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

2.13.1.3i Progression from Regional Pain to Widespread Pain

Littlejohn and Guymer (2019) suggest that the ubiquitous presence of segmental symptoms and signs adjacent to a spinal region in regional pain syndrome suggests that certain biomechanical factors are important. They hypothesise that referred pain from deeply placed structures via mechanoreceptor input from deep spinal musculo-ligamentous structures, perhaps associated with strain or degenerative change, that interacts with sensitised dorsal horn neurones at the relevant spinal level. Conversely it could be local neuro-inflammatory factors that drive these segmental changes.

References
Littlejohn, G.O. and Guymer, E., 2019. Chronic pain syndromes: overlapping phenotypes with common mechanisms. F1000Research, 8.
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Carvalho‐E‐Silva et al (2019) found genetic factors to significantly contribute to the variance in chronic LBP including lifetime chronic LBP, activity limitation, and pain intensity associated with more recent episodes of LBP, but not for pain intensity associated with people's report of the worst pain episode. Heritability estimates were fairly similar across different LBP outcomes in a population-based twin sample, and not dependent on how it is assessed or experienced. However, we could not detect any significant heritability for a report of intensity experienced during the worst LBP episode experienced. Of course as we study these areas we may find genetic contributors which may be difficult to draw out due to significant contributions of environmental factors.

References

Carvalho‐E‐Silva, A.P.M., Harmer, A.R., Pinheiro, M.B., Madrid‐Valero, J.J., Ferreira, M., Ordoñana, J.R. and H. Ferreira, P., 2019. Does the heritability of chronic low back pain depend on how the condition is assessed?. European Journal of Pain, 23(9), pp.1712-1722.
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Øiestad et al (2020) state they found no association between structural imaging findings and back pain.

Which if you're looking for a very surface level headline broad statement is just about defensible. However there is far more we know when you look at the literature.

Similarly an earlier review by Maher et al (2017) cites Steffens et al review of MRI findings as follows (incorrectly as 2014, actually 2013).
"Findings from a systematic review (12 studies) did not show consistent associations between MRI findings and future episodes of low back pain."

However, Steffens et al’s (2013) systematic review actually found it was not possible to pool findings due to lack of quality but single studies reported significant associations for type 1 Modic changes with pain, disc degeneration with disability in samples with current LBP and disc herniation with pain in a mixed sample. A quick scan of a Maher et al's review and you may think MRI's are fairly useless. Read the original and you may realise it's early stages in our research of the area, some associations have been found and more work is needed.

Conclusions such as these are then spoon fed on social media to the occasional therapist that glances on twitter.

References
Maher, C., Underwood, M. and Buchbinder, R., 2017. Non-specific low back pain. The Lancet, 389(10070), pp.736-747.

Øiestad, B.E., Hilde, G., Tveter, A.T., Peat, G.G., Thomas, M.J., Dunn, K.M. and Grotle, M., 2020. Risk factors for episodes of back pain in emerging adults. A systematic review. European Journal of Pain, 24(1), pp.19-38.
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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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