Non-specific low back pain (LBP) has been researched and many have speculated correlations between physical activity and disability. Traditionally, it is assumed that patients who have LBP feel more disabled, report more restrictions within their daily life and as a result, are less physically active. It is important to note that disability and physical activity are not synonymous terms. The ICF states disability is an umbrella term that covers 3 aspects of health: body functions and structures, activity limitations, and participation restrictions. Physical activity is defined as the execution of a task or action by an individual. Simply, disability focuses on what people are unable to do, and physical activity focuses on what people are able to do.

Lin et al recently conducted a systematic review and meta-analysis to assess if a relationship exists between physical activity and disability in acute, sub-acute, and chronic non-specific LBP. Inclusion criteria required disability to be assessed by a self-report questionnaire (eg, Roland Morris Disability Questionnaire, Oswestry Disability Index) and physical activity to be assessed utilizing self reports forms (eg, Baecke Physical Activity Questionnaire, International Physical Activity Questionnaire), or movement instruments such as pedometers or accelerometers. The authors grouped patients into three categories: acute, sub-acute, and chronic. The acuity was based upon duration of LBP: acute (< 6 weeks), sub-acute (6 weeks – 3 months), and chronic (> 3 months).

To Finish Reading, Go to www.forwardthinkingpt.com

1. Pain is 100% of the time, an output from the brain. In 1996, Ronald Malzack developed the concept of the neuromatrix. The neuromatrix, in simplistic terms, is all of the mechanisms within the brain, that when activated, produce pain. So when your ankle hurts, the pain is generated by information gathered by the brain. Pain is simply a defense mechanism developed to protect the body.

2. The degree of injury does not always equal the degree of pain. Research has told us that very major injuries may not hurt at all and very minor injuries may hurt alot. The degree of pain you experience is more related to past experiences. For example, if you have sprained your ankle in the past and then you sprained it again, the second sprain will likely hurt more. This is because the brain has learned to protect that ankle following the prior injury and defends it through pain.

3. Despite what MRIs X-Rays and CT Scans show objectively, this may not be the root cause of your pain. While diagnostic imaging may give us excellent views of your internal anatomy, it gives us little information about pain. A study performed on individuals 60 years or older, who had no symptoms of low back pain, found that 36% had a herniated disc, 21% had spinal stenosis and over 90% had a degenerated or bulging disc. What shows up on an image may or may not be related to your symptoms.

4. Psychological variables, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different things and psychological components are one of them. A recent study in the Journal of Pain showed that psychological variables pre-total knee replacement was highly related to long-term pain post-total knee replacement. The treatment of these co-morbities may actually be more effective than surgery.

5. Arthritis does not cause pain. Despite the two being related, not all individuals with arthritis experience pain. Pain from arthritis is often correlated to secondary variables such as inactivity, depression, etc.

For the 6-10, Check out my full article @ Yahoo.com

http://www.change.org/petitions/the-commission-on-accreditation-in-physical-therapy-education-to-ensure-that-pain-science-is-incorporated-into-pt-program-curriculums

For decades, physical therapists, osteopaths and chiropractors have manipulated the spine in countless patients with low back pain.  Despite proposed theories to explain the effects and prediction rules to forecast who will receive benefit, little evidence has been produced to tell us what is actually occurring when the back is manipulated.   A prospective case series, published in last months edition of Spine , investigated the immediate and short-term effects of a high-velocity, low amplitude spinal manipulation on those with low back pain.

Keep Reading…

Occasionally, I get questions about  the effectiveness of Active Release Techinques (ART) or what it is, so I thought I would look into this form of treatment to understand it a little better.  I spent some time researching ART on various websites including the ART provider’s information and the ART website.  

The basic idea is that a series of hands on techniques based on massage are used to diagnose and treat pain from muscle and soft tissue tightness. 

From activerelease.com:

“The basic premise is simple, just not easy. Shorten the tissue, apply a contact tension and lengthen the tissue or make it slide relative to the adjacent tissue.  It’s as simple as playing a piano and just as difficult.”

 This treatment idea is similar to “anchor and stretch” or “pin and stretch” techniques commonly used in massage.  This is a more detailed explanation on Aetna’s website under the Experimental and Investigational Interventions section:

 “Active release technique is a patented soft tissue system that treats problems with muscles, tendons, ligaments, fascia and nerves (e.g., headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow).  These conditions have one important commonality — they often result from injury to over-used muscles.  Each ART session is a combination of examination and treatment.  The ART provider uses his/her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves.  Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.  These treatment protocols – over 500 specific moves – are unique to ART.  They supposedly allow providers to identify and correct the specific problems that are affecting each individual patient.  Active release technique is similar to some massage techniques, albeit more aggressive.” (1)

 The mention of hands on treatment to break up adhesions to restore optimal texture, motion, and function of soft tissue is prevalent in all of the information that I found.  One of the main differences compared to massage/stretching is that a contact point is maintained with the hands while the patient actively moves his/her body to provide longitudinal movement of nerves, ligaments, fascia, and muscles to assist the treatment.

 The list of conditions/injuries that ART can help is too long to list, but it seems to be the majority of issues neuromuscloskeletal.   According to the websites I found, it is more successful, effective, and cost effective than conventional therapies.  The results are mentioned to be more predictable, but no clarification on how they are more predictable.  Although it is not stated outright, it is suggested that you can resume normal physical activity faster after ART. So is this the panacea of treatments?

All of the information I found stated only ART credentialed providers can tell you if ART will work for you.  If ART was based on sound scientific principles why couldn’t anyone with an appropriate anatomical education be able to determine if ART would work?  The active release technique website (an ART provider)  says that their treatments are very different from other soft tissue, bodywork, massage, or other therapy. I think it is interesting that they just left the last option as other therapy.  Are there no ‘other therapies’ that could be slightly similar to ART?

 If you go to activerelease.com the first thing you notice is their logo and then a banner that reads “The Gold Standard of Soft Tissue Treatment.”  Unfortunately, they don’t have anything to support this claim.  A search of PubMed finds several studies on ART, but they are case studies using multiple techniques including ART, and small pilot studies with varying results.  Despite the lack of proof of it’s effectiveness there are thousands of ART providers and there are no shortage of testimonials across the web as to it’s effectiveness.  But just because there is a lack of proof of it’s effectiveness doesn’t mean it does not work.  Based on descriptions of the techniques and YouTube videos, massage therapists and PT’s have been using similar techniques with good results for years.

Based on the information I found it seems like ART is just clever marketing of new techniques to do what we already are doing (or at least should be doing).  These techniques may be more effective, but the problem is that nobody has properly researched the techniques to see if they are more or less effective.  So what is your opinion? Is this just clever marketing or truly a different set of skills we should have for our patients?

1) Aetna Clinical Policy Bulletin Chiropractic Services. http://www.aetna.com/cpb/medical/data/100_199/0107.html .  Accessed 10/5/11.