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Advanced amputee training

Prosthetics and Biokinetics

by Neil Hopkins Biokineticist, posted in Uncategorized

Advanced gait retraining and high performance prosthetic training is important if you want to take full advantage of your prosthesis. Irrespective of the level of amputation or the type of prosthesis, you will benefit from seeing a Physiotherapist / Biokineticist, in conjunction with your Prosthetist, for exercise and gait retraining post-prosthetic fitting. If you want to run, jump, live an active outdoor lifestyle then seeing a Physiotherapist / Biokineticist that has trained to understand prosthetic components is highly recommended.

Mobility grades:

Ottobock uses a classification system called MOBIS® . To Ottobock quality and individuality are the top priority in the fabrication of a modular lower limb prosthesis. As a result Ottobock designed the MOBIS® to assist Prosthetists in making the correct choice of prosthetic components. According to Ottobock, the MOBIS® focuses on people and their need for enhanced quality of life. With the aid of the MOBIS® symbol, the prosthetist can immediately recognise the mobility grade and user weight for which functional components such as prosthetic feet, knee joints and hip joints are recommended.

Mobility grade on the MOBIS® symbol:

1) Indoor walker: The user has the ability or the potential to use the prosthesis for transfers or for the purpose of moving slowly on level floors. The amount of time and the distance the user can walk are seriously limited due to his or her condition.

Therapy goal: Restoring the ability to stand and to walk indoors to a limited degree.

2) Restricted outdoor walker: The user has the ability or the potential to walk slowly with the prosthesis and to negotiate low environmental obstacles like curbs, single steps or uneven surfaces. The amount of time and the distance the user can walk are seriously limited due to his or her condition.

Therapy goal: Restoring the ability to stand and limited ability to walk indoors and outdoors.

3) Unrestricted outdoor walker: The user has the ability or the potential to walk with the prosthesis at a medium to high speed as well as at different speeds and simultaneously overcome most natural obstacles. He or she is also capable of walking outdoors and engaging in professional, therapeutic and other activities that do not subject the prosthesis to above-average mechanical strain. There may be an increased need for safety due to secondary circumstances (additional disability, special living conditions) combined with medium to high mobility demands. The amount of time and the distance the user can walk are only mildly restricted compared with individuals without disabilities.

Therapy goal: Restoring the ability to stand and to walk without any restrictions indoors and with only mild restrictions outdoors.

4) Unrestricted outdoor walker with especially high requirements: The user’s ability or potential to walk with a prosthesis is similar to that of the unrestricted outdoor walker. The amount of time and walking distance are not limited. Moreover, due to the high functional demands, a high degree of shock, tension and distortion can occur.

Therapy goal: Restoring the ability to stand, walk and move both indoors and outdoors without any limitations.

Without limitations:

That is a big statement. It is the dream of every prosthetic user. To have unrestricted movement. No limitations. If you are a MOBIS® 3 (wanting to progress to a 4) or a MOBIS® 4 (wanting to be better) then seeing a Biokineticist for advanced training can help you to improve your fitness and strength so that you can excel, and live a life without limitations.

Watch the clips below to see how a well trained amputee, using advanced prosthetic components (Genium X3 Ottobock), can achieve great things.

Is Biokinetics for me?

Ask your Prosthetist if you are a suitable candidate for advanced gait re-training or exercise conditioning.  They can then recommend an experienced Biokineticist or Physiotherapist in your area.  It is important that the person you see has prosthetic experience and/or works closely with your Prosthetist.

Acknowledgements:

1) Ottobock MOBIS poster: http://professionals.ottobock-export.com/cps/rde/xbcr/ottobock_export_en/OK2592-GB-01-1202w.pdf LINK
2) Ottobock MOBIS: http://professionals.ottobock-export.com/cps/rde/xchg/ottobock_export_en/hs.xsl/81.html LINK
3) Ottobock Website: http://www.ottobock.com/en/ LINK
4) Ottobock YouTube: https://www.youtube.com/results?search_query=ottobock+channel LINK
5) Ottobock amputee exercise App: https://itunes.apple.com/en/app/fitness-for-amputees/id864940455?mt=8 LINK

Exercises for joint replacement

Biokinetics for joint replacement surgery

by Neil Hopkins Biokineticist, posted in Uncategorized

 

Biokinetics plays an important role pre- and post-surgery.  Your surgeon might refer you to a Biokineticist prior to surgery to improve your physical capacity (which improves surgical outcome and minimises surgical risk) or post-surgery once you have reached a certain level of function / completed your physiotherapy. Therefore a Biokineticist forms part of the medical team that can help guide you through the joint replacement journey.

It is well documented that exercise will yield positive results pre- and post-surgery. From strength and flexibility gains, to maintaining and/or improving cardiovascular fitness.  Below is a very good clip from Dr Mike Evans explaining how to prepare for your surgery, as well as how to recover after it. It is taken from his website Evans Health Lab (http://www.evanshealthlab.com/)

Some take home messages from the clip:

“Minor surgery is surgery that happens to someone else”. This is a humorous anecdote but actually quite appropriate.  Joint replacement surgery is a major life event.  It requires a game plan / strategy. Planning for your surgery, and recovering after it, is an active process rather than a passive one.  The medical team (surgeon / GP / Physiotherapist / Biokineticist) are there to assist and guide you through the process, but the most important thing is that you are involved in the process too. You are a team member. You are at the centre of it.  And as a result you are equally responsible for the outcome. The hard work, and effort that YOU put in will be rewarded.

Dr Mike Evans lists 5 key aspects of joint replacement surgery:
1) Muscle strength and fitness
2) Managing expectations
3) New normal
4) Exercise and lifestyle
5) Attitude

Using Mike’s 5 key aspects in a South African context (Physiotherapy and Biokinetics):

1) Muscle strength and fitness:

As part of your planning for your surgery you can seek the advice from a Biokineticist / Physiotherapist to help in the creation of an exercise routine.  Your exercise routine can be tailor made to suit your needs, and to ensure that you do not experience pain while doing the routine.  It is not necessary to see the Biokineticist on a weekly basis. If you are disciplined enough to exercise on your own you can get a homework programme, which can save you a lot of money.

Your routine can help in building muscle strength, improving flexibility, and increasing exercise tolerance. The gains in strength will help with post-operative walking and recovery.  And even if you cannot train your “injured” / affected side you can train the unaffected side and upper body to make life easier for bed transfers and crutch walking.  The stronger and fitter you are the easier your recovery will be.

2) Managing expectations:

Seeing a Physiotherapist, and eventually a Biokineticist, post surgery can help with managing expectations. The Physiotherapist / Biokineticist can act as a mentor to guide you through the changes, and help you to understand what is appropriate post surgery and what is not.  There are always goals to be attained, but never any fixed timelines as such. Each surgery needs to be managed on a case by case basis, as people respond differently to surgery. Your medical team is there to assist you in reaching your goals, and monitor that you are on the road to recovery.

3) New normal:

There is no point in using your new joint to stay the same. Before surgery you may walk with a limp, experience pain, or be limited in your active daily life. Obviously the new joint will be swollen and uncomfortable post surgery, but the medical team is there to help monitor and assist you back to full function. Seeing your orthopaedic surgeon for regular check ups to assess the scar, joint strength and range, as well as gait (walking pattern) is important.  Your surgeon will arrange these milestones with you pre- or post-surgery.  The goal of the Physiotherapist / Biokineticist will be to assist you with the joint range of motion, strength, general fitness and conditioning, as well as gait retraining.

4) Exercise and lifestyle:

You may be required to make a couple of adjustments to your home environment following your surgery.  They can be as simple as removing loose carpets and clutter so that you avoid trip / slip hazards. For more complex cases it is recommended that you seek the help of an Occupational Therapist to assist with the placement of ramps / rails / hoists etc.

Some joints and joint replacements may come with a set of “rules”. The surgeon may wish you to avoid certain movements or joint ranges (at certain times).  These rules will be communicated to the Physiotherapist / Biokineticist prior to your first consultation.  The Physiotherapist / Biokineticist can then explain how to avoid those movements in day to day activities.

Patients may also be required to see an Orthotist to purchase toilet seat raises, crutches, elevated cushions, or other devices that may be needed post surgery.  These may not be necessary but certainly something to consider when budgeting financially for a joint replacement.

In terms of exercise you will progress from in-hospital exercise rehabilitation with the Physiotherapist to out-patient rehabilitation with the Physiotherapist.  Once you have reached certain milestones you will be cleared to exercise with the Biokineticist. It is important to remember that healing can take up to a year.  That is not to say that you have to continue treatment for that long, but certainly you need to keep exercising and keep progressing.  Far too many patients get limited results post surgery because they discontinue too soon. There is the misconception that the hospital exercises and walking will be sufficient. Remember there is a medical team. Your Physiotherapist and Biokineticist are not in competition with each other. They are team-mates and have different roles to play at different stages of your healing.

5) Attitude:

This is essential. Having the right attitude is key. As Dr Mike Evans states: it is a balance of optimism with realism. Your attitude and effort will determine the outcome.

If you are confused and the entire process is overwhelming don’t be afraid to ask for help. The medical team is there to help you.

Is Biokinetics for me?

Ask your Surgeon or Physiotherapist if they feel that you may benefit from seeing an exercise specialist like a Biokineticist.  Otherwise contact your local Biokineticist directly to discuss your case history. If you are not a suitable candidate the Biokineticist will refer you back to your Surgeon / Physiotherapist for more information / treatment.

Now watch the clip and see for yourself: 

(please note Biokinetics is a South African medical profession and is not mentioned directly in the clip)
YouTube – Mike Evans on Hip and Knee Replacement

Acknowledgements:
1) Dr Mike Evans Health Lab – http://www.evanshealthlab.com/ LINK
2) Dr Mike Evans YouTube – https://www.youtube.com/user/DocMikeEvans LINK

Lower back pain rehabilitation

Exercise rehabilitation for lower back pain

by Neil Hopkins Biokineticist, posted in Uncategorized

Lower back pain will affect most adults at least once in their life time. Some individuals are lucky and only experience an acute bout of back pain. Others are less fortunate and progress into a state of chronic lower back pain. The good news is that a number of chronic lower back pain patients can benefit from a carefully structured exercise programme and lifestyle modification.

Exercise can help in reducing lower back pain and associated functional disability. However, when it comes to determining what the “right” kind of exercise is, it may become difficult to determine fact from fiction with so many opinions available online. There is an overwhelming amount of information on exercise rehabilitation for lower back pain and unfortunately a lot of misinformation. Sifting the truth from post-truth can be tricky.

That is why it is important to look deeper than just blogs and social media shares. That is where the Cochrane group comes in. They are the scientists who scrutinise scientists and keep the public up to date on relevant topics.

 

Cochrane reviews on exercise and low back pain



What is a Cochrane review?

Cochrane reviews are systematic reviews of primary research in human health care and health policy. Cochrane reviews are internationally recognized as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of diagnostic tests for some conditions in a specific patient group and setting. Cochrane reviews are published online in the Cochrane Library (LINK).

Who are the Cochrane Back and Neck group?
Cochrane Back and Neck (CBN) [formerly the Cochrane Back Review Group (CBRG)] is one of over 50 international Cochrane review Groups. The CBN coordinates the publication of literature reviews of diagnosis, primary and secondary prevention and treatment of neck and back pain and other spinal disorders, excluding inflammatory diseases and fractures (LINK)

1) Motor control exercise for acute non-specific low back pain. (LINK)

Summary: Motor control exercise (isolating specific muscles such as Transversus Abdominus) showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment for reducing pain or disability among patients with acute and subacute LBP.

  • Review question: To evaluate the effectiveness of motor control exercise (MCE) (isolating specific muscles such as Transversus Abdominus) for patients with acutenon-specific low back pain (LBP).
  • Background: LBP is a common disorder that is often associated with pain and disability. One common intervention for patients with LBP is exercise therapy, and MCE is widely used for these patients. However, its effectiveness for patients with acute LBP remains unclear.
  • Search date: Evidence is current to April 2015.
  • Study characteristics: The Cochrane Library included in the review three trials evaluating acute or subacute pain in patients with LBP (n = 197 participants). Most participants were middle-aged and were recruited from primary or tertiary care centres. Duration of treatment programmes ranged from four weeks to six weeks.
  • Key results: MCE showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment for reducing pain or disability among patients with acute and subacute LBP. Whether MCE can prevent recurrences of LBP remains unclear.
  • Quality of the evidence: Results of this review include evidence of very low to moderate quality. The Cochrane back and neck group downgraded all comparisons for imprecision due to small study sample sizes.
2) Motor control exercise for chronic non-specific low-back pain. (LINK)
 
Summary: Little or no difference is observed between Motor control exercise (isolating specific muscles such as Transversus Abdominus) and other forms of exercise. (Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.)
  • Review question: To evaluate the effectiveness of motor control exercise (MCE)(isolating specific muscles such as Transversus Abdominus) in patients with chronic non-specific low back pain (LBP).
  • Background: Motor control exercise is a popular form of exercise that aims to restore co-ordinated and efficient use of the muscles that control and support the spine. Patients are initially guided by a therapist to practise normal use of the muscles during simple tasks. As the patient’s skill increases the exercises are progressed to more complex and functional tasks involving the muscles of the trunk and limbs.
  • Search date: The evidence is current to April 2015.
  • Study characteristics: In total, 2431 participants were enrolled in 29 trials. The study sample sizes ranged from 20 to 323 participants, and most of them were middle-aged people recruited from primary or tertiary care. The duration of the treatment programmes ranged from 20 days to 12 weeks, and the number of treatment sessions ranged from one to five sessions per week. Sixteen trials compared MCE with other types of exercises, seven trials compared MCE with minimal intervention, five trials compared MCE with manual therapy, three trials compared MCE with a combination of exercise and electrophysical agents, and one trial compared MCE with telerehabilitation based on home exercises.
  • Key results and quality of evidence: MCE probably provides better improvements in pain, function and global impression of recovery than minimal intervention at all follow-up periods. MCE may provide slightly better improvements than exercise and electrophysical agents for pain, disability, global impression of recovery and the physical component of quality of life in the short and intermediate term. There is probably little or no difference between MCE and manual therapy for all outcomes and follow-up periods. Little or no difference is observed between MCE and other forms of exercise. Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.
3) Pilates for low back pain. (LINK)
Summary: The overall quality of the evidence in this review ranged from low to moderate. There is some evidence for the effectiveness of Pilates for low back pain, but there is no conclusive evidence that it is superior to other forms of exercise.
 
  • Review question: To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain.
  • Background: Low back pain is an important health problem around the world. One of the most common treatments is exercise and in recent years Pilates has been a common option for treating low back pain.
  • Search date: The Cochrane back and neck group conducted searches up to March 2014. They updated the search in June 2015 but these results have not yet been incorporated.
  • Study characteristics: This review included 10 studies and 510 patients. All studies included a similar population of people with non-specific low back pain. The studies only included participants with chronic low back pain. The duration of the treatment programmes in the included trials ranged from 10 days to 90 days. The duration of follow-up varied from four weeks to six months. None of the included studies measured follow-up beyond six months. The sample sizes ranged from 17 to 87 participants.
  • Key results: The included studies demonstrated that Pilates is probably more effective than minimal intervention in the short and intermediate term for pain and disability outcomes, and more effective than minimal intervention for improvement in function and global impression of recovery in the short term. Pilates is probably not more effective than other exercises for pain and disability in the short and intermediate term. For function, other exercises were more effective than Pilates at intermediate-term follow-up, but not at short-term follow-up. Thus, while there is some evidence for the effectiveness of Pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercise. Minor or no adverse events were reported for the interventions in this review.
  • Quality of evidence: The overall quality of the evidence in this review ranged from low to moderate.

4) Exercises for adolescent idiopathic scoliosis. (LINK)

Summary: No evidence for or against scoliosis specific exercises. The two included studies yielded very low quality evidence that SSEs added to other treatments are more effective than electrical stimulation, traction and posture training for avoiding curve progression, and that SSEs as a standalone treatment yield almost the same results as general physiotherapy.
  • Adolescent idiopathic scoliosis (AIS) is a rare (2% to 3% of the general population) spinal deformity affecting young people aged 10 through the end of the growth period. The deformity may continue into adulthood. AIS is characterised by one or more three-dimensional spinal curves. Disability, cosmetic deformity, pain, activity limitation, quality of life issues, breathing problems and the possibility of the scoliosis remaining with the person into and throughout adulthood are commonly associated with this condition. The cause of AIS is unknown.
  • Treatment for AIS varies according to the degree of severity of the curves. Just the same, exercise is almost always a part of the treatment plan. In milder cases, exercise may be the main treatment, and in more severe cases it may serve as an adjunct. In the UK and the US, physical therapy for scoliosis consists mainly of general strengthening and stretching exercises, along with exercise protocols with which the treating therapist is familiar. There is a corresponding feeling among practitioners in these geographical locations that physical therapy for scoliosis is not effective.
  • Scoliosis specific exercises (SSEs) are individualised exercises aimed at reducing the deformity. SSEs are taught in clinics that specialize in scoliosis. The exercises work by changing the soft tissue that affects the spine. SSEs are also thought to work by altering control of spinal movement. There are no known side effects or risks to using SSEs.
  • The purpose of this review was to evaluate the effectiveness of SSEs in reducing curve progression and postponing or avoiding invasive treatment such as surgery in adolescents with AIS. Two studies involving 154 patients total were included. The review found no evidences for or against SSE. The two included studies yielded very low quality evidence that SSEs added to other treatments are more effective than electrical stimulation, traction and posture training for avoiding curve progression, and that SSEs as a standalone treatment yield almost the same results as general physiotherapy.
  • Possible limitations of this review included the small number of studies that met the inclusion criteria and a high risk of bias, particularly selection bias. More randomised controlled trials are needed in this area, along with a deeper understanding of the types of SSEs useful for the adolescent with AIS.

5) Exercises for prevention of recurrences of low-back pain. (LINK)

Summary: Moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

  • Back pain is a common disorder that has a tendency to recur. The Cochrane back and neck group conducted this review to see if exercises, either as part of treatment or as a post-treatment programme could reduce back pain recurrences. The Cochrane back and neck group searched for studies that included persons with back pain experience, interventions consisting of only exercises and that measured recurrences of back pain.
  • There were nine studies with 1520 participants. There was moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting.
  • Adverse (side) effects of exercising were not mentioned in any of the studies. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

6) Exercise therapy for treatment of non-specific low back pain. (LINK)

Summary: Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

  • Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in populations visiting a healthcare provider. In adults with subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

Conclusion:

1) Motor control exercise for acute low back pain:

  • Are motor control exercises better than spinal manipulative therapy for acute low back pain? No 
  • Are motor control exercises better than other forms of exercise for acute low back pain? No 
  • Are motor control exercises better than other forms of medical treatment for reducing pain or disability? No 


2) Motor control exercise for chronic low back pain:

  • Are motor control exercises better than other forms of exercise for chronic low back pain? No
  • Does the therapist’s training / qualification / background have an effect on exercises for chronic low back pain? Yes 

3) Pilates for low back pain:

  • Is Pilates effective for treating low back pain? Yes 
  • Is Pilates superior to other forms of exercise in treating low back pain? No 

4) Exercises for adolescent idiopathic scoliosis:

  • Are scoliosis specific exercises effective as a stand alone intervention? Limited evidence 
  • Are scoliosis specific exercises effective as an additive to other interventions? Limited evidence 

5) Exercises for prevention of recurrences of low back pain:

  • Are exercises able to prevent recurrences of low back pain? Limited evidence 

6) Exercise therapy for treatment of low back pain:

  • Is exercise therapy effective at decreasing pain and improving function in adults with chronic low back pain? Yes 
  • Is exercise therapy more effective than no treatment or other conservative treatments for acute low back pain? No
Take home message:

Can exercise help with low back pain?

It depends on the nature and duration of the back pain as well as the type of exercise.

  • Chronic non-specific low back pain can benefit from exercise rehabilitation.
  • Acute low back pain and specific (neurogeneic, discogenic, spondylilosthesis, etc.) conditions may respond better to other modalities initially.

What type of exercise will help with chronic low back pain?

  • There is no consensus on one definitive exercise intervention. Therefore it is wise to steer clear of dogmatic approaches and practitioners that give guarantees on their particular modality. The data above indicates that Pilates and core stability (motor control exercise), which have been heralded as a cure for back pain, are not superior to general exercise.  Movement is good, but using the right kind of exercise at the right time is important. Patients need to find a practitioner that can assess their needs and give them an exercise intervention that is tailor made to their needs, not to dogmatic beliefs.

Is Biokinetics for me?

Ask your Orthopaedic Surgeon (back specialist), GP or Physiotherapist if they feel that you may benefit from seeing an exercise specialist like a Biokineticist. Otherwise contact your local Biokineticist directly to discuss your case history. If you are not a suitable candidate the Biokineticist will refer you back to your Specialist / Physiotherapist for more information / treatment.

Published Cochrane review articles on exercise for low back pain:

Pending Cochrane review articles on exercise for low back pain:
Acknowledgements:

1) Cochrane library. (LINK)
2) Cochrane library: Back and Neck. (LINK)
Biokineticist Biokinetics Back Pain

Biokinetics: Exercise and back pain

by Neil Hopkins Biokineticist, posted in Uncategorized

Low Back Pain:

The lower back (Medical term: low back) is an integral part of the entire human movement chain. It functions as part of a complex network of the skeletal, muscular and nervous systems. When the low back is injured it can affect one or all of these systems. As a result of its complex and undistinguished aetiology, the treatment for low back pain remains controversial.

Treatment options for low back pain include the following:

  • Analgesics.
  • Muscle relaxants.
  • Antidepressants.
  • Nonsteroidal anti-inflammatory drugs.
  • Epidural steroid injections.
  • Manipulation.
  • Back schools.
  • Electromyographic biofeedback.
  • Traction.
  • Orthoses.
  • Behaviour therapy.
  • Transcutaneous electrical nerve stimulation.
  • Acupuncture.
  • Exercise therapy.

Eighty to 90% of acute low back pain episodes dissipate within 8 – 12 weeks regardless of any intervention, but 5 – 10% regress into chronic low back pain.

Therapeutic exercises for chronic low back pain have been shown in numerous randomised controlled trials to be beneficial in reducing pain by up to 60% and improving functional ability by up to 47%. Furthermore, a Cochrane review on low back pain found evidence to support exercise therapy as an effective intervention in the treatment of chronic low back pain.

When prescribing exercises for an individual with low back pain the following goals need to be considered:

  • Improve performance in endurance activities.
  • Improve muscular strength around the spine.
  • Eliminate any impairments in spinal flexibility.
  • Reduce the intensity of the pain being experienced by the individual.
  • Reduce back pain-related disability.

Biokinetics

Dr Mike Evans on Low Back Pain:

Dr Mike Evans posts user friendly videos on complex medical issues. He makes science and medicine simple. You can check out his videos on YouTube (LINK) or on his website (LINK). His whiteboard health videos are well worth the time.

Below is a summary of his whiteboard video on low back pain. The video link follows at the end of the post.

Summary of the video:

Context:

  • Low back pain is one of the top 2 reasons why people see their GP.
  • Low back pain accounts for 40% of all missed worked days in the USA.
  • Low back pain often resolves on its own without intervention. We can take care of ourselves.
  • Severity of the pain does not reflect the seriousness of the underlying problem.
  • 30% recurrence in 6 months. 40% recurrence in 12 months.
  • We should view back pain as a chronic vulnerability, rather than discrete events.
  • It is important to have a “back resilience plan” and a support team to help.

 

Back pain pattern 1: Back dominant.

  • Pain is back dominant. Mostly in the low back.
  • Pain can radiate down to the glutes, hips, and legs, but is predominantly in the back.
  • There is relief with movement.
  • There are particular movements help alleviate the discomfort, and movements that aggravate it.
  • Often back “spasms”.
  • Some dominant pain is “good pain”. It is not associated with damage to the spinal cord or nerves. Often does not require surgery.

 

Back pain pattern 2: Leg dominant.

  • Often related to a disc problem (disc putting pressure on the nerves).
  • Pain travels down the legs (“sciatica” / Sciatic pain).
  • Pain down the leg – below the buttock to the foot.
  • The leg pain is dominant.
  • It is a constant pain that gets better with rest / lying down.
  • Sciatica often gets better on its own, But may need: Special advice, medication, imaging.
  • Leg pain is “predictable”. Certain activities / movements cause pain, other take it away.
  • Pain anywhere in the leg.
  • Gradually worsening.
  • Heaviness that causes the individual to stop moving. Known as Neurogenic Claudication. It is related to stenosis / narrowing of the spinal canal. When severe it is hard for the nerves to keep up with activity.

 

Red flags: (may need more investigation)

  • Sudden change in bladder and bowel control (numbness around groin / rectal area).
  • Infection / TB.
  • Risk for fracture (Fall, motor vehicle accident, osteoporosis).
  • Cancer (Previous history of cancer, constant pain lasting weeks, not able to alleviate).
  • Diseases (Ankylosing Spondylitis).

 

Yellow flags: (attitude and outlook are important)

  • Belief that back pain is harmful or a disability.
  • Fear and avoidance of activity / movement.
  • Low mood isolation.
  • Belief that passive rather than active treatments will help.

 

Should I get an MRI / Xray?

  • A study by Prof Richard Deyo (LINK) showed that only 1/2500 back Xrays show a clinically significant finding.
  • What is the harm in getting a screening Xray? Radiation, cost, time.
  • One study with 98 asymptomatic subjects showed that 2/3rds had disc problems.
  • Pain does not equal pathology.

 

So what works?:

    • Movement – “motion is lotion”.
    • Exercise (LINK).
    • Avoid bed rest (people who dont move fare worse off).
    • Over the counter medication for pain.
    • Spinal manipulation from a Chiropractor / Osteopath*.
    • Massage.
    • Accupuncture*.
    • Active therapies combined with exercise.

(* 8-10 sessions max. If no improvement then more treatments unlikely to help.)

 

“Complex problems rarely find their solution in one place”:

  • Need a multi-factoral approach.
  • Need a multi-disciplinary team.

 

Advice:

  • Less is more.
  • Acknowledge the pain. Don’t focus on it.
  • Small changes can make a big difference. 80/20 rule.
  • Resilience plan needed.
  • Mindset is critical.
  • Develop daily habits.
  • Have a knowledge of self.

Dr Mike Evans video on Low Back Pain:

Biokinetics and back pain:

Biokinetics can help with what Dr Evans refers to as “chronic vulnerability”:
  • A Biokineticist can help you with your back resilience plan.
  • A Biokineticist can educate you on your condition and prescribe corrective exercises.
  • A Biokineticist can also give you advice on ergonomics and work station modification for back pain.
  • A Biokineticist can be part of your network to help guide and support you.
Acknowledgements:
1) Dr Mike Evans on YouTube (LINK)
2) Dr Mike Evans website (LINK)
3) Prof Richard Deyo – Overtreating Low Back pain: Time to back off  (LINK)
Biokinetics: Return to running safely.

Biokinetics APP review: C25k

by Neil Hopkins Biokineticist, posted in Uncategorized

Biokinetics and return to running:

One of the most frequently asked questions from a running patient is: “when can I run again?”. This APP assists the return to running process in a somewhat objective way.  The running load (distance, as well as walk to run ratio) is controlled quite strictly to ensure that there is a lower risk of overuse injury. It is a very dull process for a runner, but it is worth the time you invest.

From sitting on the couch to running 5Km:

“C25K® is the easiest program to get beginners from couch potatoes to 5Km distance runners in 8 weeks. Over 5 million people did it! Tailored for first time runners.”

This is a great programme for patients that are wanting to begin running and / or for patients returning from injury. If you follow the prescribed running / walking intervals you will be progressed safely to 5km.

“The proven C25K (Couch to 5K) program was designed for inexperienced runners who are just beginning an exercise routine.The plan’s structure prevents new runners from giving up and at the same time challenges them to continue moving forward. C25K works because it starts with a mix of running and walking, gradually building up strength and stamina to fully running 5Km.”

C25K (LINK)

Download the programme:

C25k (APPLE)
C25k (ANDROID)

Image: Fatboyruns (LINK)

Below is a visual representation of the walking to running ratio:

Image: Reddit (LINK)
 “The journey of a thousand miles begins with a single step” Lao Tzu