Back In Business Physio

24/06/2024

https://www.medscape.com/viewarticle/walking-helps-guard-against-recurrent-low-back-pain-2024a1000bhl

Regular walking can help adults with a history of low back pain avoid recurrent bouts of low back pain, a randomized controlled trial has found.

21/06/2024

Climate change and increasing morbidity. This pertains to Latin America, but similar issues here in Australia, when it comes to fine particulate morbidity from increasingly intense and prolonged bush fires. People over 65 and under 1, particularly at risk to heat stress as well. The former have less heat shock proteins as they age, as the length of their proteins is reducing with each telomere splicing.

Until 2022, there was no evidence that Mexico was conducting a vulnerability and adaptation assessment or drafting a plan to adapt to the health effects of climate change.

21/04/2024

I recently followed up on a client who I'd been seeing for performance issues whilst road cycling. After a ride on a hot day, he fainted in the shower - presumably dehydration. He hit his head and subsequently developed POTS like symptoms. Paroxysmal Orthostatic Tachycardia Syndrome is often a debilitating misdiagnosed or undiagnosed condition. Frequently seen in on-going concussion syndrome, but also in people with autonomic dysfunction associated with Ehler Danlos Syndrome or Hypermobility Syndrome.

21/04/2024

Very disturbing investigation on Headaches and Su***de. "The risk for su***de attempt was four times higher in people with trigeminal and autonomic cephalalgias (TAC), and the risk for completed su***de was double among those with posttraumatic headache compared with individuals with no headache." Very important for physiotherapists to realise this in post traumatic headache.

Headache, including tension-type, migraine, and posttraumatic, are robustly associated with both attempted and completed su***de, a large study shows.

10/03/2024

This was a client of mine. Still driving and living at home until recently. One of the most remarkable people I’ve ever met!!…. And he did all his exercises to the letter!!!! RIP

07/03/2024

Patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction, either at 10% BW or 50% BW, reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up. (Marie-Eve Isner-Horobeti et al 2016 J Manipulative Physiol Ther 39, 45-654)

Dosage of 30-50% body weight does not take into account the patients morphology (floppy vs st**fy), nor the state of their pathology. It has been hypothesised that, the high dose biomechanical construct (30-50% body weight), based on cadavers and anecdotal history (James Cyriax 1950's) of inter-vertebral separation, is much too high, if a neurophysiological approach is to be considered. By incrementally adding load, from 10->25kg, it can be noted, when a normalisation of signs and symptoms occurs. Moreover, at a certain point of loading, the signs and symptoms begin to deteriorate once again. It is considered, that this latter methodology, more appropriately takes into account, neurophysiological phenomenon such a neurogenic inflammation, deterministic chaos immunological responses, descending sympathetic as well as peripheral sympathetic nervous system responses as well as the need to clinically respect muscle spasm. Clinically, this has been a tried and tested method, where presumably a certain dose of traction takes pressure off the blood vessels and nerves inside the IVF and potentially stretches the capsule of the Z-joint, whereas a dose which is too large, stretches pain sensitive structures which re-invokes muscle spasms and re-introduces compression. Reflexogenic muscle spasms must be respected.

Importantly, lumbar traction is also thoracic traction, as tension as far as the upper thoracic rings can dissipate with the application of low dose 'lumbar traction'

Dose Force = the normalisation of S+S : Position = antalgic position, supine with legs in 90º flexion, supine with legs in slight flexion : Frequency = 1-2 times per week. Intermittent vs Constant = whatever feels best for the patient, however the clinician should be aware that I/T loading causes pre-conditioning and potentially greater creep and hysteresis.

Read more : https://back-in-business-physiotherapy.com/physiotherapy-teaching/neurophysiology-of-treatment-with-traction.html

07/03/2024

Patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction, either at 10% BW or 50% BW, reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up. (Marie-Eve Isner-Horobeti et al 2016 J Manipulative Physiol Ther 39, 45-654)

Dosage of 30-50% body weight does not take into account the patients morphology (floppy vs st**fy), nor the state of their pathology. It has been hypothesised that, the high dose biomechanical construct (30-50% body weight), based on cadavers and anecdotal history (James Cyriax 1950's) of inter-vertebral separation, is much too high, if a neurophysiological approach is to be considered. By incrementally adding load, from 10->25kg, it can be noted, when a normalisation of signs and symptoms occurs. Moreover, at a certain point of loading, the signs and symptoms begin to deteriorate once again. It is considered, that this latter methodology, more appropriately takes into account, neurophysiological phenomenon such a neurogenic inflammation, deterministic chaos immunological responses, descending sympathetic as well as peripheral sympathetic nervous system responses as well as the need to clinically respect muscle spasm. Clinically, this has been a tried and tested method, where presumably a certain dose of traction takes pressure off the blood vessels and nerves inside the IVF and potentially stretches the capsule of the Z-joint, whereas a dose which is too large, stretches pain sensitive structures which re-invokes muscle spasms and re-introduces compression. Reflexogenic muscle spasms must be respected,

Force = the normalisation of S+S : Position = antalgic position, supine with legs in 90º flexion, supine with legs in slight flexion : Frequency = 1-2 times per week. Intermittent vs Constant = whatever feels best for the patient, however the clinician should be aware that I/T loading causes pre-conditioning and potentially greater creep and hysteresis.

https://back-in-business-physiotherapy.com/physiotherapy-teaching/neurophysiology-of-treatment-with-traction.html

More importantly - lumbar traction is actually also thoracic traction.
http://cdnback-in-business-physiotherapy.r.worldssl.net/images/stories/mechanicaltraction/mechan9.gif

20/12/2023

Attack dog