Back Pain Treatment Today: 10 things you might not know about low back pain

2011-07-26 / Back Pain / 0 Comments

10 things you might not know about low back pain

1. One-half of all working Americans admit to having back pain symptoms each year; 80 percent of the population will experience a back problem at some point in their lives.

2. Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.

3. Most cases of back pain are mechanical or non-organic — meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

4. Americans spend at least $50 billion each year on back pain — and that’s just for the more easily identified costs.

5. Fifty to 70 percent of individuals without back pain will have positive MRI’s for disc bulges or herniations. In most cases, the disc is not the cause of pain.

6. Spinal manipulation and other hands-on treatments (active release, myofascial release, trigger point therapy, Graston technique) are better treatments then anti-inflammatory drugs or muscle relaxers for acute low back pain.

Visit to see Dr. John utilizing myofascial release as well as the Graston technique.

7. Spinal stabilizer muscle strength, endurance and motor control essential in limiting the debilitating effects of low back pain and preventing chronicity. There are specific physical therapy exercises that can be done to enhance these muscle groups.

8. The sacroiliac joint and the muscles around the spine and pelvis are the most common cause of low back pain.

Visit to see Dr. John perform hand-on therapy to the sacroiliac joint.

9. Chiropractic and physical therapy care are more cost-effective in the treatment of low back pain versus medical care (drugs, injections, surgery, MRI, X-rays).

10. There is hope for your low back pain. You can improve your condition today. Mishock Physical Therapy & Associates can help.

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call for a free phone consultation at 610-327-2600 or e-mail your questions to . Also, visit us online to learn more about our treatment philosophy, our physical therapy staff, and our four convenient locations in Gilbertsville, Skippack, Phoenixville, and Barto at Our mission is to exceed the expectations of our patients by providing excellence in care and service. We are here to serve you. Dr. Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.

Doctor Discovers Solution to Back Pain

Dr. Michael Ho announced a new solution to back pain and is giving 50% off to all readers of the Calgary Herald. “I guarantee it’ll help your back pain,” says Dr. Ho. Each household is limited to only 2 belts.

We have all suffered with some sort of pain and know how debilitating it can be.

Walter Rose never had pain until the day he awoke to crippling pain two years ago. “I woke up one morning and I couldn’t even get out of bed. My back seized up and I took a pain pill hoping the pain would disappear. It never did,” recalls the 50 year old fireman.

This story is very similar recounts 51 year old Peggy. “I had worked in the bank for over 20 years and my neck, back and shoulders are in pain everyday. Sitting all day has caused me to hunch over and I get terrible back pain.”

Both Walter and Peggy were sent from one specialist to another and yet the pain never went away. Finally both wound up at Dr. Michael Ho’s clinic in Toronto. To their surprise, Dr. Ho’s treatments were different and he also provided them with a treatment belt to use at home. After a few treatments, both patients couldn’t believe the results.

” My biggest regret is that I didn’t know of Dr. Ho sooner. I honestly don’t suffer with the pain anymore and I tell everyone about Dr. Ho and his belt. I must of bought 3 or 4 as gifts. This is the best purchase I have ever made,” exclaimed Peggy.

“Treatments can provide temporary relief, but the condition usually reoccurs. The reason is because the patient is lacking the home therapy treatments between visits and therefore the level of improvement may not be sufficient. Back pain treatments can cost thousands of dollars with no guarantees. This is why most people think they have to live with the pain. There needed to be another solution that people could afford and still be just as effective” says Dr. Michael Ho.

Dr. Michael Ho is a Canadian doctor that is internationally recognized for his expertise in treating pain.. His specialized technique and devices target the cause of the pain in order to effectively treat and provide long-term relief for his patients.

“In order to get immediate and long-term relief, you must understand the cause of the pain. Pain can be caused by muscle tension, stress and misalignments which can cause tense and tight muscles, putting excess strain on the joints and nerves causing a pinching effect that prevents proper circulation and oxygen to the muscles. When the muscles are deprived of oxygen, cramping, numbness, stiffness, swelling and pain can occur.”

“Canadian clinics have all the equipment and resources to help the patients, but the problem is that to effectively treat chronic pain, the treatments must be ‘ more frequent and for a longer period of time. ” This was very frustrating because I knew the patient couldn’t afford the time or money to come to the clinic everyday.

This is why Dr. Ho developed a home use back pain belt that allowed patients to treat themselves at home whenever they experienced any pain.

“After years of development, we were able to develop a Decompression Belt for back pain that is extremely effective in relieving pain, easy to use, they are affordable and you can use them at home.”

Dr. Ho has developed a clinical grade decompression belt that can be used in the comfort of your own home, allowing you to help relieve your back pain immediately at home – saving you the time, money and pain. Dr. Ho’s new Decompression Belt is endorsed by medical professionals and customers that have suffered with long-term, chronic back pain.

“Every patient with back pain should be wearing this belt because it gives you core strength and support in your spine, and a traction effect for great pain relief. The great thing is that patients with chronic back pain can wear this belt and get their life back. They can feel more confident, be more active, and do things that they love doing,” explains back specialist, Dr. Rice.

DR-HO’S Decompression Belt expands to allow traction, providing spinal support and pain relief for the lower back. Wrapped firmly around your waist, the Decompression Belt will provide pain relief in as little as 20 minutes, even if you have suffered with back pain for many years. By decompressing your disc, you relieve the pressure on the nerve, allowing better circulation & less pain in your back & legs.

“I have used many modalities to treat my patients, but nothing has been as effective as this decompression belt. I developed this belt for people suffering from herniated discs, pinched nerves, sciatica and back pain caused by aging and poor posture Whether you are working, walking or sitting, this belt can help protect, support and treat your back. Most importantly, you can be pain-free,” explains Dr. Ho.

Since making the Decompression Belt available to the public, we have sold out of inventory multiple times. “As a proud Canadian company, we saved a limited number of belts for readers of the Calgary Herald”. As an exclusive special, Dr. Ho has agreed to give the first 100 customers 50% off as well as include DR-HO’S Magic Instant Heat Therapy Pad absolutely free!

“The Decompression Belt will help eliminate your back pain fast, safe and without the use of drugs. You don’t have to live with your back pain any longer.”

Oh, my aching back! Does that back pain require rest or Rx?

Back pain is a common ailment, affecting more than 80 percent of adults at any given time. According to the American Academy of Family Physicians, most people experience back pain at some point in their lives — and 90 percent get better within a few weeks or respond well to non-surgical treatment, such as home care or physical therapy.

But how does a person know if their aching back requires medication and rest, or surgery?

Back pain doesn’t discriminate by age or fitness level, but most frequently strikes men and women between ages 30 and 50 due to the natural aging process, as well as sedentary lifestyles and lack of exercise — or too much exercise. Unfortunately, the risk of low back pain from disc disease or spinal degeneration increases with age.


Injury-related back pain is most often “acute” — meaning the pain usually goes away on its own, with rest. Back pain that lasts more than three months may be due to disease or aging, and is termed “chronic.”

Most low back pain follows some trauma to the back, but according to the National Institute on Neurological Disorders and Stroke, other causes include: degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, joint or disc irritation, or congenital spine abnormalities.

Obesity, smoking, stress, poor physical condition and certain sleeping positions are also causes of back pain.

The most common culprit, however, is muscle strain caused by lifting something too heavy or twisting the back in an unusual way.

A more severe consequence of lifting something heavy is the herniated disc. The disc is a cushion between two adjacent bones in the back. If the disc’s thick outer coating is damaged, its soft, spongy inner core can leak or bulge, causing nerve inflammation.

When damaged discs press on the nerve roots, then pain can radiate down the sciatic nerve (the large nerve that carries nerve fibers to the leg), and sciatica or leg pain can result.

Degenerative disc disease can cause pain due to normal age-related wear, but some people experience this pain more intensely than others. Other back issues develop from chronic conditions such as spinal stenosis, the narrowing of the spinal canal due to arthritis and bulging discs.

Treatment options

Most back pain can be resolved with non-surgical treatment. If these methods are unsuccessful, see your doctor for a medical evaluation. He or she may prescribe oral medications or physical therapy as a first step. If conservative methods do not relieve your pain, surgery may be a treatment option — especially if other symptoms suggest problems with a spinal nerve.

These symptoms include back pain that lasts longer than a few weeks, awakens you at night, or accompanies other symptoms such as muscle tightness and stiffness, severe leg pain (in the buttocks or radiating down the back of the leg), a tingling sensation in the leg, a change in bowel or bladder habits, or fever, chills and sweats.

A medical exam and imaging tests (X-ray, MRI, CT scan or ultrasound) can diagnose the source of back pain. If your back pain requires surgery, the good news is, most spine surgery techniques are now minimally invasive, involving a small incision, less scarring and shorter recovery time. Both orthopedic physicians and neurosurgeons perform spinal surgery.

Types of surgery

One surgical method, microdiscectomy, removes a small portion of bone or disc material through a tiny incision of the lower back without disturbing joints, ligaments and muscles in the lower spine.

Laser procedures are not covered by insurance and have very limited indications, so I probably would not promote this. Even more extensive decompression and fusion procedures can be done with minimally invasive procedures.

After minimally invasive back surgery, a patient may be able to get out of bed and walk on the same day or the day after surgery, and return quickly to walking, daily activities, and work as early as one to two weeks after the procedures, followed by physical therapy to regain strength.

Dr. Linda D’Andrea is a member of the medical staff at Pottstown Memorial Medical Center, Department of Surgery. She is a graduate of Temple University School of Medicine and completed a general surgery internship at the Medical College of Pennsylvania. She also completed a residency in orthopedics at Boston University Medical Center. Spinal fellowships were completed at Shriners Hospital for Children in Philadelphia and Temple University Hospital. D’Andrea is board certified by the American Board of Orthopaedic Surgery and is in practice with Brandywine Institute of Orthopaedics, 600 Creekside Drive, Pottstown.


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Back Pain Treatment News: Sit Up Straight. Your Back Will Thank You.

2011-06-24 / Back Pain / 0 Comments

Sit Up Straight. Your Back Will Thank You.

EVERYONE wants to avoid back trouble, but surprisingly few of us manage to escape it. Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain.

But back pain is notoriously difficult, and expensive, to remedy.

“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”

Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.

Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.

“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.

Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.

“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”

Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.

THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.

There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.

If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.

“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).

The American Physical Therapy Association’s Web site ( offers a simple tool that lets you search for physical therapists by ZIP code and specialty.

Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.

If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

Oswalt’s Back A Pain For Phillies

It is officially time to be very concerned about Roy Oswalt. The back issue lingers. His fastball slows. One wonders if his head and heart are in the game.

Last night’s loss dropped Oswalt to 4-6 with a 3.79 ERA. He has won only once since April 21. Do you realize that Kyle Kendrick has better stats than Roy? Kendrick is 4-4 with a 3.23.

As Richie Ashburn used to say, hard to believe, Harry.

Lower back tightness forced Oswalt out of last night’s game in St. Louis after two innings. He was trailing 4-0. It was his shortest outing in two seasons. “I was more heaving the ball than throwing it,” Oswalt told reporters. He expects to have an MRI on Monday.

The Phillies right-hander has had these back issues before. He left a game against Florida with back spasms on April 15, tried to pitch through it in his next two starts, only to land on the disabled list a couple of weeks later. Now the back is acting up again. Not a good sign.

It may not have helped that he was driving back-hoes and bulldozers, aiding in the tornado clean-up back home in Weir, Mississippi for more than a week. His stint on the 15-day DL began shortly after he returned. Whether that aggravated his condition is anyone’s guess, but it probably didn’t help. While he tended to the problems on the home front with the Phillies’ blessing, it is a bit curious that Oswalt would leave the team for that length of time. His family members were safe and unharmed, and his property suffered minimal damage.

It was the second time the Oswalts had suffered through the horrors of a tornado. The family home, the one Roy grew up in, was completely destroyed the first time around. This storm wasn’t nearly as bad, at least not in their area. Roy seemed to return with a renewed perspective on life in general. He talked about how baseball was “fourth on the list,” of his priorities. It made one question whether Oswalt’s passion for the game still burns. And if it doesn’t, that is a bigger problem than a recurring injury.

It appears that his back has not been right all year and that it is a factor in his struggles. It could be the chief reason for the two-time 20-game winner’s diminished velocity. Oswalt’s WHIP of 1.298 is his highest since 2007. But Phillies fans must hope the MRI is clean, and that he’s not headed for another stay on the DL; that this isn’t a chronic injury that derails his season. With such an impotent offense, the Phils cannot afford to be down to just three aces. They have the best record in baseball thanks mainly to their outstanding pitching. They need all four aces, and each on top of his game. Because a rotation of Halladay, Lee, Hamels, Worley and Kendrick somehow seems far too mortal, doesn’t it? The Phillies aren’t quite as formidable without Oswalt, or for that matter, with a scuffling Oswalt.

The way this team struggles to score runs, they need him to be the Roy Oswalt of a year ago, the one who went 7-1 as a Phillie. They need him. With a healthy back, and his head in the game.

System to cut surgery wait times

A new provincewide system aims to dramatically reduce wait times for patients with lower back pain.

When initial treatments don’t work, back pain patients are often added to a long lineup of people waiting to see a spine surgeon. The average wait time is about six months, and after all that waiting, more than 80 per cent of those patients don’t end up in the operating room, says Dr. Daryl Fourney, associate professor of neurosurgery at the University of Saskatchewan.

Education sessions for front-line health workers, plus two new spine clinics in Saskatoon and Regina, will attempt to steer patients away from long waits for specialists and get them into treatment more quickly. The goal: to whittle the family doctor-to-surgeon wait time down from six months to six weeks for the minority of patients who do need to go under the knife.

“Patients often wait an agonizingly long time to see a spine surgeon in Canada, only to find out – after they’ve had expensive tests like an MRI – that they don’t need surgery,” Fourney said at the opening of Saskatoon’s spine clinic in City Hospital. “The system, the way it is, is just not working very well.”

The strategy, called a “spine pathway,” began last year with education sessions for family doctors, chiropractors, nurse practitioners and physiotherapists, bringing them up to speed with the best evidence-based treatments for back pain.

About 450 health professionals have taken the course so far.

If trying best practices doesn’t work, health professionals can refer patients to the new spine clinics, which opened last month.

The clinics will determine who should see a surgeon, and who could benefit from other therapies – ideally cutting down surgeons’ queues.

The provincial strategy is a Canadian first, and possibly the first of its kind in the developed world, says Fourney .

“I don’t think throwing more money at the existing system is going to fix it,” he said. “What’s going make improvements and changes is really looking at what we’re doing, and trying to change the system around using those resources more effectively.”

Jackie Mann, vice-president of acute care for the Saskatoon Health Region, says the new approach should also help cut down on unnecessary MRI scans, and hopefully reduce wait times for the high-tech images.

More than a third of the MRIs done in the province are done on lower backs, and the new tack aims to reduce their numbers by five per cent within a year.

Treating back pain quicker

After waiting in agony for more than a year to get a diagnosis, Bryce McAuley is relieved the province has a prescription to assess and treat low back pain more quickly.

“I can’t get around – I drag one leg most of the time,” the 76-year-old Manor resident said on Thursday.

McAuley is one of 55 patients who have been referred to Regina’s spine pathway clinic since it opened in early May.

A spine pathway clinic on Broad Street in Regina and one at Saskatoon’s City Hospital have been set up to speed up the treatment and assessment of people suffering from low back pain.

The Ministry of Health worked with a team of national and international experts to classify all spine conditions into four patterns of pain. Family physicians, chiropractors and physiotherapists can take an online course (www. spine to learn how to use a standardized system to identify whether a patient’s back pain can be resolved with exercises and rest, or if an MRI or surgical referral is required.

“This is the only comprehensive spine care pathway,” said Regina neurosurgeon Dr. Joseph Buwembo. “It is a first for Saskatchewan and it’s a first for Canada. And, as far as we know, there is no other pathway of this nature in the world.”

McAuley is impressed by the treatment he’s received at the Broad Street clinic. After a thorough assessment by a physiotherapist, the senior was finally diagnosed.

“Three vertebraes are completely deteriorated and the sciatic nerve is causing pain down my right hip and leg … I’ve had constant pain for quite a few years,” he said.

On June 30, he’ll learn more about the surgery he requires.

At the Regina clinic’s official opening on Thursday, Health Minister Don McMorris said the spine pathway is part of the government’s overall plan to ensure that by 2014 no residents wait longer than three months for surgery.

“It’s difficult for family physicians to diagnose a patient with one of the 900 possible spine conditions,” McMorris said.

“The volume of referrals means wait times for MRIs and specialist consultations are just way too long. Saskatchewan’s spine pathway is addressing those challenges.”

Each year, about 10,000 Saskatchewan residents see a health-care professional because of back pain. About 5,000 are referred to a spine specialist, but only 20 per cent require surgery.

With a streamlined process, Buwembo expects patients will have shorter waits to see a specialist after their family doctor, chiropractor or physiotherapist refers them.

“We’re looking at 12 weeks as the patient journey to the final decision to treat, which will be a reduction from 42 weeks,” he said.

Dr. Brian Laursen, a busy family practitioner, said the spine pathway “is exactly what I need for my patients with low back pain.”

The pathway allows family doctors to identify patterns of pain based on the patient’s history and a simple examination.

“If I can go directly to managing the symptoms instead of finding out what the causes are, it makes my life a lot easier and it certainly makes it a lot easier for my patients,” Laursen said.

He said the pathway identifies a number of red flags that suggest potentially more serious underlying causes.

“We actually have a failsafe mechanism built into the pathway,” Laursen said.

If a serious problem is identified, the patient will get an urgent referral to a surgeon for assessment.

About 36 per cent of all MRIs performed in the province are for low back pain and injuries.

This year, the pathway’s goal is a five-per-cent reduction in the number of spine patients referred for an MRI.

For every 100 people removed from the wait list for an MRI of the spine, the wait time for an elective MRI is reduced by a week.

The ministry will spend about $675,000 to operate the provincial spine clinics in 2011-12.

“It’s a small number compared to what we’re going to see in savings on the back end,” McMorris said.

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Back Pain News

2010-12-07 / Back Pain / 0 Comments

St Jude Medical reports positive results from chronic low back pain study

St. Jude Medical, Inc., a medical device company, has announced two-year results in a post-market clinical study evaluating neurostimulation for the management of chronic low back pain.

The study found that 70 percent of neurostimulation patients reported overall pain relief of 50 percent or better at their final two-year visit. Additionally, 88 percent of these patients reported that their quality of life was improved or greatly improved.

“This study is the largest neurostimulation study conducted to date and is specifically designed to gather more information about the effectiveness of spinal cord stimulation for low back pain,” said Dr Eugene Mironer, presenter of the results and managing partner of the Carolina Center for Advanced Management of Pain in Spartanburg, S.C. “Our findings at the two-year mark indicate that the therapy is sustainable long-term. In addition to reporting an improvement in their quality of life, 89 percent of patients were satisfied or very satisfied with their results.”

Neurostimulation therapy uses an implantable medical device to deliver mild electrical pulses to the epidural space to mask or interrupt pain signals as they travel to the brain. St. Jude Medical is sponsoring this research to continue to build on the published data supporting the long-term sustainability of the therapy.

“There is a growing body of evidence that confirms the effectiveness of neurostimulation for the management of chronic pain, especially for those patients who have tried multiple therapies only to continue to suffer with pain,” said Chris Chavez, president of the St. Jude Medical Neuromodulation Division. “Over the course of the past decade, physician training, technology improvement and patient selection criteria have advanced greatly. Our study validates the significant impact of these advances in further improving the effectiveness of neurostimulation therapy.”

Low back pain patients’experiences of work modifications; a qualitative study

Research indicates that work modifications can reduce sickness absence and work disability due to low back pain. However, there are few studies that have described modified work from the perspective of patients.

A greater understanding of their experiences may inform future workplace management of employees with this condition.

Methods: Individual semi-structured interviews were conducted with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain.

Data was analysed thematically.

Results: Many participants had made their own work modifications, which were guided by the extent of control they had over their hours and duties, colleague support, and their own beliefs and attitudes about working with back pain. A minority of the participants had received advice or support with work modifications through occupational health.

Access to these services was limited and usually followed lengthy sickness absence. Implementation largely rested with the manager and over-cautious approaches were common.

Conclusions: There was little evidence of compliance with occupational guidance on modified work.

There appears to be insufficient expertise among managers and occupational health in modifying work for employees with low back pain and little indication of joint planning. On the whole, workers make their own modifications, or arrange them informally with their manager and colleagues, but remain concerned about working with back pain.

More effective and appropriate application of modifications may increase employees’confidence in their ability to work.

Lower back pain is a very common problem

Lower back pain is a very common problem and the chances of having it reoccur are likely, but why is this? Low back pain can be caused from many different tissues and pathologies, but the lumbar multifidus muscles (LMM) are one cause that is often overlooked and neglected.

The lumbar multifidus muscles (LMM) stabilize the spine when in a neutral position. When the spine is injured, a reflex occurs that can inhibit the activation of the lumbar multifidus muscles (LMM). When this inhibition persists, atrophy and fatty invasion of the muscle will ensue and often persist after the pain is gone. When the lumbar multifidus muscles (LMM) atrophies, it causes instability within the lower back which can lead to prolonged pain. Assessment of the lumbar multifidus muscles (LMM) as a source of pain with reoccurring low back pain is often overlooked. If the LMMs are the cause of pain, rehabilitation is essential if longterm resolution is to be achieved.

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