A medical research and evidence perspective

Here is how Healthy Back Solutions are getting such outstanding results in the assessment, treatment and prevention of back pain.

Musculoskeletal disorders are the most common complaint that cause people to be absent from work and the second most common complaint presented to doctors. Low back pain (LBP) is the most common musculoskeletal disorder, followed by back pain in the neck and shoulder area.

The classification/diagnosis of back and neck problems is difficult. In some conditions (20%) of the back and neck pathogenesis is relatively well known, resulting in aetiology, pathophysiology, and prognosis and cause specific treatment being known. However in as much as 80% of LBP and CSP it is hard to pinpoint the tissue or segment responsible for pain, leaving a weak association between tissue damage and subjective impairment or work disability. The precisely recommended biopsychosocial model facilitates treatment without necessitating a full explanation for the origin of pain. The model provides a description of the patient’s situation; but as the focus is on the subjective experience of the patient, the goal of treatment can be set at restoring physical function, amelioration of pain and the adoption of new pattern of behaviour.

Eight percent of adults over 30 have had at least 1 episode of LBP. Fifty per cent of adults have experienced more than five episodes of LBP and approximately 17% of adults experience chronic LBP.

In an overwhelming number (80%) of patients with LBP the cause is functional (non-specific) and does not automatically require diagnostic imaging examination. Diagnostic imaging is required only if a serious disorder is suspected or if symptoms persist for more than 6 weeks.

Acute LBP triggers spasm reactions and reflex inhibition of the paravertebral muscles within the first 24 hours. The function of the paraspinal muscles is not always automatically restored after pain precedes. If acute pain caused by tissue damage becomes prolonged, widespread deficits in motor control may develop.

They may cause excess activity of the paraspinal muscles during rest, delay in the reaction reflexes of the trunk muscles, deficits in their co-ordination, in addition to deficits in balance control. A vicious cycle results in chronic low back disorder. When this situation exists the motion of the back becomes restricted and muscle strength and endurance are weakened.

Typical symptoms of LBP disorders include local pain, a pain radiating to lower extremities, back stiffness or fatigue. In chronic disorders that cause work disabilities, the role of psychological and psychosocial factors in especially prominent symptoms of the back rarely result in severe deficits in daily activities or loss of independent coping, but the symptoms are the cause of permanent occupational disability, especially in physically demanding jobs. Back disorders also contribute significantly to short spells of sickness, absence from work, subjectively experienced impairment, and the use of pain medication and physiotherapy services.

The role of a doctor’s clinical examination is crucial in determining the need for further tests and defining the course of treatment. Serious conditions (i.e. malignancy, infections and nerve root compressions) should be diagnosed early and require specialist referral.

With acute LBP bed rest should be avoided, and patients should be encouraged to continue daily activities within the limits permitted by pain. Early efficacious treatment of pain using anti-inflammatory pain medication, limiting pain provoking physical loading but remaining active in daily living and short tern deduce the risk of chronicity.

Progressively evidence has shown that when patients are provided with correct information about the beginning of their back pain and the nature of the condition they have a reduction in anxiety and increased satisfaction with the treatment. The patient should be encouraged to move the back and carry out effective rehabilitation exercises which include strengthening and stretching. The strengthening exercises should be sufficiently intensive to promote general fitness, and should be individually designed. These programmes should be supervised and target in part the deep lumbar extensors of the back.

Functional restoration using biopsychosocial model is a course of action in which progressive exercise (guided by a physiotherapist) is combined with a cognitive-behavioural approach. Here patient’s mistaken beliefs are rectified and patients are supported in modifying their behaviours to directions that are beneficial to health.

A systemic Cochrane review and meta-analysis include 18 randomized trials that followed this approach. It revealed that the average reduction in sickness absence from work obtained by the functional restoration approach was 45 days per 12 months.

A further Cochrane review based on ten random controlled trials concluded for treatments that includes exercises for functional restoration.

Healthy Back Solutions, with the aid of David Health Soultions is the only complete model of functional restoration available in Australia today.

Research Articles