Recurrence of Low Back Pain is Common ...

🔺Low back pain does have a good natural history with many recovering over a 4-6 week period. However many go on and develop recurrent symptoms.

🔺This current study looked at two main questions:

1️⃣ How commonly and how quickly does LBP reoccur in a cohort of people who have recently recovered from an episode of LBP?

2️⃣ What are the prognostic factors for a recurrence of LBP

👥 n = 250 subjects who had recovered from an episode of low back pain within the past month.

🤕 About 70% of people in the study had a recurrence of low back pain during follow-up.

🤔 Prognostic factors for a recurrence:
- Exposure to awkward posture, long time sitting, and more than two previous episodes of low back pain.

https://www.sciencedirect.com/…/artic…/pii/S1836955319300591

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Disc Herniation Regression

Just because the herniation is big on the MRI, doesn't mean they can't recover
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#repost InfoPhysiotherapy
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Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment! 👌
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Photo Credit: Cor-Kinetic
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📕Article abstract by Chiu et al., 2015:
https://www.ncbi.nlm.nih.gov/pubmed/25009200

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Information About the Human Body.

Number of bones - 206
Number of muscles - 639
Number of kidneys - 2
Number of milk teeth - 20
Number of ribs - 24 (12 pairs)
Number of chambers in the heart - 4
Largest artery - Aorta
Normal Blood pressure - 120 - 80
Ph of blood - 7.4
Number of vertebrae in the spine - 33
Number of vertebrae in the Neck - 7
No of bones in middle Ear - 6
Number of bones in Face - 14
Number of bones in Skull - 22
Number of bones in Chest - 25
Number of bones in Arms - 6
Number of bones in each human ear - 3
Number of muscles in the human arm - 72
Number of pumps in heart - 2
Largest organ - Skin
Largest gland - Liver
Smallest cell - Blood cell
Biggest cell - Egg cell (ovum)
Smallest bone - Stapes
First transplanted organ - Heart
Average length of small intestine - 7 m
Average length of large intestine - 1.5 m
The average weight of newborn baby - 2.6 kg.
Pulse rate in one minute - 72 times
Body Temperature - 36.9o C (98.4o F)
Average blood volume - 4 - 5 liters
Average life of RBC - 120 days
Pregnancy period - 280 days
Number of bones in human foot - 33
Number of bones in each wrist - 8
Number of bones in hand - 27
Largest endocrine gland - Thyroid
Largest lymphatic organ - Spleen
Largest cell - Nerve cell
Largest part of brain - Cerebrum
Largest & strongest bone - Femur
Smallest muscle - Stapedius (Middle ear )
Number of chromosomes in human cell - 46 (23
pairs)
Number of bones in Newborn body - 300
Largest muscle - Buttock (Gluteus Maximus)

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THE MYTH OF CORE STABILITY - FREE FULL TEXT REVIEW

Great full text review paper below outlining why core stability exercises, in particular transverses abdominis (TrA) exercises, are likely misguided for people with low back pain.
The paper examines:
1 The role of TrA as a stabiliser and relation to back pain: is TrA that important for stabilisation?
2 The TrA timing issue: what are the timing differences between asymptomatic individuals and patients with LBP? Can timing change by core stability (CS) exercise?
3 Abdominal muscle strength: what is the normal strength needed for daily activity? Can CS exercise affect strength?
4 Single muscle activation: can single muscle be selected? Does it have any functional meaning during movement?
The paper’s conclusions:
-Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation.
-The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote core stability.
-Weak or dysfunctional abdominal muscles will not lead to back pain.
-Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.
-Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise.
-Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic influence is related to the exercise effects rather than CS issues.
-There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities.
-Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.
Check out the review paper here!

http://www.cpdo.net/Lederman_The_myth_of_core_stability.pdf

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10 points highlight what doesn’t improve tendinopathy of the lower limb.

1️⃣Don’t rest completely.
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Treatment should initially reduce painful, high tendon load movements and introduce beneficial loads (eg, isometrics, heavy-slow resistance).
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2️⃣Don’t prescribe incorrect exercise.
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To be effective tendons must be loaded quickly with spring-like Exs, such as:
Jumping
Changing direction
Sprinting
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3️⃣Don’t rely on passive treatments.
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Passive treatments do not increase the load tolerance of tendon and are not helpful in the long term.
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4️⃣Avoid injection therapies.
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Injections of substances into a tendon have been shown to be no more effective than placebo in good clinical trials.
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5️⃣Don’t ignore tendon pain.
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Pain usually increases 24 hours after excess tendon load.
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An increase in pain of >2/10 on a daily loading test should initiate reduction in aspects overloading the tendon (point 2).
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6️⃣Don’t stretch the tendon.
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Stretching only adds detrimental compressive loads to the tendon.
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7️⃣Don’t use friction massage.
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An effect on local nerves may reduce pain (Short-term), only for it to return with high tendon loads.
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8️⃣Don’t use tendon images for diagnosis, prognosis or as an outcome measure.
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Abnormal tendon images (ultrasound and MRI) in isolation do not support a diagnosis of tendon pain as asymptomatic pathology is prevalent.
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9️⃣Don’t be worried about rupture.
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Pain is protective as it causes unloading of a tendon.
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🔟Don’t rush rehabilitation.
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The muscle-tendon unit requires time to build strength and increase capacity (3 months or more).
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Summary:
The best treatment for tendon pain = Exercise-Based Rehabilitation.
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Starting with a muscle strength program, progressing through to more spring-like exercises, and including endurance aspects will load the tendon correctly and give the best long-term results.
••••••••••
📚Cook J. Ten treatments to avoid in patients with lower limb tendon pain. BJSM. 2018.

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"Good Posture" myth.

Are you sitting up straight when reading this? You might want to think again! More evidence against the "good posture" myth. 
i) Slouching improves disc height & disc hydration.
ii) A trend toward increased disc height with more lumbar flexion!

https://www.sciencedirect.com/…/artic…/pii/S0003687017301709

Via Dr. Derek Griffin

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When to apply Ice or Heat for a Muscle Pain?

When to use ICE:

Ice should ALWAYS be used after an acute injury or trauma to any other area of the body.
Ice is a potent vasoconstrictor: cold causes the muscles of the body those lining the walls of our blood vessels, to constrict decreasing the swelling and pain associated with the body’s inflammatory response. As the vessels constrict, fewer inflammatory mediators seep into the area. In the case of musculoskeletal injuries, decreasing the inflammatory response decreases pain and prevents hyperimmune Une response in the area.
Ice should be applied at 15-20 minute intervals only, with at least an hour and a half in between icings.
Ice should be used for the first 48-72 hours following injury. Never use heat during this time.
Ice can also be used to alleviate pain associated with chronic back pain. Ice should be used after exercise, especially strenuous exercise, but NEVER before stretching or exercising. As ice causes increased muscle constriction and tension, its use before physical activity can lead to injury.

When to use HEAT:

Heat is used to relax and relieve tension associated with muscle stiffness and tension. Heat is best used to treat chronic, consistent back, neck and/or other musculoskeletal pain.
Heat can be applied before stretching and exercising to eliminate muscular stiffness and spasms. Warm towels or compresses work best.
These are just basic rules of thumb for treating back pain with heat or ice. If you have been diagnosed with an auto-immune disease, always discuss heat and ice therapies with your specialist. If you find that ice and/or heat seem to intensify your pain, avoid its use and consult with treating practitioner.

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