Understanding Chronic Pain

Kieran is passionate about helping people get out of chronic pain and back to what they do best.

Want to stay up to date with the evidence?

Sign up here for short evidence-based summaries and other essential info


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




Extrapment or Entrapment of Synovial Folds

Meniscoid like synovial folds fill the space between facets in the lumbar spine (Bogduk 2005). There is speculation that these synovial folds become entrapped (swollen and inflamed from minor trauma that prevents the gliding of the opposing joint surfaces) or extrapped (buckled and caught on the joint margin during full flexion that prevents the superior joint surface from gliding downwards and backwards) (Fryer 2016).

Bogduk, N., 2005. Clinical anatomy of the lumbar spine and sacrum. Elsevier Health Sciences.
Fryer, G., 2016. Somatic dysfunction: An osteopathic conundrum. International Journal of Osteopathic Medicine, 22, pp.52-63.

View on Facebook

Acute low back
58% of guidelines in Oliveira et al’s (2018) review suggested maintaining normal activities.

Non-specific low back pain,
Re-assurance that low back pain is not a serious condition is recommended in most guidelines (Oliveira et al 2018), 42% of guidelines in Oliveira et al’s (2018) review suggested maintaining normal activities.

Oliveira, C.B., Maher, C.G., Pinto, R.Z., Traeger, A.C., Lin, C.W.C., Chenot, J.F., van Tulder, M. and Koes, B.W., 2018. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, pp.1-13.

View on Facebook

Manipulation and Chronic Low Back Pain

Clinical prediction rules based on clusters of signs and symptoms have been proposed to identify responders to MT (Cleland et al., 2007). Flynn et al (2002) performed the following manipulation with the symptomatic side down. This was identified by pain on forward flexion, most pain on sacral sulcus palpation, the patient’s description of most painful side or a coin toss if neither of the previous provided a direction of preference!

They assessed 11 variables and found 95% success when these five conditions were met; <16 days of symptoms, >35°of internal rotation in one hip, hypomobility with lumbar spring testing, FABQ work subscale score <19, and no symptoms distal to the knee. Perhaps this could be refined further by not performing the technique if a coin flip was required. The clinical prediction rule has been validated with a follow up. (Childs et al., 2004).

View on Facebook

Follow us