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pablo w -> Re: New Study (March 8, 2005 11:00:00 AM)
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I haven't read the whole article, will have to access it when it comes to the hospital library.
The classification of patients labelled with non-specific low back pain is something that is brought up regularly by people researching segmental stabilisation. What Peter O'Sullivan, for example, has said is that there is a subgroup of patients with chronic non-specific low back pain who are more likely to benefit from a muscle retraining approach. I never got the impression that treating every chronic low back patient with the same approach is advocated. Where there are clinical signs from examination and findings in the history consistent with a segmental instability and impaired load transfer, the approach works. So yes, clssification is important. Do we manipulate everyone with back pain, for example? No, but we now have a useful prediction rule that helps determine who will benefit from it. The same applies to a segmental stabilisation approach. No I don't have a study to prove it, but we can look at exclusion criteria from studies, as it tells us a lot about who we may not be able to apply the findings to.
There is debate as to what stabilisation means. At the recent World Congress on Low Back and Pelvic Pain, in Melbourne, Australia, Stuart McGill and Paul Hodges (among other world-renowned researchers) presneted different sides of the argument. As Stuart McGill said, "show me the patient", meaning that every patient is different, while there may be patterns. Peter O'Sullivan presented findings of patients having directional movement preferneces in the direction that makes their symptoms worse. The patient's presentation has to be taken into account.
Clinically this is what I have seen. Not every patient needs or will benefit from specific focused retraining of transversus abdominus and multifidus. The research is done using real-time ultrasound feedback, which I persoanally don't have access to. Can I generalise that I will obtain the same results without it? Maybe these muscles improve in their function with a general approach, but I am not aware of any studies looking at this. It may not even be that important, as long as function improves and symptoms decreas. I don't have a great way of determining if specific muscle function did improve.
Now, if the findings of this research are taken to mean that specific exercises are no better than general conditioning exercises, and that an individualised program isn't necessary to achieve positive outcomes, maybe we will lose a lot of professional ground to exercise trainers. And if it can be shown that this will achieve results similar to what physiotherapists achieve, then rightly so. It is already happening.
Pablo
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