Summer 2021 Back to the spine
Is it a bird, is it a plane and does it matter? STOPS, STarTs and the case for individualising treatment
The STarT Back and Specific Treatment of Problems of the Spine (STOPS) back pain trials both evaluated the effect of individualising treatment to the specific features of each patient’s presentation. The STarT Back trial did this based on psychosocial prognostic factors thought to predict long-term back pain, and the screening tool derived from that has been incorporated into the current NICE guidelines on the management of back pain. The STOPS trial is less well known and unique in that treatment was tailored to both specific psychosocial factors and clinically familiar pathoanatomical factors. Both studies had good results in terms of outcome. The STOPS trial deserves closer attention and is the focus of this article because it provides, for the first time, evidence that a comprehensive and pragmatic application of pathoanatomical specific treatment is of value to back pain patients. Perhaps, more importantly, its results also challenge some long-standing assumptions about the importance of psychosocial factors in predicting chronic low back pain.
Howard M Turner
Low back pain (LBP) is a common complaint that significantly impacts training, competition and sport performance development. In many athletes LBP can evolve into a persistent problem associated with fear and anxiety related to training, poor training practices and the ongoing long-term demands of medical and therapeutic interventions. For some, LBP alone or associated with spinal injury can become career ending. This article aims to demystify LBP in people participating in sport and exercise. It provides a review of its prevalence and common causes, together with research-based clinical diagnostic criteria. A summary on modifiable and non-modifiable risk factors associated with LBP and spinal injury in athletes, followed by a review of evidence behind some of the common mitigating strategies used clinically with recommendation for practice is included.
Cauda Equina Syndrome: the essential facts every physiotherapist should know
Cauda Equina Syndrome (CES) has potentially devastating effects not only for the patient, but also for the practitioner, should misdiagnosis and litigation occur. Deciphering which patients require an emergency referral from those who need close monitoring can be troublesome, given that there are a number of differential diagnoses that can masquerade as CES symptoms. It is no wonder, therefore, that practitioners are frequently over- or under-referring patients. This article will aim to establish a greater understanding of how CES symptoms progress and how to physically examine for these. The impact of this could dramatically reduce misdiagnosis and improve management in CES patients.
Understanding disc herniation: a historical perspective
The disc herniation is such a familiar diagnosis and such a familiar sight on an MRI that it is easy to forget what a complex and remarkable thing it is. In looking back at how the disc herniation was first discovered, and at the efforts made thereafter to understand why they are painful and why they occur in the first place, we can gain new insight into a familiar topic
Bodies of evidence?
This article examines how anatomy and the world of the anatomical sciences has changed little in 300 years and suggests that what is being taught to medical professionals is outdated, reductionist and missing elements that are regarded as problems for healthcare within an allopathic model. With examples of how human anatomy is missing vital detail relevant to physiotherapy, this article proposes a radical change in the way anatomy is taught and considered by healthcare practitioners from all disciplines.
Physiotherapy changing lives... setting up a physiotherapy service in South Rwanda
Overwhelmingly, the drive for physiotherapists is to help others through our skills and knowledge. In some cases this is extended beyond the clinic and treatment of individual patients to volunteering to help promote physiotherapy for the benefit of wider communities. Here, Kate Hunt shares her experience of being part of a team of who travelled to southern Rwanda to help to set up a physiotherapy service for the community there.