Outside The Box Ideas

Are common treatments for low back pain - more MRIs, strong pain medication, injection therapy and surgery working? And if they are, why has the number of LBP sufferers remained stagnant? Is it because LBP care is becoming progressively discordant with clinical guidelines? Is there more to LBP than meets the eye? 

This course will critically reassess LBP and consider other factors that could be influencing your patients’ LBP – and give you tools to approach LBP differently.

The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) has long been accepted by many practitioners who work hard to treat this condition. 

However, the authors of this article maintain that there is no scientific basis for this diagnosis. So what now? What if patients present with the clinical phenomena associated with MPS and TrPs? 

This paper looks at all the evidence relating to the subject and offers plausible explanations and considerations for the treatment of MPS patients.

Evidence based medicine has had many benefits. However the authors of this article argue that it has also had some negative, unintended consequences. This course offers a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment.

Manual and physical therapists often use a postural–structural–biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions. It is believed that postural deviations, body asymmetries and pathomechanics are the predisposing/maintaining factors for many musculoskeletal conditions. The PSB model also plays an important role in clinical assessment and management, including the choice of manual techniques and the exercise prescribed.

However, this model has been eroded by research in the last two decades, introducing profound challenges to the practice of manual and physical therapy. This on-line course will examine how the sciences are challenging the PSB model, using lower back pain as an example.

The principle of core stability has gained wide acceptance for the prevention of injury in training and as a treatment modality for rehabilitation of various musculoskeletal conditions, in particular of the lower back. There has been surprisingly little criticism of this approach to date.  

This article re-examines the original findings and the principles of core stability/spinal stabilisation approaches and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury.

Management of chronic low back pain and leg pain requires a multifactorial approach. Low back pain can be difficult to treat as the clinician not only has to identify the underlying causative factors to restore homeostasis to the system, but also has to ensure that the treatment does not unnecessarily exacerbate the symptoms. 

The aim of treatment is to increase the active control of the passively unstable and associated areas so that the patient can operate within an increased envelope of function, and with minimised symptom recurrences. The training must be simple, requiring minimal equipment so that it is readily accessible to the individual and can be practised frequently. As chronic problems are never cured, only managed, therapists and patients must manage the symptoms over the long term.

The mechanisms through which manual therapy inhibits musculoskeletal pain are likely multifaceted and related to the interaction between the intervention, the patient, the practitioner, and the environment.

Placebo is traditionally considered an inert intervention; however, the pain research literature suggests that placebo is an active hypoalgesic agent. Placebo response likely plays a role in all interventions for pain and we suggest that the same is true for the treatment effects associated with manual therapy.

The magnitude of a placebo response may be influenced by negative mood, expectation, and conditioning. We suggest that manual therapists conceptualize placebo not only as a comparative intervention, but also as a potential active mechanism to partially account for treatment effects associated with manual therapy. We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain.