Welcome
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).
References
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.
Manual therapy as maintenance care delivered by chiropractors was more effective at reducing days with LBP than symptom directed treatment in a randomised controlled trial, although it did require more total visits (Eklund et al 2018).
I have some sympathy for chiropractors who really want to help their patients. Some patients don't want to exercise but will come in for twice a week chiro, and it probably quite a nice experience for them. In contrast, exercise still needs to be done regularly and its not like you do it for a month and then never again.
journals.plos.org/plosone/article?id=10.1371/journal.pone.0203029
journals.plos.org
Background For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC),....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.
References
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.
The Therapeutic Alliance and Low Back Pain, assess it, plan where to get it to, consider which factors to work on and put it in your session plan. Possibly the best blog you'll read on the therapeutic alliance today! www.kieranmacphail.com/the-therapeutic-alliance-and-low-back-pain/
Kieran Macphail » The Therapeutic Alliance and Low Back Pain
kieranmacphail.com
The Therapeutic Alliance and Low Back Pain Written by Kieran Macphail on November 17, 2018. Posted in Uncategorized The therapeutic relationship has been defined as; “A helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and oth...Lederman (2017) outlines a process approach involving three processes in recovery, repair after an initial injury, promoting adaptation of systems and alleviation of symptoms where this is possible.
For example repair is central to recovery after an acute disc, ligament or muscle injury. Adaptation is more important in canal stenosis for example where encouraging a flatter lumbar lordosis. Symptomatic relief may be more central in managing chronic low back pain. In this case pain, but also stiffness, parasthesia, anxiety and kinesiophobia may all be targets. This not so much a paradigm shift as just another very complimentary way of looking at things. I recommend the paper for consider the excellent figures and tables, some of the claims and arguments I do not recommend.
www.cpdo.net/Lederman_A_Process_model_in_Manual_and_Physical_Therapies.pdf
cpdo.net
The Therapeutic Alliance and Low Back Pain, assess it, plan where to get it to, consider which factors to work on and put it in your session plan. Possibly the best blog you'll read on the therapeutic alliance today!
www.kieranmacphail.com/the-therapeutic-alliance-and-low-back-pain/
Kieran Macphail » The Therapeutic Alliance and Low Back Pain
kieranmacphail.com
The Therapeutic Alliance and Low Back Pain Written by Kieran Macphail on November 17, 2018. Posted in Uncategorized The therapeutic relationship has been defined as; “A helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and oth...Fryer (2016- free courtesy of the good folk at IJOM) gives an excellent review of the osteopathic somatic dysfunction, from possible pathoanatomical causes to reviewing Korr's fascinating work I lasted studied about 10 years ago! Synovial folds between the facets is another very interesting area that I'd completely forgotten about. Very interesting and well worth a read. www.sciencedirect.com/science/article/pii/S1746068916300025#bib22
Somatic dysfunction: An osteopathic conundrum
sciencedirect.com
Somatic dysfunction is considered a central concept for the theory and practice of osteopathy, but its relevance to the modern profession is questiona…In some cases of chronic low back pain resolution can occur whilst the MRI looks the same. Lederman (2017) suggests this shows that repair has not taken place and in fact adaptation and alleviation of symptoms are the primary processes. However, it may be that the MRI findings were not the cause of the symptoms. To prove such an hypothesis a gold standard for patho-anatomical pain would be required such as positive discography. This disc would then have to remain positive whilst all other symptoms significantly improved.
On reviewing Lederman's process approach.
www.sciencedirect.com/science/article/pii/S1746068916300074?fbclid=IwAR1mWZc_nc_RKc_SVtTOwGQpkhO3...
A process approach in osteopathy: beyond the structural model
sciencedirect.com
The innate capacity of the body/person for self-recovery and healing is a key concept in osteopathy and the basis of clinical management for a broad r…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).
Naloxone partially prevents placebo effect by stopping opioid system- old but interesting and relevant to understanding mechanism of placebo effects which influence us all.
www.sciencedirect.com/science/article/pii/0304395983902038
Partial antagonism of placebo analgesia by naloxone
sciencedirect.com
Thirty subjects were given a placebo (intravenous saline), which was described as a known pain killer, once a week for 3 consecutive weeks. Experiment…
