Ross Baines
Aboriginal Health
Musculoskeletal
Low Back Pain - Has the evidence changed your practice?
Health Promotion Through Cycling
Last Modified 2/8/99
You can expect low back pain to trouble 80% of your patient population at some time. With health outcomes and evidence based practice being key issues in healthcare today this short article aims to remind GPs to seek treatment programs that have proven efficacy. The Australian Physiotherapy Association has recently developed a position statement on the efficacy of conservative treatment for low back pain having conducted an extensive literature review with specific reference to physiotherapy treatments.
Research recommends joint mobilisation/manipulation, encouraging early activity, education and specific exercise programs supervised by physiotherapists, as being integral components to an evidence based treatment program.
Evidence based practice treatments should include: ï Mobilisation/manipulation ï Early activity ï Education ï Specific exercise programs
There is no current evidence to support acupuncture, electrotherapy, traction, bed rest, Feldenkrais, Alexander technique, or massage. In the absence of research to justify treatment, the practitioner should provide the referring doctor with treatment goals, a prognosis and details of improvement on examination, and improvement in function to justify further treatment.
Physiotherapists are skilled in manual therapy, patient education and facilitation of specific exercise programs. To improve outcomes look for these evidence based treatment programs when planning management of patients with low back pain.
Ross Baines (MAPA) is a physiotherapist.
If you would like to read about a specific aspect of physiotherapy in future editions of GPSpeak, phone Katherine Breen Kurucsev at the division on (02) 6622 4453.
Discussion
|
WHO DO YOU LISTEN TO!!! Low Back Pain - Has the evidence changed your practice? |
|
WHO DO YOU LISTEN TO!!! JOAN JOHNSON, craftie@subdimension.com Posted 27/6/2001 8:02 PM I have had LBP NOW SINCE 1981 after a car accident. After going from dr.to dr. until 1995 I was told it was all in my mind, go home take 2 panadol and lay down everybody gets lower back pain.Well in 1995 my back collapsed completly and when they finally operated the Specialist was horrified with the damage that he found and NOW too late to fix. I had already had lost 70% of the use of the spinal nerve because it was squashed thinner than a piece of paper for seven cms. and the discs were damaged and now it is a race between the degeneration of the discs or the nerve which is going to be the first one to put me in a wheelchsir permanently.After much physio ,Specialists,G.P.s',pain clinics etc. it was decided over a four year period that the best treatment for me so I could have some quality of life was to introduce me to narcotics because other pain relief was doing nothing and whilst on the narcotics I was able to manage things that I cannot do without the right regime.I went Joan Linda Monardo, monardo@smartchat.net.au Posted 10/7/2001 10:35 PM I suffered from acute pain in both my ring fingers with nerve pain radiating up my arms. This was diagnosed as pain radiating down my ulna nerve from my neck. Other symptoms were blue spots on my fingernails and symptoms worsening in the cold. I did have neck pain but when my neck pain got better, my finger pain got worse. Still I could not get the problem diagnosed. It wasn't until I asked my doctor to refer me to a hand surgeon that I began to make progress. He believed my finger pain to be related to my neck also! I insisted that my neck pain had gone so it didn't make sense to me. He sent me for an ultrasound and xray of my fingers as he thought it may be glomus tumours, but he was doubtful as it rarely occurs in more than one site. Sure enough, the results proved glomus tumours in both ring fingers which were subsequently removed and the pain has now gone. 10 years of excrutiating nerve pain because doctors won't listen. |
|
Low Back Pain - Has the evidence changed your practice? Peter Bryner, pbryner@net1.nw.com.au Posted 30/10/2000 1:27 PM As a chiropractor the evidence has changed my practice. I have alsways tried to solve a clients problem with an antomically plausible solution. The problem with the 'evidence' is that when these supposedly wonderful and eclectic meta-analyses are performed by unbiased individuals you can't help wondering why so may different conclusions about appropriate care for LBP can exist. There are profession-based guidelines, there are many country-specific guidelines etc. So you end up caring for people with a mixture of what you have experienced in practice tempered by what other people says works... P. margaret, bobmarg@ctberinternet.com.au Posted 15/12/2000 8:42 PM I HAVE HAD SEVERE LOWER BACK PAIN FOR SEVERAL YEARS NOW AT LEAST 5.I JUST KEPT ON WORKING AND WALKING AND EXERCISING LIKE I WAS TOLD TOO. FINALLY I WENT TO A SPECIALIST WHO TOLD ME TO JUST FORGET ABOUT MY PIAN AND EXERCISE. AT THIS STAGE I WAS IN UNBEARABLE PAIN WORSE THAN LABOUR PAIN. I WENT TO A PHYSIO WHO SAID THE IMFLAMATION WAS SO BAD TO START RESTING TILL IT SETTLES DOWN A BIT.I DID NOT KNOW WHERE TO YURN TO AS EVERYONE HAD DIFFERENT IDEAS. I WAS A VERY DETERMINED PERSON WITH A HIGH TOLERANCE TO PAIN. THAT IS HOW I GOT SO BAD IN THE FIRST PLACE.SO I TOOK CHARGE OF MY OWN LIFE AND FOUND A PHYSIO WHO PRACTISED THE Mckenzies METHOD OF PHYSIO AND SELF HELP EXERCISES. I STUCK TO THESE AND I DID NOT HAPPEN OVER NIGHT BUT I DID IMPROVE TO THE POINT WHERE MOST DAYS I COULD WALK AROUND WITH OUT UNBEARABLE PAIN. I MIGHT ADD I ALSO SUFFERED PELVIC PAIN AND HIP AND SACRALIAC JOINT PAIN AS WELL. YET THE SPECIALIST COULD NOT TELL ME WHY I WAS SUFFERING IN THIS AREA.THE MCKENZIES METHO |
|
Return to top of page This page was last built on 11/7/2001; 8:47:10 AM. It was originally posted on 15/1/2000; 10:22:19 PM. Webmaster:  lemlink@medicineau.net.au |
 |
Index |  |
Health Promotion Through Cycling |
MedicineAu