UNDERSTANDING LOW BACK PAIN

Kieran is passionate about understanding all the factors that cause low back pain; the genetic, environmental, physical, psychological and the lifestyle components. This helps you get out of pain and then develop a lifestyle that helps prevent recurrence of pain.


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Kieran is a chartered physiotherapist, registered nutritional therapist and corrective exercise specialist who specialises in helping people in chronic pain get back to what they do best.

Kieran is fascinated to understand the causes of someone's pain. From here he puts together a plan using physiotherapy, exercise, nutritional therapy and education to help you get back to what you do best.

Kieran is based at the Bowskill Clinic, 4 Duke Street, W1U 3EL near Bond Street tube station. Where patients are unable to attend the clinic he can do home appointments.

To find out more about Kieran see his bio here

To ask Kieran a question or book an appointment; call 07830160323 email kieran@kieranmacphail.com

Martinez-Rodriguez et al (2018) randomly divided 21 women with fibromyalgia into three groups: A (core stabilization exercises + lacto-vegetarian diet), B (placebo + lacto-vegetarian diet) and C (control). The intervention lasted 4 weeks. Pain assessments (EVA scale) and body composition (bioimpedance) were performed at the beginning and at the end of the intervention. Group A showed significant changes in pain reduction and body composition at the end of the intervention, increasing muscle mass and decreasing fat mass. In addition, this group significantly improved outcomes compared to groups B and C. The correlations showed a relationship between muscle mass and pain reduction referred to at the end of the study in patients in group A. It’s very disappointing there is not more data on this intervention, more outcome measures weren’t taken for example to understand levels of systemic inflammation via hsCRP. With a more thorough analysis in evening such small samples we could begin to understand the relationship such interventions have on the chain events that leads to people reporting more or less pain.

References
Martinez-Rodriguez, A., Leyva-Vela, B., Martinez-Garcia, A. and Nadal-Nicolas, Y., 2018. Effects of lacto-vegetarian diet and stabilization core exercises on body composition and pain in women with fibromyalgia: randomized controlled trial. Nutricion hospitalaria, 35(2), pp.392-399.
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Oliveira et al (2019) found high-quality evidence that people with chronic musculoskeletal pain are 1.91 times more likely to report having a cardiovascular disease compared with those without chronic musculoskeletal pain in a systematic review of 20 papers. Systemic inflammation is one possible underlying factor that could give rise to both conditions. For example hsCRP levels are higher in both groups.

References
Oliveira, C.B., Maher, C.G., Franco, M.R., Kamper, S.J., Williams, C.M., Silva, F.G. and Pinto, R.Z., 2019. Co-occurrence of chronic musculoskeletal pain and cardiovascular diseases: a systematic review with meta-analysis. Pain Medicine.
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Severity and duration of diabetes were both closely associated with Modic changes but not severe intervertebral disc degeneration (Ekşi et al 2019).
References
Ekşi, M.Ş., Kara, M., Özcan-Ekşi, E.E., Aytar, M.H., Güngör, A., Özgen, S. and Pamir, M.N., 2019. Is diabetes mellitus a risk factor for modic changes?: A novel model to understand the association between intervertebral disc degeneration and end-plate changes. Journal of Orthopaedic Science.
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The effects of the microbiome on pain mechanisms are incredibly broad, of particular note is the ability for it to regulate the maturation and function of microglia (brains immune cells which can alter firing patterns of all neurons). Through this mechanisms its tricky to think of a pain the gut microbiome couldn't influence. ...

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Very interesting CRPS patient last week. No pain on active movements or palpation. Pain 10/10 after 10 minutes plus walking or standing. Now needs to be stood on to get pain relief, previously clicking his back relieved it.

I suspect a decrease in descending inhibition. He used get relief with clicking his back (stimulates descending inhibition), now needs much larger forces to stimulate it (people standing on him). His pain comes on with low level nociceptive stimulus- prolonged holds but quickly escalates, suggesting an exaggerated temporal summation potentially due to a lack of descending inhibition.
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