lumbar
Tell Me Where it Hurts?
05/03/11 13:45 Filed in: Clinical Pearls
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.
Read More...
Read More...
0 Comments
Facet Joints - What's Really Going On in There?
26/10/10 19:37 Filed in: From the Research | Clinical Pearls
When asked the question "Where does spinal pain come from?", most of us would consider the facet joints to be a prime source. Indeed, epidemiology tells us that 31% of chronic lumbar pain and 55% of persistent cervical pain arises from the facet joint 'tissues' (1). But exactly what 'tissues' are we talking about?
If we interrogate the concept of facet joint pain we quickly come to realise that there's no 'one size fits all' diagnosis. And if this is the case, then there's also no 'one size fits all' prognosis, nor treatment. So what does research tell us about the nature of zygapophysial pain? Terms such as 'synovitis' and 'adhesions' are often promoted as an explanation, and they may well be part of the spectrum of facet joint lesions. But how common are these entities, and what causes them?
Read More...
If we interrogate the concept of facet joint pain we quickly come to realise that there's no 'one size fits all' diagnosis. And if this is the case, then there's also no 'one size fits all' prognosis, nor treatment. So what does research tell us about the nature of zygapophysial pain? Terms such as 'synovitis' and 'adhesions' are often promoted as an explanation, and they may well be part of the spectrum of facet joint lesions. But how common are these entities, and what causes them?
Read More...
Does Distance Running Really Harm You?
03/08/10 18:32 Filed in: From the Research
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?
Read More...
But is there any data to support these assertions?
Read More...
Adjusting Deranged Discs - Just What Are We Doing?
20/06/10 21:08 Filed in: From the Research
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?
Read More...
But what is going on at a tissue level? And can our adjustments influence the connective tissue features of common spinal derangements?
Read More...
What Are You Adjusting? Hyper or Hypo?
03/06/10 11:22 Filed in: From the Research | Clinical Pearls
To most chiropractors quality of spinal motion is a prerequisite for spinal health. We have an intrinsic understanding that a joint must move normally to be normal - or at least to stay that way. As such, our examinations are heavily geared towards assessing and quantifying the relative motion of each segment. We then give it a rating: 'normal', 'hypermobile' or 'hypomobile'.
Most of the time chiropractors tend to focus upon finding areas of limited motion - segments of greater stiffness that would benefit from an adjustment. Indeed, the majority of definitions of joint dysfunction suggest that reduced mobility is a cardinal sign, and that we should try to stay away from any hypermobile segment.
But is this really what's going on? Is it truly the stiffer joints that are the prime source of pain in most of our patients? And is it the stiffer joints that benefit the most from manipulation? Or could it actually be the hypermobile joints that should be the target of, and beneficiaries of, the neurological effects of an adjustment?
Read More...
Most of the time chiropractors tend to focus upon finding areas of limited motion - segments of greater stiffness that would benefit from an adjustment. Indeed, the majority of definitions of joint dysfunction suggest that reduced mobility is a cardinal sign, and that we should try to stay away from any hypermobile segment.
But is this really what's going on? Is it truly the stiffer joints that are the prime source of pain in most of our patients? And is it the stiffer joints that benefit the most from manipulation? Or could it actually be the hypermobile joints that should be the target of, and beneficiaries of, the neurological effects of an adjustment?
Read More...
Proprioception Part II - It's More Complex Than You Thought
22/05/10 16:36 Filed in: From the Research
In our last blog entry (Proprioception - The Key to Chiropractic Care) we looked at the accruing evidence that chronic and recurrent spinal disorders are frequently accompanied by proprioceptive deficits. We also took the view that these deficits might actually be the 'weakness' that precedes an acute episode of pain.
So far it has been suggested that this lack of sensory feedback might exist somewhere in the peripheral structures, such as in the multifidus muscle groups, or in the muscle spindles themselves. Brumagne and colleagues (1) suggested that "it is possible that reduced proprioceptive acuity in the lumbosacral spine is a precursor to back injuries and their sequelae. Poor perception of spine orientation may lead to more frequent excursions beyond the range of mechanical stability, thereby risking mechanical injury to spinal tissues."
But could the problem be central - in the brain itself?
Read More...
So far it has been suggested that this lack of sensory feedback might exist somewhere in the peripheral structures, such as in the multifidus muscle groups, or in the muscle spindles themselves. Brumagne and colleagues (1) suggested that "it is possible that reduced proprioceptive acuity in the lumbosacral spine is a precursor to back injuries and their sequelae. Poor perception of spine orientation may lead to more frequent excursions beyond the range of mechanical stability, thereby risking mechanical injury to spinal tissues."
But could the problem be central - in the brain itself?
Read More...
Proprioception - The Key to Chiropractic Care
11/05/10 20:10 Filed in: Clinical Pearls | From the Research
Since the inception of the chiropractic profession its practitioners have struggled with models of spinal dysfunction. While early notions of structural misalignment have largely given way to ‘functional’ concepts, the average field doctor still questions the exact nature of such lesions. So the question still remains, “What exactly is going on inside the spines and nervous systems of our patients?”
Clearly there are many differing clinical diagnoses that can be made when we attempt to pick a source of pain or a ‘tissue in lesion’. These might include a meniscoid extrapment, a zygapophysial synovitis or one of the various grades of annular tear/disc herniation. However, in such instances we could view any tissue damage as the result of a functional derangement that was already in existence at the time of injury. In other words, many spinal pain syndromes are a symptom of a greater deficit underneath - not simply the unlucky result of an inappropriate movement or accident.
But what ‘deficit’ might precede a spinal injury? And how would we know it was present if our patients are asymptomatic?
Read More...
Clearly there are many differing clinical diagnoses that can be made when we attempt to pick a source of pain or a ‘tissue in lesion’. These might include a meniscoid extrapment, a zygapophysial synovitis or one of the various grades of annular tear/disc herniation. However, in such instances we could view any tissue damage as the result of a functional derangement that was already in existence at the time of injury. In other words, many spinal pain syndromes are a symptom of a greater deficit underneath - not simply the unlucky result of an inappropriate movement or accident.
But what ‘deficit’ might precede a spinal injury? And how would we know it was present if our patients are asymptomatic?
Read More...
Nerve Root Sedimentation Sign in Lumbar Stenosis
27/04/10 21:08 Filed in: Clinical Pearls
One of the great challenges facing the front-line clinician is to decide whether a radiological finding is actually relevant.
I’m sure that you are all too aware that many ‘abnormalities’ seen on imaging studies are present in an asymptomatic population (for example, 52% of asymptomatic individuals have at least one disc bulge evident on MRI(1)).
So what about lumbar spinal stenosis? When a patient complains of leg pain while walking (claudication), how can we tell whether the stenosis visualised on their MRI scan is relevant and demonstrates the cause of their symptoms? Or should we keep looking for another source of pain? Perhaps their complaint is vascular in origin?
Read More...
I’m sure that you are all too aware that many ‘abnormalities’ seen on imaging studies are present in an asymptomatic population (for example, 52% of asymptomatic individuals have at least one disc bulge evident on MRI(1)).
So what about lumbar spinal stenosis? When a patient complains of leg pain while walking (claudication), how can we tell whether the stenosis visualised on their MRI scan is relevant and demonstrates the cause of their symptoms? Or should we keep looking for another source of pain? Perhaps their complaint is vascular in origin?
Read More...