I recently attended a further education course on low back pain run by Dr Johnson McEvoy, a practising musculoskeletal physiotherapist in Co. Limerick. He presented us with the latest research regarding the assessment, diagnostic criteria and treatment for lower back pain. Given clients with lower back pain make up a large proportion of those who come to the clinic for treatment, I had a particular interest in furthering my skills and knowledge in this area. I immensely enjoyed this course and have gained valuable knowledge in treating this area of the body.
Here are a few of my learning highlights:
- Dr. McEvoy emphasised the importance of the pathoanatomical diagnosis in lower back pain, isolating or indeed ruling out a physical driver to the patient's pain. I found this to be an interesting perspective given recent shifts in emphasis regarding diagnosis and treatment in low back pain. Diagnosis of lower back pain is tending towards a more generalised ‘holistic’ approach in academic circles, inclusive of and sometimes solely emphasising psychological and social pain drivers, while not necessarily identifying a structural cause to the pain. It is very important to identify a structural or physical source (for example an irritated joint, strained muscle etc.) of pain if there is one. In some cases however, there may be an absence of a clear physical driver to the pain and treatment may then be guided by a more psychosocial approach (affecting psychological and sociological drivers to pain), however this decision is one which should be arrived at by ruling out physical sources of pain after a thorough physical assessment.
- Lower back pain is a broad area and often has a myriad of symptoms, many of which can masquerade as pain from other sites in the body. When you are sore, it can be difficult to discriminate pain 'is it your hip or back?' Clinically, as a physiotherapist or doctor it can be difficult to answer this question and make a specific diagnosis. All that is clear is that you are feeling pain at the time. That's why it was very useful to consider what the research evidence shows regarding the ‘grouping’ of clinical tests during assessment to provide the greatest likelihood of identifying the pertinent physical component which may be driving your pain. It was also interesting to learn that some tests widely used were of little consequence if not grouped alongside other tests. I found this information to be invaluable in streamlining my own assessment by cutting out diagnostic tests which are not going to contribute to an evidence informed diagnosis. I have found that I have more time left to treat my patients after the assessment which will ultimately lead to a better outcome.
- The specificity of the diagnosis has a positive effect on the treatment chosen for the patient and will help to determine a specific program of exercise to garner the best results. Dr McEvoy is a fellow advocate of multimodal treatment to optimise the results of treatment, something mirrored in the latest guidelines and research.
All in all it was a very beneficial course with great practical application and I am looking forward to utilising aspects in my own clinical practice.
By Carol O’Brien BSc Physio