Du Toit Physiotherapy

14/04/2026

Interesting read: a possible cause of chronic lower back pain without definite findings on imaging may be link to your gut microbiome

https://www.facebook.com/share/p/1RAQ9YMJuC/

𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝗪𝗶𝘁𝗵 𝗖𝗵𝗿𝗼𝗻𝗶𝗰 𝗟𝗼𝘄 𝗕𝗮𝗰𝗸 𝗣𝗮𝗶𝗻 𝗪𝗶𝘁𝗵𝗼𝘂𝘁 𝗔𝗱𝘃𝗮𝗻𝗰𝗲𝗱 𝗗𝗶𝘀𝗸 𝗗𝗲𝗴𝗲𝗻𝗲𝗿𝗮𝘁𝗶𝗼𝗻 𝗘𝘅𝗵𝗶𝗯𝗶𝘁 𝗚𝘂𝘁 𝗠𝗶𝗰𝗿𝗼𝗯𝗶𝗼𝗺𝗲 𝗗𝘆𝘀𝗯𝗶𝗼𝘀𝗶𝘀

As physical therapist and clinical exercise physiologists, we are constantly looking for the "why" behind those persistent cases where a patient’s MRI doesn't match their level of pain and disability.

📘 A brand-new study by Sima et al. (2026, https://onlinelibrary.wiley.com/doi/10.1002/jsp2.70174) offers a compelling look at the "gut-disk axis" as a potential driver for chronic low back pain (LBP). Historically, we’ve relied on imaging to find structural culprits, but as Sima and Diwan (2025, https://pubmed.ncbi.nlm.nih.gov/39867670/) point out, many patients lack an easily identifiable surgical pathology. This research bridges that gap by investigating how our internal ecosystem might be fueling spinal inflammation from the inside out.

𝗧𝗵𝗲 𝗦𝗰𝗶𝗲𝗻𝗰𝗲 𝗼𝗳 𝘁𝗵𝗲 𝗚𝘂𝘁-𝗗𝗶𝘀𝗸 𝗔𝘅𝗶𝘀

The study compared 28 chronic LBP patients without advanced disk degeneration to 28 healthy, matched controls. The researchers built upon the work of Li et al. (2022, https://pubmed.ncbi.nlm.nih.gov/35286474/), who first proposed the "gut-disk axis"—a pathway where intestinal dysbiosis leads to systemic inflammation that eventually sensitizes the nerves around our spinal disks. This theory is supported by earlier findings from Shmagel et al. (2019), who found a significant association between dysbiosis and the presence and severity of musculoskeletal pain, particularly in the lower back.

📊 What Sima et al. (2026) discovered was a significant drop in alpha diversity (the richness of the microbiome) in LBP patients. This is a hallmark of dysbiosis also noted by Nitert et al. (2020, https://pmc.ncbi.nlm.nih.gov/articles/PMC7492308/) in overweight back pain cohorts. Specifically, the LBP group showed a depletion of Bacteroidota and Parabacteroides. These "good" bacteria produce short-chain fatty acids (SCFAs), which Agus et al. (2021, https://pubmed.ncbi.nlm.nih.gov/33272977/) and Ney et al. (2023, https://pubmed.ncbi.nlm.nih.gov/36977462/) have shown are vital for maintaining the gut barrier and suppressing pro-inflammatory cytokines like IL-17.

𝗪𝗵𝘆 𝗜𝘁 𝗠𝗮𝘁𝘁𝗲𝗿𝘀 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀?

When these protective bacteria are lost, "bad" players like Proteobacteria and Desulfobacterota take over. This shift increases intestinal permeability allowing endotoxins to enter the bloodstream. Once these toxins reach the intervertebral disk, they can trigger the infiltration of nociceptive fibers. This process, supported by research from Larsen (2017, https://pubmed.ncbi.nlm.nih.gov/28542929/) on Prevotella-induced inflammation and Cheng et al. (2013, https://pubmed.ncbi.nlm.nih.gov/23680281/) on Th17 cell frequency, might explain the pathogenesis and pain severity of IVD degeneration in part.

💡 Ultimately, this suggests that our role in the clinic might extend beyond biomechanics. Emerging evidence hints that therapies we already use, like exercise and psychologically informed practice, might actually help by enhancing microbial diversity. This study reinforces that we need a holistic, biopsychosocial approach to back pain that considers systemic inflammation and perhaps even microbiome-targeted interventions to get our patients moving better.

19/11/2025

Weights (resistance training) for bone strength!!

A small rebellion against fragility.
A quiet vote for independence, longevity, and a life
that stays wide, capable, and fully yours.

11/11/2025

Your spine is not a fragile structure:)

11/11/2025

Spinal manipulation can help people feel better, yes — but it’s not realigning bones or changing structure. The spine isn’t that fragile, and you’re not “putting it back in place.” It’s about reducing pain and improving movement. 😎👍🏾😎

11/11/2025

If your spine was truly misaligned, you’d be paralysed.
Now, yes, that’s a bit dramatic — but it makes the point.

You see so much nonsense online about pain being caused by “misalignment.” It’s absolute garbage. Your spine isn’t misaligned. Think about it logically: it’s surrounded by strong ligaments and supported by muscles that keep it stable.

Of course, pain can come from the spine — but that doesn’t mean something is “out of place.” If something was actually misaligned, we’d be talking about a fracture or dislocation, and you wouldn’t be walking into a clinic for some “magical realignment.”

That click or pop people hear during treatment? It doesn’t mean bones have been “put back into place.” You’re not made of Jenga bricks or Lego.

So if anyone tells you that you’re misaligned and they’ve “realigned” you — they’re talking complete rubbish.

And before anyone jumps in with, “But why do I feel better after the manipulation then?” — simple. You feel better because your body feels safe. Your nervous system has calmed down. That’s it. There’s nothing magical happening. Nothing’s been “put back in.” It’s just your body responding to something it perceives as safe.

05/11/2025

Movement matters

Every time you skip your walk, your brain and body quietly take note.
Muscle isn’t just for the young or the vain but it is your life insurance policy.

It protects your joints, stabilizes your balance, boosts your mood and even helps your memory.

Yes, lifting weights might do more for your mind than another crossword puzzle!

The real problem?

Too many people “retire” from movement.
We treat the gym like it’s for athletes instead of medicine for everyone.
The truth is simple and uncomfortable.
If you stop challenging your muscles, your brain follows.

Don’t let comfort steal your strength.
Pick up something heavy, learn something new, move like your life depends on it.

Because it does.

11/10/2025

11/08/2025

Rewiring in progress ...

07/08/2025

Did some puppy pilates yesterday! Keetmanshoop

04/08/2025

03/08/2025

Few great thoughts... we are not the "broken bodies" we believe we are...

15/04/2025

Osteoarthritis thoughts...
Very different from what we "believe" is it:

We used to think osteoarthritis was “wear and tear.”
But it turns out it’s more than mechanics. Much more than mechanics.

It’s genetic.
It’s metabolism.
It’s inflammation.
It’s systemic.

Your joints don’t break down from movement.

Our joints break down more from not moving.

That means you have more control than you think.
Improve your habits. Improve your health.
Your joints will thank you.