An incongruent answer to the incongruence theory

Around 20 years ago, researchers started asking questions about the relationship between sensorimotor incongruence (SMI) and chronic non-specific pain conditions. Initially the relationship was raised within the framework of phantom limb pain, but since cortical reorganisation was also present in people with other types of chronic pain (e.g., … [Read more...]

Extending scope of practice – physiotherapists’ perceptions of managing non-specific low back pain

There is considerable evidence demonstrating the multi-dimensional nature of non-specific low back pain (NSCLBP)[1], and recent guidelines and mission statements recommend a broad bio-psychosocial (BPS) approach to NSCLBP [2,3]. However, despite growing awareness of the value of embedding psychosocial factors into clinical practice recent studies … [Read more...]

Can video games help older people with back pain?

Low back pain is the leading cause of disability worldwide [1] and up to 90% of people will experience low back pain at some point in their life [2]. The small percentage of people who develop chronic and disabling symptoms account for most of the burden of low back pain, and these are mostly older people [3]. Low back pain becomes more severe … [Read more...]

Patient education: panacea, public relations, or path to better care for patients with low back pain?

Part 2 What should patient education involve? Clinical guidelines provide little detail on the what, where, and how long of patient education. There are common features on what should be included: advice to stay active, reassuring of a good prognosis, nothing seriously wrong. Unfortunately, there isn’t much more than that. We don’t, for example, … [Read more...]

Explaining Pain for Acute Back Pain – reflections on Traeger et al. part 2

4. Why am I excited? First up, one of the great liberators of being a scientist is that we are not just permitted to change our minds, we are actually required to do so when the data say so. The Very Excellent Kevin Vowles uses the phrase ‘dance to the data’ and I like it. So, I have changed my mind about the likely benefit of just adding a two … [Read more...]

Explaining Pain for Acute Back Pain – reflections on Traeger et al. part 1

The PREVENT trial published recently in JAMA Neurology seems to have created a storm. If  views and tweets and general social noise are your metric, then this one weighs in pretty well – over 15K views and altmetric score passing 260 inside a week. But if impact on the community and likelihood to move the field forward is more your thing, then this … [Read more...]

Talking the talk: starting the conversation

As physios we spend much of the working day talking with patients (and colleagues!) and consider it one of our core skills, whatever field we work in. These interactions are unique and personal, and have the ability to make or break the outcome of any and every treatment.  If communication is the most important skill that health professionals have … [Read more...]

How does prolonged experimental back pain alter measures of pain inhibition and facilitation?

Facilitation of central pain mechanisms is proposed to be a potential missing link between identifiable tissue damage and the severity of pain experienced across a range of painful conditions [1]. Clinically, it is purported to manifest as widespread hyperalgesia, due to impaired descending nociceptive inhibition and enhanced nociceptive … [Read more...]

Are Modic changes associated with low back pain?

About thirty years ago, de Roos et al. [1] found some signal changes in the endplates of the lumbar vertebra on MRI that had not been described in the literature before. Dr. Modic and his group picked up on the findings and described them further, classifying them into three distinct types, Type 1, Type 2 and Type 3. [2, 3] These first papers were … [Read more...]

Physiotherapists struggle to identify and deal with psychological factors in chronic low back pain

Psychological factors including catastrophizing, fear of movement and psychological distress are predictors of negative outcomes in patients with chronic low back pain (CLBP).[1] Furthermore, patients with CLBP often have comorbid depressive and anxiety disorders.[2] Healthcare professionals involved in managing CLBP are therefore challenged to … [Read more...]