Lower back pain treatment is more effective if we can correctly classify a patient and give them a specific intervention to help get resolution. In this article I will talk about evidence based practice, the different classification systems we have in physical therapy, I will highlight a system that I tend to use, and I will also give you more information to be an educated consumer so you can get relief from your lower back pain.
Dr. Murphy, when it comes to lower back pain and evidence based practice, what do you mean? There is a big push in the profession of physical therapy to provide evidence based care. Much like the profession of medicine, we have to have a clear reason why we are doing what we are doing. Often this is done through research. In its simplest form, we take a group of people with lower back pain, we try and homogenize them (make them all very similar in all their characteristics, which could be pain level, previous history, how long they have had symptoms, age, weight) and then we break up that group and we try different interventions. We then have various tools we use at the start of treatment that we can consistently retest throughout various parts of the intervention process to measure if the treatments are helping the patients. When this research is done over and over with large groups of people in various parts of the country and world and all of that research shows similar positive outcomes, we adopt that intervention approach as an evidence based approach that is effective for a group of patients, in this case patient’s with lower back pain.
For patient’s with lower back pain there are various classification systems. There is the treatment based classification, the McKenzie Method of MDT (Mechanical Diagnosis and Therapy), and the clinical practice guidelines put out by our professional organization the American Physical Therapy Association. I don’t want to muddy the water too much, because there is quite a bit of overlap between these systems. I will highlight one that I have recently been studying.
For treatment of lower back pain, The McKenzie Method of mechanical diagnosis and therapy was founded by Dr. Robin McKenzie, a New Zealand born physiotherapist. This is a comprehensive system of evaluation based on patient history, symptom presentation, and specific movement based interventions aimed at reducing the disability and pain associated with lower back pain. I will highlight the three main classification’s within the McKenzie Method next.
The first classification is called a Derangement. A derangement is described as a mechanical obstruction of an affected joint. When I say mechanical I mean movement related. It also is highlighted by inconsistency and change. The patient states that the pain is variable during the day. A patient will say that certain postures or movements will cause their lower back pain symptoms to increase/decrease, produce their pain or diminish it, and finally centralize/peripheralize. This last one is worth explaining. When we centralize pain we bring it from a widespread area to a more focal area. When we peripheralize our pain we cause it to spread further from the low back area. This is the most commonly seen syndrome and this patient often responds quickly to intervention.
We now move on to the next classification which is Dysfunction Syndrome. This syndrome is less common. This happens from mechanical deformation of structurally impaired soft tissue. This abnormal tissue may have been the result of a previous trauma, an inflammatory, or degenerative process. The tissue can get contracted, adhered, or scarred and it needs to be remodeled. This patient has a very different presentation than the Derangement. They have pain that is often always local. Their pain is also always intermittent and is produced only when loading the structurally impaired tissue. In the movement assessment they show movement that will produce the symptom, which then does not remain worse.
The Final Classification is called a postural syndrome. This syndrome normally effects a younger person with a sedentary lifestyle. Symptoms are brought on by static loading of normal tissue. We can all envision a student who is sitting with bad posture while on their cell phone or computer.
It is uncommon to see this patient in the clinic for lower back pain because a simple cue with our hands or verbally to correct their posture abolishes their symptoms. So parents, the next time you see your kids sitting like this, tell them to sit up straight!
As you have seen in this write up treating lower back pain is complex and there is a lot more to physical therapy than meets the eye. Going to a good physical therapist who can spend time listening to your story and doing a thorough examination with you is critical. Don’t accept those PT clinics that pass you off to an aide or assistant. You should be seeing the same physical therapist each visit for continuity of care. Also, you should not accept doing the same thing in their office that you could do at home. They should be educating you, giving you a home program, and putting their hands on you therapeutically. You deserve more than just being another number that they are hurrying through the office.
I offer a FREE discovery visit at my office in West Little Rock, AR or over the phone to help you make a decision about how to best deal with your lower back pain and limitation. Don’t continue to let it interfere with your life; get back to doing the things you love and enjoy.
Call or text me at 501-529-2010. I look forward to helping you reach your PINNACLE.