For Low Back Pain, Classification = Better Outcomes

Low back pain treatment is more effective if we can correctly classify a patient and give them a specific intervention to help get resolution. In this article I will talk about evidence based practice, the different classification systems we have in physical therapy, I will highlight a system that I tend to use, and I will also give you more information to be an educated consumer of your healthcare dollars.

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Dr. Murphy, earlier you talked about evidence based practice, what does that mean? There is a big push in the profession of physical therapy to provide evidence based care. Much like the profession of medicine, we have to have a clear reason why we are doing what we are doing. Often this is done through research. In its simplest form, we take a group of people with low back pain, we try and homogenize them (make them all very similar in all their characteristics, which could be pain level, previous history, how long they have had symptoms, age, weight) and then we break up that group and we try different interventions. We then have various tools we use at the start of treatment that we can consistently retest throughout various parts of the intervention process to measure if the treatments are helping the patients. When this research is done over and over with large groups of people in various parts of the country and world and all of that research shows similar positive outcomes, we adopt that intervention approach as an evidence based approach that is effective for a group of patients.


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For patient’s with low back pain there are various classification systems. There is the treatment based classification, the McKenzie Method of MDT (Mechanical Diagnosis and Therapy), and the clinical practice guidelines put out by our professional organization the American Physical Therapy Association. I don’t want to muddy the water too much, because there is quite a bit of overlap between these systems. I will highlight one that I have recently been studying.

For treatment of low back pain, The McKenzie Method of mechanical diagnosis and therapy was founded by Dr. Robin McKenzie, a New Zealand born physiotherapist. This is a comprehensive system of evaluation based on patient history, symptom presentation, and specific movement based interventions aimed at reducing the disability and pain associated with low back pain. I will highlight the three main classification’s within the McKenzie Method next.

Mechanical Diagnosis and Therapy

Mechanical Diagnosis and Therapy

The first classification is called a Derangement. A derangement is described as a mechanical obstruction of an affected joint. When I say mechanical I mean movement related. It also is highlighted by inconsistency and change. The patient states that the pain is variable during the day. A patient will say that certain postures or movements will cause symptoms to increase/decrease, produce their pain or diminish it, and finally centralize/peripheralize. This last one is worth explaining. When we centralize pain we bring it from a widespread area to a more focal area. When we peripheralize our pain we cause it to spread further from the low back area. This is the most commonly seen syndrome and this patient often responds quickly to intervention.

We now move on to the next classification which is Dysfunction Syndrome. This syndrome is less common. This happens from mechanical deformation of structurally impaired soft tissue. This abnormal tissue may have been the result of a previous trauma, an inflammatory, or degenerative process. The tissue can get contracted, adhered, or scarred and it needs to be remodeled. This patient has a very different presentation than the Derangement. They have pain that is often always local. Their pain is also always intermittent and is produced only when loading the structurally impaired tissue. In the movement assessment they show movement that will produce the symptom, which then does not remain worse.

The Final Classification is called a postural syndrome. This syndrome normally effects a younger person with a sedentary lifestyle. Symptoms are brought on by static loading of normal tissue. We can all envision a student who is sitting with bad posture while on their cell phone or computer.

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

As adults we have an obligation to ensure our kids don’t end up doing this in school now and in their jobs later!

It is uncommon to see this patient in the clinic because a simple cue with our hands or verbally to correct their posture abolishes their symptoms. So parents, the next time you see your kids sitting like this, tell them to sit up straight!

As you have seen in this write up, there is a lot more to physical therapy than meets the eye. Going to a good physical therapist who can spend time listening to your story and doing a thorough examination with you is critical. Don’t accept those PT clinics that pass you off to an aide or assistant. You should be seeing the same physical therapist each visit for continuity of care. Also, you should not accept doing the same thing in their office that you could do at home. They should be educating you, giving you a home program, and putting their hands on you therapeutically. You deserve more than just being another number that they are hurrying through the office.


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I offer a FREE discovery visit at my office or over the phone to help you make a decision about how to best deal with your pain and limitation. Don’t continue to let it interfere with your life; get back to doing the things you love and enjoy.



Call or text me at 501-529-2010. I look forward to helping you reach your PINNACLE.



Pinnacle Physical Therapy

5507 Ranch Dr Suite 203

Little Rock, AR 72223

brian@pinnacledpt.com








Lions, and Tiger, and KT tape, O My!

The golf world was set ablaze again with the sight of Tiger Woods with Kinesiology Tape on his neck. 

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

https://ftw.usatoday.com/2018/07/tiger-woods-kt-tape-neck-stiffness-reaction

 

The rumors started flying, he is hurt, what is going on, is he done for good this time? 

I wanted to write about Kinesiology Tape to give you some more information about where it came from, what it does or reports to do, and if it is beneficial. 

Where did it come from? 

Kinesiology Tape was developed KT in the 1970’s by a Japanese chiropractor named Dr. Kenzo Kase. It is made of tightly woven elastic fibres, which can be stretched to approximately 120% of their original size.  This elasticity is similar to that of human skin. 

The Kinesio Taping Method first gained recognition outside of Japan in the 1988 summer Olympics in Seoul, South Korea. Introduction to the USA occurred in March 1995 in Portland, Oregon at the Northwest Athletic Trainers Association Annual Clinical Symposium. Europe was next to find the value of Kinesio Tex Tape in 1996. The technique is used by Physical Therapists, Occupational Therapists, Certified Athletic Trainers, Massage Therapist, Doctors of Chiropractic, Medical Doctors, Nurses, and Acupuncturists all around the world.    https://kinesiotaping.com/about/what-we-do/

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

https://www.wsj.com/articles/SB10001424052748703465204575208193178227952

 

What does it do? 

Some of the purposed benefits of KT tape include: normalization of muscular function, increased vascular and lymphatic flow, reduced pain by neurological suppression, corrected joint misalignment, relieved abnormal muscle tension, and increased proprioception. 

All of these fancy words basically mean that it can help decrease pain by having an effect on your nervous system, it can help with the process of ridding your body of bi products that are harmful to you,  and it can help with stimulating your body to help heal itself. 

Is it beneficial? 

There is conflicting evidence as the effectiveness of KT tape in doing what it reports. The problem with research is that often times it is done in an environment that is more controlled. This means that it is under conditions that are not always the same as a person may experience in the real world. There are better ways to structure a research study to leave it with as little bias as we can, but the scientific process is far from perfect. 

There is a term called placebo that I feel is beneficial to define and explain. A placebo according to Wikipedia is a substance or treatment that has no intended therapeutic value. We often know of this term from studies on drugs. A control groups is often given a placebo drug which can just be a sugar pill and it acts as a way to compare the results of the patient's who are actually receiving the drug under the study. The problem with a sham or placebo taping is that any tape that touches the skin has an effect on the body which is hard to determine. We have nerves in our skin that send signals to the brain which can have an effect on the brains response (thus the purported effect on the nervous system) 

There is a very specific way that is taught on how to apply the kinesio tape. The direction of the taping, the amount of pull, the goal of the tape, the results of the evaluation and the goal of what the tape is helping to do all need to be taken into consideration as to the value they bring to help the patient reach their goals. When I treat a patient, if they mention a prior treatment or approach that was beneficial to them, I know that they have a psychological attachment to that treatment because they found it beneficial before. I am sure going to use that treatment, because I know there is value attached. The mechanism of KT tape may just be psychological in nature, if you think it works it does. The brain and nervous system, our beliefs, our feelings, our past experiences all play a large role in the physiological response of our bodies to treatment. 

We know that when we think about positive things, they tend to happen in our lives. I feel that this holds true in medicine as well, we can't forget how powerful the mind is in healing our bodies. 

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

http://ispeventcenter.com/blog-post/positive-thinking-a-gamechanger/

 

Remember that I am always here to be a resource for you. My name is Brian Murphy, I am a doctor of physical therapy and owner of Pinnacle Physical Therapy in West Little Rock, Arkansas. Please e-mail me if you have any questions: Brian@pinnacledpt.com or shoot me a call or text to 501-529-2010. 

Thanks and here's to helping you reach your PINNACLE! 

Brian 

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