One of the great challenges of clinical practice is determining the origin of pain. Indeed, the chronic uncertainty that pervades spinal diagnosis has lead to a sort of 'diagnostic paralysis' that affects clinicians of all persuasions. The conventional wisdom seems to be that "Diagnosing spinal pain through physical examination is impossible - so why even try?" This has lead to the development of a number of pragmatic approaches to the question of spinal derangement, including the development of conceptual 'models' to give some sort of theoretical framework, but avoid nailing down a finite diagnosis. For example, physiotherapist Robin McKenzie OBE suggested that the most efficient way to handle the question is to classify back pain patients into 3 broad categories and vary the treatment according to this classification. However, such approaches don't rely upon making a specific tissue diagnosis. Rather, they create a model of what's going on underneath to give some structure to your management.

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Tags: lumbar, disc

I love it when new data challenges the conventional wisdom. And a truism that is often perpetuated without interrogation is that long distance running, particularly on the road, causes osteoarthritis of the knees, hips and possibly degeneration of the lumbar discs.

But is there any data to support these assertions?

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Tags: lumbar, disc, running, osteoarthritis

In our last blog post we examined the prospect of hypermobility being a common feature of many spinal pain patients. What’s more, we also suggested that it is these hypermobile segments that can benefit from the proprioceptive burst that accompanies a spinal adjustment.

But what is going on at a tissue level? And can our adjustments influence the connective tissue features of common spinal derangements?

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Tags: lumbar, disc, clinical