Barbell Medicine Pain and Rehab Podcast #3: Low Back Pain

Papers:

2018 Lancet Low Back Series

https://www.thelancet.com/series/low-back-pain

How we frame the problem

https://www.ncbi.nlm.nih.gov/pubmed/12923482

Appropriate vs Inappropriate Imaging

https://link.springer.com/article/10.1007/s00586-019-05918-1

https://www.ncbi.nlm.nih.gov/pubmed/30760458

Myths of Low Back Pain

https://www.ncbi.nlm.nih.gov/pubmed/9674171

Do medical students believe the back pain myths?

https://www.ncbi.nlm.nih.gov/pubmed/31248406

Prevention and Treatment of Low Back Pain

https://www.ncbi.nlm.nih.gov/pubmed/29573872

Education and Low Back Pain

https://www.ncbi.nlm.nih.gov/pubmed/30737200

Gurus and Low Back Pain

https://bjsm.bmj.com/content/50/4/198?fbclid=IwAR3R-PCN6ll7eGa9JTOdciJp4udW4JRV7D_zhsg1tESyko92u6cUIvOqF14

Outline:

Introduction

Defining Low Back Pain -

A symptom NOT a disease

Defined by location

HIstory of how we’ve examined the supposed problem

Unsurprisingly, we tend to prefer organic, visible diagnosis, and place our trust in technical diagnostic results more than our own clinical judgement.

“Almost all graphs show the same pattern. They all rise in the 20s and 30s, decline in the fourth, fifth and sixth decade to almost zero or totally disappear in the 70s/80s, and mostly reappear towards the end of the century. Only the disc category shows a different pattern: it rises rapidly in the 30s and 40s to become the reigning theory in the second half of the century. It is the only etiology that keeps an 80% share within all etiologies for 4 decades.”

Normalizing the problem based on prevalence

The global point-prevalence for activity-limiting low back pain was 7.3% in 2015, which means there are about 540 million people dealing with this issue at any one time.(See Hartvigsen 2018)

Appropriate vs Inappropriate Utilization of Imaging

Downie 2018 - rates are increasing for complex imaging

Lemmers 2019 - increased healthcare cost and utilization

Negative impact of clinician words (Setchell and Darlow)

Rare cases warranting imaging (1-4%)

Non-specific nature of LBP - doesn’t mean we have no idea what’s going on BUT rather shouldn’t unnecessarily worry ourselves and our patients about the supposed “cause”.

What should we be doing with the majority of LBP cases?

Education - BUT is education alone enough

Natural History / Re-occurance

Psychosocial correlates to be considered

When should we consider a goal directed activity intervention guided by a clinician

Guruism and Low Back Pain

Final 10 minutes of Q&A

What does science tell us about the effect of different sleeping positions and LBP? - Ron_Swanson_super_Stache

How do you know when to suck it up and train as programmed vs modify or take a deload? - Pull_sumo.taste_the_rainbow

What do popping and crunching sounds when I move my low back mean? - Bangarangbarbell

Is a small twist on the ascent of the squat related to weak low back? Or glute medius to stabilize? - Vanhanen_One more question?

I want you to discuss te hypotheses of Dr. John Sarno, and how, if at all, tey comport with the - Unoriginalfit

End range loading/MckEnzie, why it works, what the lit says, if you use it in practice - Geronimo10

Does adding bodyweight make the spine more ‘stable’, as Rippertoe asserts in his latest video? - Willdavies_fitness

What happens when LBP doesn’t get better after years of pain - Blakelosangeles

Exploring different schools of though around LBP i.e. McGill, Mckenzie, etc (loved the first 2 eps). - Davinbyrne1

Is it unrelastic to expect resolution to persistent pain? - Thedrzo

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