Tag Archives: back pain

Acting as a human guinea pig to experience advanced spinal mobilisation capability of IDD Therapy

IDD Therapy is the fastest growing conservative spinal treatment.  Thoughts about the application of spinal mobilisation got me thinking about how we might make use of the parameters of treatment for different therapeutic objectives.  

In this video I act as a human guinea pig to set a treatment with an increased level of spinal mobilisation and extended duration of distraction.  That sounds more dramatic than it was since treatment is very safe, although I was slightly nervous!

IDD Therapy is a programme of treatment involving a series of one minute distraction and mobilisation cycles to decompress targeted spinal segments.

Part of the mobilisation is a patented oscillation capability at the point when the joint is distracted. Typically, this oscillation force is set at 10lbs and applied for one minute at a moderate frequency.

The computer software in IDD Therapy gives clinicians the unique ability to adjust the oscillation in line with principles of manual therapy, whether Maitland, Harmonics etc.

Oscillation Frequency & Amplitude

Differing frequency and amplitude of oscillation/mobilisation (60 seconds)                                                               Low Freq’cy      Moderate Freq’cy          High freq’cy               10lbs oscillation            20lbs oscillation

In this video, I explore what a higher oscillation force feels like by increasing the oscillation force from 10lbs to 20lbs (amplitude) at the point when the joint is distracted under tension.

Since the oscillation force has a bigger distance to travel between high tension and low tension, it is necessary to decrease the frequency, ie the number of cycles, to allow time for the distraction force to go up and down within the range of the oscillation.

This reduces the number of cycles of oscillation in a 60 second high distraction. Therefore the duration of the oscillation at the high distraction is increased from one minute to 90 seconds.

Thus the joint is opened for longer and at the same time, the joint and surrounding soft tissues are exposed to more significant distraction and mobilisation forces.

I have received many IDD Therapy treatments and observed that the combination of longer distraction at high tension and greater degree of oscillation results in a greater feeling of decompression.

The treatment feels more powerful and remains comfortable. The next day after treatment, I could feel greater range of movement, improved posture and less stiffness in the lower back.

Whilst IDD Therapy is typically given as a course of treatments for chronic disc-related conditions, IDD Therapy is used as a tool when clinicians need something more than hands alone to increase range of motion and soft tissue function in the lumbar spine.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.steadfastclinics.co.uk  www.iddtherapy.co.uk

Spinex Disc Clinic – the new name for non-invasive disc treatment in London

All physiotherapists, osteopaths and chiropractors treat intervertebral disc problems.  And yet, pain consultants up and down the country have waiting rooms full of people with back pain and neck pain, caused by disc-related problems.

Spinex Disc Clinic

Spinex Disc Clinic – Edgware Road London

Spinex Disc Clinic, a specialist back pain clinic in London helps patients caught in the back pain no-man’s land where standard manual therapy and exercise haven’t worked, and where they need something more for their pain without resorting to injections and/or surgery,

Causes and consequences. 

When it comes to back pain, cause and consequence are quite similar.  The cause of your back pain might be a herniated or slipped disc.  However, the real cause of your herniated disc is one of a number of factors such as the compression of the disc from poor posture over a long period of time, combined with a lack of exercise and so on.

So the cause of the pain is actually the consequence of changes in the body which lead to the disc problem.

All clinicians treat the causes of pain, but first of all they treat the consequences of the causes of pain.

Where Spinex Disc Clinic and other IDD Therapy Spine Centres come in, is when the consequences of the causes of pain e.g severe compression and restricted mobility, are such that manual therapy alone is not able to address the problem.

The first things to do therefore is to take pressure off the disc and improve tissue function, then the focus can be on addressing the real causes which led to the problem.

In some ways it’s like obesity treatment.

The cause of obesity is a calorie surplus each day built up over time.  The consequence of that is excess weight/ fat.  First the person has to work hard to get rid of the excess fat and then they make lifestyle changes to ensure they stay at a healthy weight.

Now, the person will make the lifestyle changes as part of the process of losing weight but they have to work harder than normal because they need to burn more calories to cut the excess.

When it comes to disc treatment, for some patients lifestyle changes alone (improved strength, more activity, better posture etc) are not enough to undo the consequences / causes of the pain.

Spinex Disc Clinic is primarily focussed on those patients with disc problems who need something more than manual therapy.

Clinical Director Sally Lansdale is a highly experienced osteopath who finally resolved her long standing problem with a series of IDD Therapy treatments.

Since then she has had two clinics offering IDD Therapy and now Spinex Disc Clinic is the evolution of those clinics now located in North West London, just off Edgware Road.

For more details about Spinex Disc Clinic, visit www.SpinexDiscClinic.com 

Case Study Template For Back Pain Treatment – Comments Invited

As we expand availability of IDD Therapy treatment for discs and nerve pain, we encourage all IDD Therapy provider clinics to write up case studies.

Ultimately we want to refine the patient cohort so that we get better predictability of outcomes and use the strength of the network for multi-centre data analysis.

We use subjective and outcome measures and I wanted to share the outline and structure of a case study template so that if someone had some suggestions for improvement, they could contribute.

The template has some details specifically for IDD Therapy treatment, but they can be deleted for use with other conditions, if someone wanted to.  The IDD CASE STUDY TEMPLATE is a word document you can click to open.

IDD Case Study Template doc

There are many different treatments for back pain and as the somewhat cruel saying goes, there is more than one way to skin a cat.  IDD Therapy spinal decompression is a tool used by clinicians when they want to decompress, distract and mobilise a targeted spinal segment in a manner they can’t achieve with their hands, or traditional traction.

Author: Stephen Small
Director Steadfast Clinics Ltd  www.steadfastclinics.co.uk  www.iddtherapy.co.uk 
email: stephen.small (@)steadfastclinics.co.uk

Sciatica or Back Pain? – Google statistics show us what people are actually looking for.

Working with clinics treating herniated discs with IDD Therapy spinal decompression, I am interested to see back pain statistics and trends around the subject of back pain.

Whilst “Back Pain” is the number one musculoskeletal condition people visit their doctor for, is it really back pain they need help with or does Google search traffic data reveal something not factored into the statistics?

Here below you can see the UK monthly search volume for certain keywords.

Google adwords Back Pain Searches

As can be seen, for every “back pain” search in Google, there are over three times as many searches for ‘sciatica’.

What about globally?

Google sciatica search results global

Again we see the same trend.

This throws up some questions which someone probably has the answers to (appreciating that sciatica and back pain are closely related): 

Is back pain more prevalent than sciatica?
Is the pain of ‘sciatica’
less bearable than ‘back’ pain?
Is it the latter which prompts proportionally more people to search for info/help with sciatica than back pain?

What do you think?

Author: Stephen Small, Director Steadfast Clinics Ltd
LinkedIn Profile
www.steadfastfastclinics.co.uk   www.iddtherapy.co.uk
Steadfast Clinics Ltd – Expanding IDD Therapy spinal decompression treatment for intervertebral discs and Thermedic Infrared Therapy Systems for joint pain and soft tissue healing.

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

muscle mass degenerationSarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

Spinal injections for back pain relief – Is there a disconnection from rehabilitation?

injectionsI recently gave a talk to a group of about 40 physiotherapists, osteopaths and chiropractors where I posed this question and asked for a show of hands.

There was universal agreement that there was a significant disconnect.

Looking at how to improve back pain treatment outcomes for both patients and over stretched healthcare budgets, there appears to be a significant opportunity to improve outcomes from spinal injections by making spinal rehabilitation an integral part of the post-injection treatment plan.

Patient pathways

There is a lot of debate about the merits of spinal injections.  The Cochrane Review (1) concludes “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain”.

Yet many clinicians report that patients do benefit which is backed up by the same Cochrane Review “it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.”

As with many back pain treatments, it is difficult to get a black and white answer since there are so many variables in play.

The typical pathway for a patient who develops chronic low back pain (or neck pain) looks something like this:

Self-prescribed pain medication
GP visit, pain medication and advice to remain active
GP visit
Manual therapy and exercise (physiotherapy)
GP visit
Consultant referral
Spinal injection
Consultant referral
Injection, possible surgery,
self-management (aka get on with it because we have no more options for you)

Self-pay patients typically bypass their GP and go straight to a physiotherapist, osteopath or chiropractor.  Private patients who are referred to a consultant often receive a spinal injection without first having a course of rehabilitation.

As a former member of the Society of Back Pain Research Committee said on stage at their annual meeting a few years ago, “I have a clinical intuition that they (spinal injections) are effective … and patients ask for them”.

Working with so many different clinicians, the problem appears to be that once a patient sees a consultant and is given an injection, many are simply sent home with little more than a recommendation to remain active, to do exercises and to possibly see a physiotherapist.

Given the costs of injections and clinical time, is this an efficient use of resources?

Manual therapists often dismiss injections because they do nothing to address the underlying condition believing them to be a band aid at best”.  Yet the purpose of the injection is not to cure the problem: it is to relieve pain to help the patient get on with their life.

If a patient can then be more active then the body has a chance to heal itself.

However, in the many cases where patients remain in pain it is perhaps in part because there is no proper rehabilitation.  Then the issue we have is what kind of rehabilitation will they get? 

If it is in the NHS, then the sort of rehabilitation a patient might access is exactly the same physiotherapy treatment which failed to address the problem in the first place.

Einstein’s definition of insanity is over quoted but to keep doing the same rehabilitation and expect a different outcome is surely insane … and an inefficient use of valuable resources.

Many spinal injections are given in the private sector.  One neurosurgeon I know sees approximately 1,500 patients a year.  He operates on 3% and gives an injection to around 20%, i.e. around 300 patients.

If a patient has an injection they leave hospital and then if they need follow up, they return to their consultant.  In some circumstances patients will receive a further injection.  If the injection hasn’t worked then the patient is more likely to become a candidate for surgery.

After all, conservative methods failed to resolve the problem.  Yet, I can’t help but feel that many of the spinal rehab programmes for patients who reach a stage of requiring (wanting) injections are simply not intensive enough.

Working with and talking to many clinicians, I often hear that if a patient is not better within four to six visits, then it’s time to look at other options.  It has become accepted dogma.

When IDD Therapy spinal decompression was originally developed, the clinicians who looked at back pain suggested in part that if they could work one on one with patients for eight hours a day, they would get much better results.

When people seriously embark on a diet to lose weight or train for a sporting event, they approach their goal with a level of commitment and intensity that is quite different to an approach to back pain rehabilitation.

Perhaps those involved in spinal rehabilitation should examine intensive programmes of spinal rehabilitation which are an agreed condition if a patient wishes to have an injection.

IDD Therapy spinal decompression programme offers such a programme for patients with disc related issues.  It is one method and undoubtedly not the only method.  A case study recently received from one provider detailed a 33 year old male office worker with a six month history of neck pain and headaches.

The patient received two injections during this time and felt no change.

He then embarked on a twice weekly course of cervical IDD Therapy.  After three weeks and six treatments, the headaches were gone and VAS pain was down to 1/10.  A further two weeks saw VAS pain at zero and no headaches.

That is a total of 10 treatments over a six week period.

All clinicians will have an opinion on the efficacy of injections.  The author believes that some people benefit from injections whilst for others there is no benefit, particularly without rehab.  However as with all back pain treatments, the difficulty is being able to predetermine who will benefit and who won’t!

There are significant costs to providing injections for back pain.  However as the British Pain Society point out, the unintended consequence of discontinuing pain interventions may be that more patients then access more costly interventions such as spinal surgery.

In the meantime, it would seem to make sense to reconnect spinal injections to a more intensive programme of spinal rehabilitation to help some patients return to a more active lifestyle.  If you have a comment, do share for others.

Staal JBde Bie RAde Vet HCHildebrandt JNelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review.Spine (Phila Pa 1976). 2009 Jan 1;34(1):49-59.
http://www.ncbi.nlm.nih.gov/pubmed/19127161

Author: Stephen Small
Director Steadfast Clinics Ltd
http://www.SteadfastClinics.co.uk

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.

Taking ‘Before Photos’ to improve rehab exercise compliance – Lessons from the fitness and weight-loss industries.

Before and After shotHave you noticed that the primary sales tool in any weight loss or fitness programme is a before and after photograph?

There is always an eye catching and impressive before-after photo.

The before photo generally shows the unsmiling face (not here though! – see below) and the classic large belly.

The after photo shows a bright smiley face with either an exposed torso or the person standing in a pair of their old ill fitting trousers!

There are many different exercise programmes and diets but generally the key reason the programmes fail is because people give up.

Thinking about this, I wonder: is the act of standing in front of the camera – embarrassed and ashamed – and getting a photo taken a key factor in cementing someone’s commitment to stick to an exercise/diet plan? 

In the goal-setting/ life coaching business, announcing your goals as a public statement of intent is quoted by leading experts as one of the cornerstones of reaching goals and achieving success. Is that what the before photo does?

So, alongside the weigh in, should anyone looking to get healthier and lose weight/ exercise get a set of before shots to paste around their house?  If we want to have the ‘after-shot physique’, perhaps the starting point on that journey is actually taking some before-shots!

What lessons can clinicians take?

With easy access digital photography at our fingertips, could clinicians make more routine use of before shots to show starting posture and weight and thus help patients comply to a given exercise/rehab/posture corrections programme?

‘This is how you look now, here is the goal and this is how we want you to look’  As one saying goes ‘if you can see it, you can believe it’ and another says ‘if you can believe it you can achieve it’.

If you have an opinion, you can use the comment box below.

PS – In the photo I use above, the before shot actually shows the guy smiling … hmmm. I wonder, in taking the photo is that he knows what he is committing himself to do and he is smiling because he is excited by that prospect?  I think that he has faith in the programme and by taking the photo he is committing himself to the end goal.

Often improvements in health are subtle and are revealed by the change in someone’s face. Patients can forget what they were like when they started, so this may really help them appreciate what you have done for them.

PPS This thought occurred to me as I wrote an earlier post about using Wall Calendars to help boost exercise compliance for spinal rehabilitation.  I applied the idea from the Insanity Exercise Programme http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machine