Barbell Medicine Pain and Rehab Podcast #3: Low Back Pain

Papers: 2018 Lancet Low Back Series https://www.thelancet.com/series/low-back-pain How we frame the problem https://www.ncbi.nlm.nih.gov/pubmed/12923482 Appropriate vs Inappropriate Imaging https://link.springer.com/article/10.1007/s00586-019-05918-1 https://www.ncbi.nlm.nih.gov/pubmed/30760458 Myths of Low Back Pain https://www.ncbi.nlm.nih.gov/pubmed/9674171 Do medical students believe the back pain myths? https://www.ncbi.nlm.nih.gov/pubmed/31248406 Prevention and Treatment of Low Back Pain https://www.ncbi.nlm.nih.gov/pubmed/29573872 Education and Low Back Pain https://www.ncbi.nlm.nih.gov/pubmed/30737200 Gurus and Low Back Pain https://bjsm.bmj.com/content/50/4/198?fbclid=IwAR3R-PCN6ll7eGa9JTOdciJp4udW4JRV7D_zhsg1tESyko92u6cUIvOqF14 Outline: Introduction Defining Low Back Pain - A symptom NOT a disease Defined by location HIstory of how we’ve examined the supposed problem Unsurprisingly, we tend to prefer organic, visible diagnosis, and place our trust in technical diagnostic results more than our own clinical judgement. “Almost all graphs show the same pattern. They all rise in the 20s and 30s, decline in the fourth, fifth and sixth decade to almost zero or totally disappear in the 70s/80s, and mostly reappear towards the end of the century. Only the disc category shows a different pattern: it rises rapidly in the 30s and 40s to become the reigning theory in the second half of the century. It is the only etiology that keeps an 80% share within all etiologies for 4 decades.” Normalizing the problem based on prevalence The global point-prevalence for activity-limiting low back pain was 7.3% in 2015, which means there are about 540 million people dealing with this issue at any one time.(See Hartvigsen 2018) Appropriate vs Inappropriate Utilization of Imaging Downie 2018 - rates are increasing for complex imaging Lemmers 2019 - increased healthcare cost and utilization Negative impact of clinician words (Setchell and Darlow) Rare cases warranting imaging (1-4%) Non-specific nature of LBP - doesn’t mean we have no idea what’s going on BUT rather shouldn’t unnecessarily worry ourselves and our patients about the supposed “cause”. What should we be doing with the majority of LBP cases? Education - BUT is education alone enough Natural History / Re-occurance Psychosocial correlates to be considered When should we consider a goal directed activity intervention guided by a clinician Guruism and Low Back Pain Final 10 minutes of Q&A What does science tell us about the effect of different sleeping positions and LBP? - Ron_Swanson_super_Stache How do you know when to suck it up and train as programmed vs modify or take a deload? - Pull_sumo.taste_the_rainbow What do popping and crunching sounds when I move my low back mean? - Bangarangbarbell Is a small twist on the ascent of the squat related to weak low back? Or glute medius to stabilize? - Vanhanen_One more question? I want you to discuss te hypotheses of Dr. John Sarno, and how, if at all, tey comport with the - Unoriginalfit End range loading/MckEnzie, why it works, what the lit says, if you use it in practice - Geronimo10 Does adding bodyweight make the spine more ‘stable’, as Rippertoe asserts in his latest video? - Willdavies_fitness What happens when LBP doesn’t get better after years of pain - Blakelosangeles Exploring different schools of though around LBP i.e. McGill, Mckenzie, etc (loved the first 2 eps). - Davinbyrne1 Is it unrelastic to expect resolution to persistent pain? - Thedrzo

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