Psychosocial symptoms are important predictors of those that do worse with chronic low back pain.
Currently the prevailing view is that psychosocial symptoms drive systemic inflammation.
Psychosocial problems increase inflammation, and inflammation increases psychosocial symptoms.
Psychosocial treatments decrease inflammation and reducing inflammation improves psychosocial symptoms.
The relationship is bidirectional and we should remember this when dealing with patients with psychosocial symptoms.
Explaining this relationship to patients may reduce the stigma associated with...
Mindfulness is basically the western term for meditation. The practice has moved from weird hippies only, to being used by CEOs and professional sport, and is now being studied fairly extensively. This blog will focus on the relevance of mindfulness to chronic low back pain. Outlining the benefits and how to start a mindfulness practice.
Psychological stress can directly influence the musculoskeletal, endocrine, immune and nervous systems through the limbic system modifying chronic pain (Macphail 2014). Psychosocial risk factors for low back pain (LBP) chronicity are well known to lead to worse...
Low back pain (LBP) is usually defined as pain localised below the costal margin (ribs) and above the inferior gluteal folds (buttock crease). It is the leading cause of disability worldwide and is becoming increasingly prevalent (Harkness et al. 2005, Hoy et al. 2012, Vos et al. 2012). Chronic low back pain (CLBP) is variously defined as lasting longer than 7-12 weeks, to 3 months (Anderrson 1999, Frymoyer 1988). LBP is typically classified as “specific” or “non-specific”. Specific LBP refers to symptoms caused by specific pathophysiologic causes, such as hernia nucleus,...
There remains controversy over whether the vastus medialis can be divided in to vastus medialis longus and vastus medialis obliquus (VMO) (Smith et al 2008). Nonetheless in rehabilitation we frequently attempt to bias our strengthening exercises towards the medial portion of the quadriceps over the lateral, with mixed success.
Research in to exercises for the vastus medialis has in general been disappointing. For example, Kushion et al (2012) found that altering the foot position from neutral to external rotation had no effect on vastus lateralis to vastus medialis ratio in straight leg raise...
The clinical audit process is the process of applying a test or multiple tests with a patient. Then applying an intervention or combination of interventions and then re-assessing the original test or tests. This process can be conducted over a period of minutes or months.
It is an incredibly useful methodology giving you feedback on the effect of your treatment. Further, if a patient centred test is used the patient indicates the success of the intervention himself or herself and thus there is “buy-in”.
A clinical example is shown below. The case history is edited to only the...