there are about 100 forms of arthritis, osteoarthritis is the most prevalent accounting for 51% of cases in Australia, and it is this form of arthritis that we will refer to in this article.

What causes osteoarthritis?

There are many causes of osteoarthritis. These include:

1. Poor posture and / or movement habits;
2. Joint trauma associated with injury or surgery and incomplete or inadequate rehabilitation;
3. Poor diet, leading to nutritional deficiencies;
4. Congenital or genetic causes;
5. Inflammatory diseases.

The common link with all these factors is that they involve abnormal or excessive joint forces, joint irritation and inflammation leading to breakdown of the covering of joints. So to a large extent, preventing the inflammation associated with abnormal or excessive forces, and joint irritation would go a long way to preventing arthritis.

Arthritis is not necessarily a consequence of aging

There is a widely held belief that arthritis is simply a consequence of age, the pain of growing old. However, arthritis is not a natural part of ageing. In fact, 2.4 million of all people suffering from the disease are of working age.

Why is arthritis so prevalent when millions of dollars in medical funding have been spent doing years of research and creating a plethora of different treatment programs?

What is the solution?

Whilst finding a genetic solution may be some years off, research suggests that early intervention can delay the onset of the disease and may reduce the number of cases of osteoarthritis by about 500,000 within 15 years.

In addition, there are actions that you can take immediately to minimise joint inflammation and therefore the impact of arthritis. The key lies with optimising joint health by:

1. Reducing chronic muscle and joint tension which leads to muscle tightness, joint stiffness, poor alignment, nervous tissue irritation and eventually pain. The best way to do this is with meditation/relaxation techniques, remedial massage, joint mobilisation and PNF or prolonged stretching (Yoga), and correcting postures and movements through the use of better equipment (e.g. pillows, beds, chairs, work stations etc.)

2. Preventing abnormal or excessive joint stresses by correcting poor posture, mal-alignment and less than ideal movement habits so that better forces are placed on the body structures. Under these circumstances, tissue and joint health actually improves and wellbeing is enhanced;

3. Improving your physical capacity, through an appropriate conditioning, rehabilitation and prevention programs. These programs must emphasize ideal alignment, correct joint stabilisation and precise muscle control with integration into the optimal performance of every day movements. Among the best programs are clinical pilates and hydrotherapy, and functional strengthening classes;

4. Good nutrition is critical. Many foods such as turmeric, ginger, fish/krill oil and flaxseed oil actually reduce the effects of inflammation whilst others associated with acidic or high glycemic foods make it worse. Knowing which foods to avoid and which ones to eat can make a massive difference in the quality of your life.

5. Ensuring that you have normal amounts of vitamin D by exposing 40% of your body to 15 minutes of sunlight before 9am.

It makes sense that these recommendations will work better if they are combined in the one program. Bodywise Health has now runs such a program, so if you suffer from arthritis, call Bodywise Health. Relief may be just a phone call away.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Bodywise Health

364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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