Altering Loads and LBP Relief study title: Can Altering Motions, Postures and Loads Provide Immediate Low Back Pain Relief? A Study of 4 Cases Investigating Spine Load, Posture and Stability Author(s): Ikeda DM & McGill SM Publication information: Spine 2012; 37(23): E1469-1475. BACKGROUND INFORMATION When assessing and managing patients with low back pain (LBP), many chiropractors successfully utilize mechanically based manual interventions, including movement and spinal loading alteration strategies. In theory, most LBP patients report movements or activities that aggravate (and argu-In addition to practising full time in Toronto, Dr. Shawn Thistle is founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners integrate current, relevant scientific evidence into their practice (www.researchreviews-ervice.com). Shawn also recently launched The Epicurean Scholar, which offers continuing education seminars combined with gour-met food and wine events (www. epicureanscholar.com). Dr. Thistle graduated from CMCC (where he lectures in the Orthopedics Depart-ment) and holds an Honours De-gree in Kinesiology from McMaster University.He also holds a certificate in Contemporary Medical Acupunc-ture from McMaster University,and is a Certified Active Release Tech-niques (ART®) Provider and Func-tional Range Release®/Functional Anatomical Palpation® instructor and provider. ably, may have originally initiated) their LBP. These can be specific motions, postures or external loads that can result in tissue irritation and pain. Some patients also exhibit patterns suggestive of “instability,” characterized by painful “instability catches” during movement (from flexion to neutral standing, for example). It is thought that this type of symptom is a manifestation of poor motor control – suboptimal muscle activation pat-terns in and around the lumbar spine during movement. Such changes, based on the current state of the literature, could be both causes and consequences of LBP. The flip side of this theory is that as clinicians, we may be able to identify exacerbat-ing positions and tasks via provocative testing, tailoring treatment and rehabilitation in-terventions accordingly with a goal of reducing pain and further tissue insult. Corrective exercises are commonly used in such cases, often immediately reducing or eliminating pain in these patients. Despite the widespread use of this approach, the mechanism behind how such in-terventions relieve pain is still largely unknown. Therefore, the aim of this four-patient case series was to examine whether changes in movement and muscle-activation pat-terns could alter spine stability and stiffness, joint loading, posture and movement. The authors proposed two hypotheses: 1. Coaching/cueing specific movement patterns would immediately alter reported pain in LBP; and (if this hypothesis is true) 2. these changes would quantitatively change stability, joint loading and posture. CONCLUSIONS AND PRACTICAL APPLICATIONS In three of the four subjects studied, there was a clinically significant reduction in pain, supporting the authors’ first hypothesis that altering movement and muscle-activation patterns can have an immediate impact on pain levels. But (this is the important part), there does not seem to be one common “critical” biomechanical variable that was domi-nant in producing the effect. This finding has two important implications: 1) patients are individuals – meaning what works for one person may not work for another. Cus-tomizing the movements and cues provided will help your patients obtain optimal pain relief; and 2) the biomechanical variables chosen here are sensitive to pain modulation, but they differ on the basis of the mechanism of pain. Overall, the interplay between spinal stiffness/stability and the forces related to pain elimination seems to be patient-specific. This is a crucial take-away from this case series, and implies that although provocative testing helps to identify possible interventions, the intervention needs to be specific to the individual patient to be most effective. • To read this review in full, including study methods, strengths and weaknesses, pertinent results and additional references, please visit the Current Issue page at www.canadianchiro-practor.ca. 62 • CANADIAN CHIROPRACTOR | DECEMBER 2011 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
Chiropractic + Naturopathic Doctor December 2012: Page 62
