Self-care or medical care for low back pain: what patients want

For a while I’ve been asking what constitutes ’self management’ for chronic pain. On the one hand there are a group of people who firmly believe that regular medical treatment (including injections every three months or so) is a perfectly legitimate way to maintain a normal life. On the other hand there are people [...]

The myth of core stability: part 2

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Following on from yesterday’s post about core stability, today I want to look at training, back pain prevention and rehabilitation as it relates to core stability.
Motor learning moves from conscious attention to make certain movements through to movements that are basically over-learned or automatic. There are considerable differences in how a beginning [...]

The myth of core stability

Editor’s Selection IconFads come and fads go, and no more so than in managing back pain. One of the more durable fads has been the plethora of exercises to ’strengthen the core’. I’ve been searching for a good review of the literature on core stability, and surprisingly found one in a journal I [...]

Take the pain away and the other problems go too? A loooooong post

There are some days I despair that the biopsychosocial model will EVER take hold in the died-in-the-wool medical interventionist strongholds.
This quote from a discussion with a colleague might help you join in my pity party…The conversation is about a case of a young woman with 18 month history of neck pain post-MVA, she has been [...]

Safety behaviours – do they maintain kinesiophobia?

Let me start by saying this post is conjecture, but based both on observing patients, and after reading an interesting paper on ’subtle avoidance and safety behaviours relevant to social anxiety’.
First some definitions: I hope you’re all familiar with the term ‘kinesiophobia’, or ‘fear of movement’ – it’s the fear and avoidance of movements that [...]

More about acupuncture: press needles as a placebo

Slightly tangential to my normal topics, I located this article today on a placebo procedure that may work for acupuncture.
Many people will be aware that in acupuncture, it’s really difficult to truly conduct a double-blind trial where both the person receiving and the person giving the treatment are unaware of which is the ‘active’ treatment. [...]

Seeing people progress

A quick post this morning before I search for some Friday funnies!
I saw a few patients this week after having had just over a fortnight off work – and you know how sometimes working in pain management can seem unrewarding, progress can be incredibly slow, one step forward, two sideways… Well here are some progress [...]

Splish! Splash! Hydrotherapy for chronic back pain is pretty good!

Just a quickie post this morning, but one that I couldn’t resist.
You know how nice it is to be soaking in a hot bath or hot pools after doing some great energetic thing (vacuuming the house? gardening?) – and how many people with chronic pain tell us that a soak in a bath or a [...]

If we can get rid of the pain, is it worth knowing about psychosocial factors in acute back pain?

There are times when it seems the biopsyschosocial model is given lipservice amongst people working in the pain medicine field.  Yes, I do hear them say ‘the biopsychosocial model is important but you’ve got to remember Engel’s model starts with the bio…’
I’ve often wondered if it’s worthwhile pursuing the idea that if we can abolish [...]

Early management of low back pain – activity is good, early self-management is best!

It must be really difficult to be a reductionist, biomedically-oriented doctor who believes fervently in the need to ‘abolish pain’ in order for people to recover from low back pain. It must be even more difficult when the ’source of the nociception’ fails to be identified even after numerous placebo-controlled ‘diagnostic’ nerve blocks have [...]