Podcasts about spine j

Episode 31Seven Minute Summary (SMS)1. Preoperative Radiographic Predictors of Fusion following Decompression Surgery. Spine Nov 15. 20242. Pulmonary Function in Patients with Idiopathic Scoliosis after 40 years. Spine J. Nov 2024

11/26/2024Seven minute Summary1. TLIF cage subsidence: incidence and risk factors. JNS OCT 20242. Post operative Pain control and Long term Surgical outcome. Spine J. Sept 20243. Lumbar Apex as Risk factor for ASD following short segment fusion. Spine Oct 15,2024

10/31/2024Seven Minute Summary1. Risk factors for readmission following Spinal Epidural Abscess. Clin Spine J. Aug 2024. 2. Change in Bone Mineral Density (Hounsfield Units) following treatment with four osteoporotic medications. J NeuroSurg Spine. Sept 2024. 3. Changing Epidemiology of Traumatic Spine Injuries. Trend analysis of 26 years. Spine J. Sept 2024.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 19, 2018 Some have estimated the annual cost of chronic back or neck pain in the US to exceed $200 billion per year. And the economic burden is almost as unbearable as the pain faced by patients. This week on the program, we discuss the clinical and radiographic aspects of structural spine disease--or spondylosis--and expert recommendations on how to manage it. Produced by James E Siegler. Music by Steve Combs and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making, especially not for back surgery. REFERENCES Baron EM, Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 2007;60(1 Supp1 1):S35-41. PMID 17204884Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M. An evidence-based stepwise surgical approach to cervical spondylotic myelopathy: a narrative review of the current literature. World Neurosurg 2016;94:97-110. PMID 27389939Rindler RS, Chokshi FH, Malcolm JG, et al. Spinal diffusion tensor imaging in evaluation of preoperative and postoperative severity of cervical spondylotic myelopathy: systematic review of literature. World Neurosurg 2017;99:150-8. PMID 27939797Stino AM, LoRusso SJ. Myelopathies due to structural cervical and thoracic disease. Continuum (Minneap Minn) 2018;24(2, Spinal Cord Disorders):567-583. PMID 29613900Witiw CD, Tetreault LA, Smieliauskas F, Kopjar B, Massicotte EM, Fehlings MG. Surgery for degenerative cervical myelopathy: a patient-centered quality of life and health economic evaluation. Spine J 2017;17(1):15-25. PMID 27793760  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Olá pessoas! Você já julgou um profissional da saúde por ele não pedir exames de imagem? Se sim, ouça esse episódio com o Fisioterapeuta Fabiano Fonseca e veja como um exame de imagem pode não ser tudo isso que você está pensando. Será que o exame clínico, a famosa avaliação física, pode ser melhor que uma radiografia? Vem conosco nesse Drops que vamos levantar mais uma polêmica e derrubar um mito gigantesco da área da saúde. A música de abertura do programa (Podium) é de autoria do compositor e músico Anderson Botega e as vozes da introdução são do Diogo Bob e Marlos Sanuto. Se você acha muito importante nosso projeto, saiba que você pode nos ajudar financeiramente. Independente do valor, você vai permitir que possamos expandir e gerar mais conteúdo de qualidade. Para saber CLIQUE AQUI e conheça nosso programa de patronato. Siga-nos nas redes sociais procurando por @Quatrode15_ no instagram e Quatrode15 no facebook. Não deixe de entrar em contato conosco através do nosso e-mail contato@quatrode15.com.br ou deixando aqui o seu comentário! Se não estiver cansado das nossas vozes você pode nos seguir a nossa equipe nas redes sociais Yuri Motoyama, Gilmar Esteves, Fabiano Fonseca, Daisy Motta e Ana Luiza Lopes. Referências Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2017 Apr;17(4):554-561. doi: 10.1016/j.spinee.2016.11.009. Epub 2016 Nov 17. PMID: 27867079.

Join us for this super speedy review of a recent study on the benefits and harms of treatments for chronic nonspecific low back pain without radiculopathy. We review the below study: https://pubmed.ncbi.nlm.nih.gov/36400393/Feise RJ, Mathieson S, Kessler RS, Witenko C, Zaina F, Brown BT. Benefits and harms of treatments for chronic nonspecific low back pain without radiculopathy: systematic review and meta-analysis. Spine J. 2023 May;23(5):629-641. doi: 10.1016/j.spinee.2022.11.003. Epub 2022 Nov 17. PMID: 36400393.Learn more on www.DrJournalClub.comTake our Evidence-Based Medicine Bootcamp: https://drjournalclub.com/critical-evaluation-bootcamp/Learn more and become a member at www.DrJournalClub.comCheck out our complete offerings of NANCEAC-approved Continuing Education Courses.

What we talked about: 1:10- Example case of lateral hip pain 2:30- Diagnosis of lateral hip pain 7:50- Differential diagnoses 12:00- Exercises for rehabbing lateral hip pain 13:30- Management of pain 19:45- Treatments References: -Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001 Sep;44(9):2138-45. -Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J. 2002 Jul-Aug;2(4):251-4. -Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomized clinical trial. BMJ 2018; 361:k1662. -Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed. 2000 May;28(5):38-48. -Fitzpatrick J, Bulsara MK, O'Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. Am J Sports Med. 2018 Mar;46(4):933-939.

Forestil dig at have så ondt i ryggen og med så intens udstråling i benene, at du mest af alt bare har lyst til at skære kroppen af fra navlen og nedefter. Gennem 20 år har Palle haft rygsmerter on and off, men efterhånden blev de fremtrædende og konstante. Selvom Palle har været gennem et hav af undersøgelser og behandlinger, var der ikke rigtig noget, der virkede. Palle fik konstateret diskusprolaps, men valgte ikke at blive opereret. I stedet opsøgte han behandling hos Smertevidenskab, som gav ham troen på, at han kunne blive sig selv igen. Du har sikkert hørt om eller selv fået diagnosen diskusprolaps og ligesom Palle tænkt, at det er ekstremt farligt, og at man skal passe meget på og skåne ryggen mod belastning. Men er det nu også rigtigt? Forholder det sig sådan at ved at undgå belastning af ryggen, så bliver den stærk og robust? I denne episode kan du høre, hvordan Palle genvandt tilliden til sin krop og evnen til at dyrke idræt på højt niveau igen, som er blevet kronet flere gange med halve Ironmans - ja i flertal. Næsten alle behandlinger har en eller anden “nu og her” effekt. Desværre er det ikke altid, at den kan mærkes på den lange bane. Vi interviewede i 2017 Palle, som fortæller om den effekt, han oplevede, af behandlingen, han modtog tilbage i 2014. Derudover har vi igen lavet et kort interview for at høre Palle, hvordan han har det i dag start november 2021, så du kan få et indtryk af, hvor lang behandlingseffekten nogle gange kan være. Hovedpunkter Sammenhængen med diskusprolaps og rygsmerter Kan man behandle kroniske rygsmerter? Heler en diskusprolaps? Forskellen på effekten af operation og konservativ behandling til personer med diskusprolaps. Kan man være smertefri, når man har en diskusprolaps? God fornøjelse Relevant forskning Risikofaktorer ved brug af opioider Chou R, el al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015   Diskusprolaps og sammenhæng med smerter efter et år el Barzouhi A, et al. Leiden-The Hague Spine Intervention Prognostic Study Group. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013   Diskusprolaps og diskus udbulninger uden smerter Brinjikji W, et al.. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015   Hvilke faktorer har en sammenhæng med om man får diskusprolaps: Tvillingestudie Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009

Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Spine J. 2014 Nov 1;14(11):2525-45. doi: 10.1016/j.spinee.2014.04.022. Epub 2014 Apr 24. PMID: 24768732 --- Send in a voice message: https://anchor.fm/moveman/message

Listen as chiropractor and founder of the Cox Technic, Dr. James Cox explains what Cox Technic is and why it is so effective for treating back pain. James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H) Dr. Cox is the developer of Cox® Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the Keiser University, National University of Health Sciences, Palmer College of Chiropractic Research Center, Loyola Stritch School of Medicine, University of Illinois, University of Iowa, Auburn University, etc. He is a member of the postgraduate faculty of the National University of Health Sciences and has been privileged to speak throughout the world. Resources: About Dr. Cox curriculum vitae  More about Cox Technic Find a Back Doctor The Cox 8 Table by Haven Medical References: Chesterton P, Evans W, Wright M, Lolli L, Richardson M, Atkinson G. Influence of Lumbar Mobilizations During the Nordic Hamstring Exercise on Hamstring Measures of Knee Flexor Strength, Failure Point, and Muscle Activity: A Randomized Crossover Trial. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30201-3. doi: 10.1016/j.jmpt.2020.09.005. Epub ahead of print. PMID: 33248746. INFLUENCE OF LUMBAR MOBILIZATIONS DURING THE NORDIC HAMSTRING EXERCISE ON HAMSTRING MEASURES OF KNEE FLEXOR STRENGTH, FAILURE POINT, AND MUSCLE ACTIVITY: A RANDOMIZED CROSSOVER TRIAL. AFTER SPINAL MOBILIZATION, IMMEDIATE CHANGES IN BILATERAL HAMSTRING FORCE PRODUCTION AND PEAK TORQUE OCCURRED DURING THE NHE. THE EFFECT ON THE NHE FAILURE POINT WAS UNCLEAR. ELECTROMYOGRAPHIC ACTIVITY INCREASED ON THE IPSILATERAL SIDE. Meet the Nordic hamstring exercise, also known as the Nordic hamstring curl—your potential new favorite go-to that can help keep you healthy while boosting your performance.  me 19 Lead researcher Nicol van Dyk, Ph.D., of Aspetar Orthopaedic and Sports Medicine Hospital in Qatar, told Runner's World the move is simple: Begin in a kneeling position with both ankles secured—tucking your feet under a bar, for example, or having a running buddy hold them down—and then progressively lean forward as slowly as possible while keeping your back straight. When you can't resist anymore, just fall forward, catching yourself with your hands against the floor. Check out the video below for how to do it properly.   Ekşi MŞ, Özcan-Ekşi EE, Özmen BB, Turgut VU, Huet SE, Dinç T, Kara M, Özgen S, Özek MM, Pamir MN. Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain. J Pediatr Orthop B. 2020 Nov 27. doi: 10.1097/BPB.0000000000000833. Epub ahead of print. PMID: 33252539. FATTY INFILTRATION IN THE PARASPINAL MUSCLES AND IVDD WERE CLOSELY ASSOCIATED WITH MODIC CHANGES IN CHILDREN AND ADOLESCENTS WITH LBP. LUMBAR IVDD IN CHILDREN AND ADOLESCENTS COULD BE THE RESULT OF A MECHANICAL PATHOLOGY   Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30153-6. doi: 10.1016/j.jmpt.2020.07.006. Epub ahead of print. PMID: 33248744. DETERMINATION OF BIODEX BALANCE SYSTEM CUTOFF SCORES IN OLDER PEOPLE WITH NONSPECIFIC BACK PAIN: A CROSS-SECTIONAL STUDY BBS CUTOFF SCORES ARE SENSITIVE AND SPECIFIC IN DISTINGUISHING BETWEEN POOR AND GOOD POSTURAL PERFORMANCE IN OLDER PEOPLE WITH NSLBP.   TRACTION EFFECTS: TRACTION AND DISTRACTION STUDIES ON WHICH OUR WORK IS BASED. Luigi Albano, DC introduced the first paper on which I built the remaining studies. This gives us foundational understanding as to the benefits of placing a spine into distraction prior to producing ranges of motion – IT FIRST REDUCES STENOTIC EFFECTS THAT COULD CAUSE GREATER NERVE AND DRG COMPRESSION AND CHEMICAL INFLAMMATORY IRRITATION. - JMC   Gaowgzeh RAM, Chevidikunnan MF, BinMulayh EA, Khan F. Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial. J Back Musculoskelet Rehabil. 2020;33(2):225-231. doi: 10.3233/BMR-171099. PMID: 31282394. A COMBINATION OF SPINAL DECOMPRESSION THERAPY WITH CORE STABILIZATION EXERCISE HAS PROVEN TO BE MORE SIGNIFICANT WHEN COMPARED WITH CSE ALONE TO REDUCE PAIN AND DISABILITY IN SUBJECTS WITH CHRONIC LDP.   Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017 Sep 22;30(5):1015-1022. doi: 10.3233/BMR-169581. PMID: 28505956. THIS STUDY SHOWED THAT PATIENTS WITH LHNP RECEIVED PHYSIOTHERAPY HAD IMPROVEMENT BASED ON CLINICAL AND RADIOLOGIC EVIDENCE. NON-INVASIVE SPINAL DECOMPRESSION THERAPY (NSDT) CAN BE USED AS ASSISTIVE AGENT FOR OTHER PHYSIOTHERAPY METHODS IN TREATMENT OF LUMBAR DISC HERNIATION.   Karimi N, Akbarov P, Rahnama L. Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging: A single arm clinical trial. J Back Musculoskelet Rehabil. 2017;30(2):247-253. doi: 10.3233/BMR-160741. PMID: 27636836. SEGMENTAL TRACTION THERAPY MIGHT PLAY AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LBP STIMULATED BY LDH.   Kamanli A1, Karaca-Acet G, Kaya A, Koc M, Yildirim H Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 247-253, 2017 CONVENTIONAL PHYSICAL THERAPIES WITH LUMBAR TRACTION WERE EFFECTIVE IN THE TREATMENT OF PATIENT WITH SUBACUTE LDH. THESE RESULTS SUGGEST THAT CLINICAL IMPROVEMENT IS NOT CORRELATED WITH THE FINDING OF MRI. PATIENTS WITH LDH SHOULD BE MONITORED CLINICALLY   Choi J, Lee S, Hwangbo G. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation. J Phys Ther Sci. 2015 Feb;27(2):481-3. doi: 10.1589/jpts.27.481. Epub 2015 Feb 17. PMID: 25729196; PMCID: PMC4339166. SPINAL DECOMPRESSION THERAPY AND GENERAL TRACTION THERAPY ARE EFFECTIVE AT IMPROVING THE PAIN, DISABILITY, AND SLR OF PATIENTS WITH INTERVERTEBRAL DISC HERNIATION. THUS, SELECTIVE TREATMENT MAY BE REQUIRED   JUDOVICH BD. Herniated cervical disc; a new form of traction therapy. Am J Surg. 1952 Dec;84(6):646-56. doi: 10.1016/0002-9610(52)90127-x. PMID: 12986095. CLINICAL STUDIES INDICATE THAT IN THE AVERAGE INTRACTABLE CASE THE CERVICAL SPINE SHOULD BE STRETCHED BY FORCE RANGING FROM 25 TO 45 POUNDS. ALMOST HALF THE PATIENTS IN A SERIES OF SIXTY CASES EXPERIENCED PARTIAL OR COMPLETE MOMENTARY RELIEF WHEN THIS FORCE WAS APPLIED. ROENTGEN STUDIES REVEAL THAT IN THE AVERAGE PATIENT THE INTERVERTEBRAL SPACES OF THE CERVICAL SPINE BEGIN TO SHOW MEASURABLE WIDENING WITH TRACTION FORCE RANGING FROM 25 TO 50 POUNDS. THE NECESSARY FORCE TO RELIEVE PAIN CANNOT BE TOLERATED BY THE AVERAGE PATIENT WHEN IT IS ADMINISTERED AS A CONSTANT PULL. IF ADMINISTERED INTERMITTENTLY, ADEQUATE AND MUCH GREATER TRACTION LOAD CAN BE TOLERATED WITHOUT THE DISCOMFORT WHICH WOULD NORMALLY ACCOMPANY SUCH FORCE. A NEW METHOD OF MOTORIZED INTERMITTENT TRACTION IS PRESENTED. THE CLINICAL RESULTS OF INTERMITTENT TRACTION, BECAUSE OF ADEQUATE FORCE, HAVE BEEN EXCELLENT AS COMPARED TO CONVENTIONAL TRACTION METHODS.   Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000 Jun;9(3):202-7. doi: 10.1007/s005869900113. PMID: 10905437; PMCID: PMC3611397. BECAUSE OSTEOPATHIC MANIPULATION PRODUCED A 12-MONTH OUTCOME THAT WAS EQUIVALENT TO CHEMONUCLEOLYSIS, IT CAN BE CONSIDERED AS AN OPTION FOR THE TREATMENT OF SYMPTOMATIC LUMBAR DISC HERNIATION, AT LEAST IN THE ABSENCE OF CLEAR INDICATIONS FOR SURGERY. Further study into the value of manipulation at a more acute stage is warranted.   Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low-back pain. Can Fam Physician. 1985 Mar;31:535-40. PMID: 21274223; PMCID: PMC2327983. RESULTS OF SPINAL MANIPULATION IN 283 PATIENTS WITH LOW BACK PAIN ARE PRESENTED. THE PHYSICIAN WHO MAKES USE OF THIS RESOURCE WILL PROVIDE RELIEF FOR MANY PATIENTS.   Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210. doi: 10.1016/j.jmpt.2003.12.023. PMID: 15129202. THE APPARENT SAFETY OF SPINAL MANIPULATION, ESPECIALLY WHEN COMPARED WITH OTHER “MEDICALLY ACCEPTED” TREATMENTS FOR LDH, SHOULD STIMULATE ITS USE IN THE CONSERVATIVE TREATMENT PLAN OF LDH.   Kane MD, Karl RD, Swain JH. Effects of Gravity-Facilitated Traction on lntervertebral Dimensions of the Lumbar Spine*. J Orthop Sports Phys Ther. 1985;6(5):281-8. doi: 10.2519/jospt.1985.6.5.281. PMID: 18802302. MEAN POSTERIOR SEPARATION WAS SIGNIFICANT AT ALL LEVELS EXCEPT L1-L2 AND L5-S1. MEAN INTERVERTEBRAL FORAMINAL SEPARATION WAS SIGNIFICANT AT ALL LEVELS BUT L5-S1. IF INCREASES IN INTERVERTEBRAL DIMENSIONS PLAY A ROLE IN THE RELIEF OF LOW BACK SYNDROME, THEN GRAVITY-FACILITATED TRACTION MAY BE AN EFFECTIVE MODALITY IN THE TREATMENT OF THIS CONDITION.   Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther. 2008 Mar;31(3):191-8. doi: 10.1016/j.jmpt.2008.02.001. PMID: 18394495. TRACTION, ULTRASOUND, AND LOW POWER LASER THERAPIES WERE ALL EFFECTIVE IN THE TREATMENT OF THIS GROUP OF PATIENTS WITH ACUTE LDH. THESE RESULTS SUGGEST THAT CONSERVATIVE MEASURES SUCH AS TRACTION, LASER, AND ULTRASOUND TREATMENTS MIGHT HAVE AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LDH   Chung TS, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology. 2015 Jun;275(3):755-62. doi: 10.1148/radiol.14141400. Epub 2015 Jan 22. Erratum in: Radiology. 2015 Jun;275(3):934-5. PMID: 25611735. HERNIATED LUMBAR DISKS: REAL-TIME MR IMAGING EVALUATION DURING CONTINUOUS TRACTION CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.   Isner-Horobeti ME, Dufour SP, Schaeffer M, Sauleau E, Vautravers P, Lecocq J, Dupeyron A. High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial. J Manipulative Physiol Ther. 2016 Nov-Dec;39(9):645-654. doi: 10.1016/j.jmpt.2016.09.006. Epub 2016 Nov 9. PMID: 27838140. HIGH-FORCE VERSUS LOW-FORCE LUMBAR TRACTION IN ACUTE LUMBAR SCIATICA DUE TO DISC HERNIATION: A PRELIMINARY RANDOMIZED TRIAL PATIENTS WITH ACUTE LUMBAR SCIATICA SECONDARY TO DISC HERNIATION WHO RECEIVED 2 WEEKS OF LUMBAR TRACTION REPORTED REDUCED RADICULAR PAIN AND FUNCTIONAL IMPAIRMENT AND IMPROVED WELL-BEING REGARDLESS OF THE TRACTION FORCE GROUP TO WHICH THEY WERE ASSIGNED. THE EFFECTS OF THE TRACTION TREATMENT WERE INDEPENDENT OF THE INITIAL LEVEL OF MEDICATION AND APPEARED TO BE MAINTAINED AT THE 2-WEEK FOLLOW-UP. DURING THE 2-WEEK FOLLOW-UP AT DAY 28, ONLY THE LT10 GROUP IMPROVED (P < .05) IN VAS (–52%) AND EIFEL SCORES (–46%).   Onel D, Tuzlaci M, Sari H, Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine (Phila Pa 1976). 1989 Jan;14(1):82-90. doi: 10.1097/00007632-198901000-00017. PMID: 2913674. COMPUTED TOMOGRAPHIC INVESTIGATION OF THE EFFECT OF TRACTION ON LUMBAR DISC HERNIATIONS. CHANGES OCCURRING UNDER THE EFFECT OF A TRACTION LOAD OF 45 KG HAVE BEEN EVALUATED IN 30 PATIENTS WITH LUMBAR DISC HERNIATION WITH CT INVESTIGATION. THE HERNIATED NUCLEAR MATERIAL (HNM) HAS RETRACTED IN 11 (78.5%) OF MEDIAN, SIX (66.6%) OF POSTEROLATERAL, AND FOUR (57.1%) OF LATERAL HERNIATIONS.   Clarke J, van Tulder M, Blomberg S, de Vet H, van der Heijden G, Bronfort G. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine (Phila Pa 1976). 2006 Jun 15;31(14):1591-9. doi: 10.1097/01.brs.0000222043.09835.72. PMID: 16778694. INTERMITTENT OR CONTINUOUS TRACTION AS A SINGLE TREATMENT FOR LBP CANNOT BE RECOMMENDED FOR MIXED GROUPS OF PATIENTS WITH LBP WITH AND WITHOUT SCIATICA. NEITHER CAN TRACTION BE RECOMMENDED FOR PATIENTS WITH SCIATICA BECAUSE OF INCONSISTENT RESULTS AND METHODOLOGICAL PROBLEMS IN MOST OF THE STUDIES INVOLVED. HOWEVER, BECAUSE HIGH-QUALITY STUDIES WITHIN THE FIELD ARE SCARCE, BECAUSE MANY ARE UNDERPOWERED, AND BECAUSE TRACTION OFTEN IS SUPPLIED IN COMBINATION WITH OTHER TREATMENT MODALITIES, THE LITERATURE ALLOWS NO FIRM NEGATIVE CONCLUSION THAT TRACTION, IN A GENERALIZED SENSE, IS NOT AN EFFECTIVE TREATMENT FOR PATIENTS WITH LBP   Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study. Arch Phys Med Rehabil. 2008 Feb;89(2):269-74. doi: 10.1016/j.apmr.2007.06.778. PMID: 18226650. TRACTION APPLIED IN THE PRONE POSITION USING THE VAX-D FOR 8 WEEKS WAS ASSOCIATED WITH IMPROVEMENTS IN PAIN INTENSITY AND RMDQ SCORES AT DISCHARGE, AND AT 30 AND 180 DAYS AFTER DISCHARGE IN A SAMPLE OF PATIENTS WITH ACTIVITY-LIMITING LBP. CAUSAL RELATIONSHIPS BETWEEN THESE OUTCOMES AND THE INTERVENTION SHOULD NOT BE MADE UNTIL FURTHER STUDY IS PERFORMED USING RANDOMIZED COMPARISON GROUPS.   REAL-TIME MR IMAGING WHILE PERFORMING TRACTION IS POSSIBLE. Mitchell UH, Beattie PF, Bowden J, Larson R, Wang H. Age-related differences in the response of the L5-S1 intervertebral disc to spinal traction. Musculoskelet Sci Pract. 2017 Oct;31:1-8. doi: 10.1016/j.msksp.2017.06.004. Epub 2017 Jun 9. PMID: 28624722. TO DETERMINE DIFFERENCES IN THE APPARENT DIFFUSION COEFFICIENT (ADC) OBTAINED WITH LUMBAR DIFFUSION-WEIGHTED IMAGING (DWI) OF THE L5-S1 IVD BEFORE, AND DURING, THE APPLICATION OF LUMBAR TRACTION STATIC TRACTION WAS ASSOCIATED WITH AN INCREASE IN DIFFUSION OF WATER WITHIN THE L5-S1 IVDS OF MIDDLE-AGE INDIVIDUALS, BUT NOT IN YOUNG ADULTS, SUGGESTING AGE-RELATED DIFFERENCES IN THE DIFFUSION RESPONSE. FURTHER STUDY IS NEEDED TO ASSESS THE RELATIONSHIP BETWEEN THESE FINDINGS AND THE SYMPTOMS OF BACK PAIN. HIGHLIGHTS: STATIC TRACTION IS ASSOCIATED WITH AN INCREASE IN ADC IN OLDER DISCS, NOT YOUNGER. INVERSE RELATIONSHIP BETWEEN BASELINE ADC AND PERCENT INCREASE WITH TRACTION. FINDINGS SUGGEST PRESENCE OF AGE-RELATED CHANGES IN THE RATE OF DIFFUSION RESPONSE.   SAAL, JEFFREY A., MD; SAAL, JOEL S., MD Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy: An Outcome Study, Spine: April 1989 - Volume 14 - Issue 4 - p 431-437 64 PATIENTS WITH LUMBAR HERNIATED NUCLEUS PULPOSUS WITHOUT SIGNIFICANT STENOSIS WERE TREATED NON SURGICALLY. 90% GOOD OR EXCELLENT OUTCOME WITH A 92% RETURN TO WORK RATE. FOR THE SUBGROUPS WITH EXTRUDED DISCS AND SECOND OPINIONS, 87% AND 83% HAD GOOD OR EXCELLENT OUTCOMES, RESPECTIVELY, ALL (100%) OF WHOM RETURNED TO WORK. SICK LEAVE TIME FOR THESE SUBGROUPS WAS 2.9 MONTHS (+/- 1.4 MONTHS) AND 3.4 MONTHS (+/- 1.7 MONTHS), RESPECTIVELY. THESE RESULTS COMPARED FAVORABLY WITH PREVIOUSLY PUBLISHED SURGICAL STUDIES. FOUR OF SIX PATIENTS WHO REQUIRED SURGERY WERE FOUND TO HAVE STENOSIS AT OPERATION.   Sari H, Akarirmak U, Karacan I, Akman H. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005 Jan-Mar;21(1):3-11. PMID: 16385939. DURING TRACTION OF INDIVIDUALS WITH ACUTE LDH THERE WAS A REDUCTION OF THE SIZE OF THE HERNIATION, INCREASED SPACE WITHIN THE SPINAL CANAL, WIDENING OF THE NEURAL FORAMINA, AND DECREASED THICKNESS OF THE PSOAS MUSCLE.   Park WM, Kim K, Kim YH. Biomechanical analysis of two-step traction therapy in the lumbar spine. Man Ther. 2014 Dec;19(6):527-33. doi: 10.1016/j.math.2014.05.004. Epub 2014 May 22. PMID: 24913413. A COMBINATION OF GLOBAL AXIAL TRACTION AND LOCAL DECOMPRESSION WOULD BE HELPFUL FOR REDUCING TENSILE STRESS ON THE FIBERS OF THE ANNULUS FIBROSUS AND LIGAMENTS, AND INTRADISCAL PRESSURE IN TRACTION THERAPY. THIS STUDY COULD BE USED TO DEVELOP A SAFER AND MORE EFFECTIVE TYPE OF TRACTION THERAPY   Chow DHK, Yuen EMK, Xiao L, Leung MCP. Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study. Musculoskelet Sci Pract. 2017 Jun;29:78-83. doi: 10.1016/j.msksp.2017.03.007. Epub 2017 Mar 20. PMID: 28347933. HORIZONTAL TRACTION WAS EVIDENTLY EFFECTIVE IN INCREASING THE DISC HEIGHT OF LOWER LUMBAR LEVELS, PARTICULARLY IN THE POSTERIOR REGIONS OF THE DISCS. FURTHER EVIDENCE OF THE EFFECTS OF TRACTION OF DIFFERENT MODES, MAGNITUDES, AND DURATIONS ON THE CHANGE IN DISC HEIGHT IS REQUIRED FOR PROPER CONTROL OF TRACTION APPLIED TO SPECIFIC DISC LEVELS. HIGHLIGHTS: MECHANICAL EFFECTS OF TRACTION ON LUMBAR DISCS WAS EVALUATED USING MRI. HORIZONTAL TRACTION USING 42% OF BODY WEIGHT WAS ASSOCIATED WITH AN INCREASED DISC HEIGHT OF LOWER LUMBAR DISCS. HORIZONTAL TRACTION ALSO RESULTED IN REDUCED LORDOSIS AND CHANGE IN TILT ANGLE. THE EFFECTS WERE MORE PROMINENT AT THE POSTERIOR DISCAL REGIONS.   Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789. a  systematic  review  of  randomized, controlled  trials  and  systematic  reviews  published  through  April 2015  on  noninvasive  pharmacologic  and  nonpharmacologic treatments  for  low  back  pain.  Updated  searches  were  performed through  November  2016. Recommendation  1: Given  that  most  patients  with  acute  or subacute  low  back  pain  improve  over  time  regardless  of  treat-ment,  clinicians  and  patients  should  select  nonpharmacologic treatment  with  superficial  heat  (moderate-quality  evidence),  massage,  acupuncture,  or  spinal  manipulation  (low-quality  evidence). If  pharmacologic  treatment  is  desired,  clinicians  and  patients should  select  nonsteroidal  anti-inflammatory  drugs  or  skeletal muscle  relaxants  (moderate-quality  evidence).  (Grade:  strong recommendation) Recommendation  2: For  patients  with  chronic  low  back  pain, clinicians  and  patients  should  initially  select  nonpharmacologic treatment  with  exercise,  multidisciplinary  rehabilitation,  acupuncture,  mindfulness-based  stress  reduction  (moderate-quality  evidence),  tai  chi,  yoga,  motor  control  exercise,  progressive relaxation,  electromyography  biofeedback,  low-level  laser therapy,  operant  therapy,  cognitive  behavioral  therapy,  or  spinal manipulation  (low-quality  evidence).  (Grade:  strong recommendation) Recommendation  3: In  patients  with  chronic  low  back  pain  who have  had  an  inadequate  response  to  nonpharmacologic  therapy, clinicians  and  patients  should  consider  pharmacologic  treatment with  nonsteroidal  anti-inflammatory  drugs  as  first-line  therapy,  or tramadol  or  duloxetine  as  second-line  therapy.  Clinicians  should only  consider  opioids  as  an  option  in  patients  who  have  failed  the aforementioned  treatments  and  only  if  the  potential  benefits  out-weigh  the  risks  for  individual  patients  and  after  a  discussion  of known  risks  and  realistic  benefits  with  patients.  (Grade:  weak  recommendation,  moderate-quality  evidence) Low  back  pain  is  one  of  the  most  common  reasons for  physician  visits  in  the  United  States.  Most  Americans  have  experienced  low  back  pain,  and  approximately  one  quarter  of  U.S.  adults  reported  having  low back  pain  lasting  at  least  1  day  in  the  past  3  months  (1).Low  back  pain  is  associated  with  high  costs,  including those  related  to  health  care  and  indirect  costs  from missed  work  or  reduced  productivity  (2).  The  total  costs attributable  to  low  back  pain  in  the  United  States  were estimated  at  $100  billion  in  2006,  two  thirds  of  which were  indirect  costs  of  lost  wages  and  productivity  (3).Low  back  pain  is  frequently  classified  and  treated on  the  basis  of  symptom  duration,  potential  cause, presence  or  absence  of  radicular  symptoms,  and  corresponding  anatomical  or  radiographic  abnormalities. Acute  back  pain  is  defined  as  lasting  less  than  4  week   Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):493-505. doi: 10.7326/M16-2459. Epub 2017 Feb 14. PMID: 28192793. Background: A  2007  American  College  of  Physicians  guideline addressed  nonpharmacologic  treatment  options  for  low  back pain. The  current  evidence  on  non-pharmacologic  therapies  for  acute  or  chronic  nonradicular  or  ra-dicular  low  back  pain from  MEDLINE  (January  2008  through  February 2016),  Cochrane  Central  Register  of  Controlled  Trials,  CochraneDatabase  of  Systematic  Reviews,  and  reference  lists. Evidence  continues  to  support  the  effectiveness  of  exercise,  psychological  therapies,  multidisciplinary  rehabilitation,  spinal  manipulation,  massage,  and  acupuncture  for  chronic  low  back  pain. Funding  Source:Agency  for  Healthcare  Research  and Quality.  (PROSPERO:  CRD42014014735)Ann  Intern  Med.2017;166:xxx-xxx.  doi:10.7326/M16-2459Annals.org the  American  College  of  Physicians  (ACP)and  American  Pain  Society  (APS)  recommended  spinal manipulation  as  a  treatment  option  for  acute  low  back pain  and  several  nonpharmacologic  therapies  for  sub-acute  or  chronic  low  back  pain.    Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, Andersen MØ, Fournier G, Højgaard B, Jensen MB, Jensen LD, Karbo T, Kirkeskov L, Melbye M, Morsel-Carlsen L, Nordsteen J, Palsson TS, Rasti Z, Silbye PF, Steiness MZ, Tarp S, Vaagholt M. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 Jan;27(1):60-75. doi: 10.1007/s00586-017-5099-2. Epub 2017 Apr 20. PMID: 28429142. Purpose: To summarise recommendations about 20 non-surgical interventions for recent onset ( If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.   Krekoukias G1, Gelalis ID1,2, Xenakis T1, Gioftsos G3, Dimitriadis Z4, Sakellari V3. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. MANUAL THERAPY SPINAL MOBILIZATION IS PREFERABLE TO CONVENTIONAL PHYSIOTHERAPY IN ORDER TO REDUCE THE PAIN INTENSITY AND DISABILITY IN SUBJECTS WITH CHRONIC LBP AND ASSOCIATED DISK DEGENERATION. THE FINDINGS OF THIS STUDY MAY LEAD TO THE ESTABLISHMENT OF SPINAL MOBILIZATION AS ONE OF THE MOST PREFERABLE APPROACHES FOR THE MANAGEMENT OF LBP DUE TO DISK DEGENERATION.   REFERENCES FOR 25% RELIEF PAPER BY WIRTH ET AL Wirth B1, Riner F1, Peterson C1, Humphreys BK1, Farshad M2, Becker S3, Schweinhardt P1. An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment. Chiropr Man Therap. 2019 Feb 5;27:6. doi: 10.1186/s12998-018-0225-8. eCollection 2019. Refs on minimal clinical improvement determination: Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158. doi: 10.1016/S0304-3959(01)00349-9. [PubMed] [CrossRef] Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, et al. Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine (Phila Pa 1976) 2007;32:2915–2920. doi: 10.1097/BRS.0b013e31815b75ae. [PubMed] [CrossRef] Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283–291. doi: 10.1016/j.ejpain.2003.09.004. [PubMed] [CrossRef] Robinson-Papp J, George MC, Dorfman D, Simpson DM. Barriers to chronic pain measurement: a qualitative study of patient perspectives.Pain Med. 2015;16:1256–1264. doi: 10.1111/pme.12717. [PMC free article] [PubMed] [CrossRef] Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10. [PubMed] [CrossRef]   Chung TS1, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology 2015 Jan 22:141400. CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.    Wong A, Parent E, Dhillon S, Prasad N, Kawchuk G: Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls? Spine: 01 September 2015 - Volume 40 - Issue 17 - p 1329–1337  doi: 10.1097/BRS.0000000000000981 PARTICIPANTS WITH LBP AND ASYMPTOMATIC CONTROLS ATTENDED 3 SESSIONS FOR 7 DAYS. ON SESSIONS 1 AND 2, PARTICIPANTS WITH LBP RECEIVED SMT (+LBP/+SMT, N = 32) WHEREAS ASYMPTOMATIC CONTROLS DID NOT (−LBP/−SMT, N = 57). IN THESE SESSIONS, SPINAL STIFFNESS AND MULTIFIDUS THICKNESS RATIOS WERE OBTAINED BEFORE AND AFTER SMT AND ON DAY 7. RESULTS. AFTER THE FIRST SMT, SMT RESPONDERS DISPLAYED STATISTICALLY SIGNIFICANT DECREASES IN SPINAL STIFFNESS AND INCREASES IN MULTIFIDUS THICKNESS RATIO SUSTAINED FOR MORE THAN 7 DAYS; THESE FINDINGS WERE NOT OBSERVED IN OTHER GROUPS. SIMILARLY, ONLY SMT RESPONDERS DISPLAYED SIGNIFICANT POST-SMT IMPROVEMENT IN APPARENT DIFFUSION COEFFICIENTS.     Wong AYL1,2, Parent EC3, Dhillon SS4, Prasad N5, Samartzis D6, Kawchuk GN3. Differential patient responses to spinal manipulative therapy and their relation to spinal degeneration and post-treatment changes in disc diffusion. Eur  Spine J. 2019 Jan 2. doi: 10.1007/s00586-018-5851-2. NON-SPECIFIC LOW BACK PAIN PATIENTS WHO RESPOND WITH >30% RELIEF SHOW HIGHER APPARENT DIFFUSION COEFFICIENT DISC DIFFUSION OF WATER THAN NON POSITIVE RESPONDERS. MRI WAS PERFORMED BEFORE AND AFTER SMT ON DAY 1 OF CARE. OSWESTRY DISABILITY TEST WAS ALSO USED.     Beattie PF, Butts R, Donley JW, Liuzzo DM. The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1. Orthop Sports Phys Ther. 2013 Nov 21. Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC. STUDY TO DETERMINE DIFFERENCES IN THE CHANGES IN DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS BETWEEN THOSE SUBJECTS WITH LOW BACK PAIN (LBP) WHO DID, AND DID NOT, REPORT A WITHIN-SESSION REDUCTION IN PAIN INTENSITY FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY (SMT) WAS DONE. CHANGES IN THE DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS AT THE L1-2, L2-3, AND L5-1 LEVELS APPEAR TO BE RELATED TO DIFFERENCES IN WITHIN-SESSION PAIN REPORTS FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY. PARTICIPANTS UNDERWENT T2- AND DIFFUSION-WEIGHTED LUMBAR MAGNETIC RESONANCE IMAGING SCANS IMMEDIATELY BEFORE, AND AFTER, RECEIVING A SINGLE TREATMENT OF SMTJ     Kuo, Ya-Wen PhD; Hsu, Yu-Chun MS; Chuang, I-Ting MS; Chao, Pen-Hsiu Grace PhD; Wang, Jaw-Lin PhD Spinal Traction Promotes Molecular Transportation in a Simulated Degenerative Intervertebral Disc Model. Spine: April 20th, 2014 - Volume 39 - Issue 9 - p E550 Traction biomechanics studied in the porcine model biomechanical benefits include disc height recovery, foramen enlargement, and intradiscal pressure reduction. 48 thoracic discs were dissected from 8 porcine spines and then divided into 3 groups: intact, degraded without traction, and degraded with traction. From Day 4 to Day 6, half of the degraded discs received a 30 min traction treatment per day (traction force: 20 kg, loading: unloading = 30 sec: 10 sec). Traction treatment is effective in enhancing nutrition supply and promoting disc cell proliferation of the degraded discs.  

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

Når vi holder fagdagen vår "The Sexy Shoulder" pleier vi å stille deltakerne et spørsmål; "Hvor mange her inne har stått bak en pasient og lurt på, hva i all verden betyr denne testen?". Som regel kommer alle hendene i været, hvilket er beskrivende for den usikkerheten vi alle står i når vi skal tolke funn. For skulderen alene er det beskrevet over 200 kliniske tester for ulike tilstander. Felles for de fleste er at de har høy sensitivitet og lav spesifisitet. Dette vil si, enkelt forklart, at vi kan provosere frem symptomer, men i svært liten grad være sikre på hvilke strukturer symptomene kommer fra. Så hva utgjør da en god klinisk test? Hvilken verdi har den? Trenger vi dem i det hele tatt, eller skal vi bruke tiden vår på noe annet enn omfattende testbatterier?Caneiro, J.P., et al.: It is time to move beyond 'body region silos' to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med, 2019.Decary, S., et al.: Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis. Phys Ther Sport, 2017. 23: p. 143-155.Fu, M.C., et al.: Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions. Spine J, 2014. 14(10): p. 2442-8.Girish, G., et al.: Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol, 2011. 197(4): p. W713-9.Hegedus, E.J., et al.: Combining orthopedic special tests to improve diagnosis of shoulder pathology. Phys Ther Sport, 2015. 16(2): p. 87-92.Hegedus, E.J., et al.: Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med, 2008. 42(2): p. 80-92; discussion 92.Hegedus, E.J., et al.: Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med, 2012. 46(14): p. 964-78.Hegedus, E.J., et al.: Orthopaedic special tests and diagnostic accuracy studies: house wine served in very cheap containers. British Journal of Sports Medicine, 2017.Herzog, R., et al.: Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J, 2016.O'Brien, S.J., et al.: The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med, 1998. 26(5): p. 610-3.Reiman, M.P., et al.: Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med, 2013. 47(14): p. 893-902.https://jevnehelse.no/2020/03/05/hva-er-en-god-test/Musikk: Joseph McDade-Mirrors

In episode 68, Dr. Aaron Horschig breaks down why you shouldn't place your complete trust in MRI results for low back pain. Research has estimated that almost a third of healthy pain free 20-year-olds currently have a disc bulge in their spine! (Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36:811-16) This number increases 10% every decade, meaning 45-50% of people between the ages of 40-50 have a disc bulge but with no back pain at all. It is highly likely to have abnormal scary findings on the MRI if you’re above the age of 60 but many of these individuals have no low back pain at all. Can a disc bulge create back pain? Sure. But just because there is one that is picked up on an MRI does NOT necessarily mean it is the root cause of your pain. Check out these referenced articles: Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69-73 Carragee E, Alamin T, Cheng I, et al. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006; 6(6):624-35 Fukuda K & Kawakami G. Proper use of MR imaging for evaluation of low back pain (radiologist’ view). Semin Musculoskelet Radiol. 2001;5(2):133-6 Master squat technique: https://squatuniversity.com/book/ Subscribe to my YouTube channel here: https://tinyurl.com/y2eq7kpr Visit the website: http://www.squatuniversity.com Like the Facebook page: https://www.facebook.com/SquatUniversity Follow on Twitter: https://twitter.com/squatuniversity Follow on Instagram: http://instagram.com/squat_university

- What you should know about MRI and Xray when you have low back pain - Most of typical imaging (making an mri, ct or xray) findings of people with LBP are part of normal aging and are not related to back pain. Using these images to explain your pain without an accurate examination and a carefully guided clinical history interview, is not supported by current scientific evidence!  Clinical guidelines say imaging should be avoided unless signs that raise suspicion for a serious underlying condition like malignancy, spinal fracture, infection of the spine, or cauda equina syndrome are present.1,2,3,4  These signs are usually called 'red flags'. And only a very small percentage of LBP categorises for this group of severe pathology, usually around 1% -> Most people do not show such signs. Are you having serious disease? (red flags) A potential serious disease is identified by your medical doctor while taking a focused history and looking/listening for so called "red flags". "Red flags are features from the patient’s clinical history and physical examination which are thought to be associated with a higher risk of serious pathology."5 There is no definite list of red flags, but the most commonly used are2: aged over 50 years old history of cancer steroid use Other commonly suggested “red flags” in clinical practice guidelines are5,2: faecal incontinence urinary retention widespread neurologic symptoms (could be a palsy, marked weakness of muscles, decreased sensation (feeling numb on your skin), something seriously wrong with your reflexes and your medical doctor will know how to look for that) no improvement in symptoms after one month unexplained weight loss fever being systematically unwell Whilst the use of red flags is recommended by all clinical guidelines there is still little empirical data for its diagnostic accuracy.5,6 If a combination of red flags raises the suspicion of your clinician he or she should assess prognostic factors such as X-rays and blood tests or magnetic resonance imaging to rule out or identify serious disease (malignancy, spinal fracture, infection of the spine, cauda equina syndrome). The so often mentioned slipped disc by itself is not considered a severe pathology! So why is imaging of your spine not recomended in the absence of red flags? To put it simple: People with no LBP can have worse mri´s, ct`s or xray´s  than people with LBP.  Most of typical imaging findings of people with LBP (such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy) are part of normal aging and are also present in 90% of individuals 60 years of age or older without even having LBP. Also more than 50% of people without any LBP between 30-39 years of age have disk degeneration, height loss, or bulging in their imaging findings.7   Furthermore no association was identified between findings like spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the the occurrence of LBP.8 No association between lumbar spine facet joint osteoarthritis, identified by multi-detector CT, at any spinal level and LBP.9 Findings on mri are also not predictive of the development or duration of low-back pain.10 Individuals with the longest duration of LBP did not have the greatest degree of anatomical abnormality.11 A recent systematic review concluded that in the acute setting of sciatica (pain radiating down the leg), evidence for the diagnostic accuracy of MRI is not conclusive.12   Let´s put in an example: If you randomly choose 100 people above 30 years of age that do not have LBP and feel perfectly fine, more than 50 of them will show the typical signs of degeneration that are often (mis)used to explain the cause of LBP. The same stands true for people with LBP. They too have a good chance to show those signs, but it is just a normal picture, your skin too does not look like the skin of a 10 year old. It´s in most cases a normal part of aging and has no corelation with pain. So getting an xray, ct or mri not only will not help you (if you lack signs of serious pathology) in treating your back pain but there are even studies that suggest that having an MRI can make things worse for people with LBP. In a study done with 3264 workers compensation cases, people with MRI came off of disability 200% slower than those who didn´t have an MRI scan.13 What really should make one think is that 80-100% of the MRI group had surgery while the no-MRI group had a surgery rate of less than 10%, still having a much faster recovery. Another study brings further evidence for worse outcomes of people with LBP that have early MRI´s regardless of radiculopathy (back and/or leg pain with muscle weakness. On average, the rate of going off disability for those who received an early MRI was approximately one-third the rate of those who did not receive MRI. "hThis evidence reinforces that both providers and patients should be made aware that when early MRI is not indicated, its use provides no benefits and could result in worse out- comes such as iatrogenic work disability and unnecessary medical procedures."14 Iatrogenic work disability means, work disability caused by health professionals.   As researcher Neil o´Connell points out in an article he wrote for www.bodyinmind.org: "(...) it’s not really the scans that are the problem, it’s the way that they are (mis)used by clinicians. Powerful images of bulging discs, degenerating joints, partial dislocations or instability are evoked to help explain the patient’s symptoms (...)"   Using these images to explain your pain without an accurate examination and a carefully guided clinical history interview, is not supported by current scientific evidence! Instead of helping you in your recovery, it could create fear, fear of movement, and probably will even contribute to your pain-condition because of that.   Remember: If you already have a mri, ct or xray of your back and worry about those "abnormalities" described by the radiologist, many people without LBP would have similiar results in their mri´s or xrays. It´s perfectly normal for a spine to show osteoarthritis, disc narrowing, spondylolisthesis discs bulging aso. It´s like having wrinkels on our skin as we are getting older.   For LBP with substantial neurologic involvement, CPGs generally did not recommend conducting any further assessment until appropriate conservative management (which was rarely defined) had failed, after which MRI or CT was generally recommended.2 Imaging is sometimes recommended where sufficient progress is not being made but the time cut-off varies from 4 to 7 weeks.1   Find out more: www.mybackrecovery.com Literatur: Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-2094. doi:10.1007/s00586-010-1502-y. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. doi:10.1016/j.spinee.2010.03.032. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176-185. doi:10.1016/j.jbspin.2011.03.019. B.K. C, J.L. B. Appropriate and safe use of diagnostic imaging. Am Fam Physician. 2013;87:494-501. http://www.aafp.org/afp/2013/0401/p494.pdfnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2013206181. Henschke N, Cg M, Rwjg O, et al. Red flags to screen for malignancy in patients with low-back pain ( Review ). Program. 2013;(2). doi:10.1002/14651858.CD008686.pub2.Copyright. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. Bmj. 2013;347(dec11 1):f7095-f7095. doi:10.1136/bmj.f7095. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199-205. doi:10.1097/BRS.0b013e31818edcfd. Kalichman L, Li L, Kim DH, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008;33(23):2560-2565. doi:10.1097/BRS.0b013e318184ef95. Borenstein DG, O’Mara JW, Boden SD, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am. 2001;83-A(9):1306-1311. http://www.ncbi.nlm.nih.gov/pubmed/11568190. el Barzouhi A, Vleggeert-Lankamp CL a M, Lycklama à Nijeholt GJ, et al. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013;368(11):999-1007. doi:10.1056/NEJMoa1209250. Wassenaar M, van Rijn RM, van Tulder MW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21(2):220-227. doi:10.1007/s00586-011-2019-8. Webster BS, Cifuentes M. Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occup Environ Med. 2010;52(9):900-907. doi:10.1097/JOM.0b013e3181ef7e53. Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38(22):1939-1946. doi:10.1097/BRS.0b013e3182a42eb6.

Some have estimated the annual cost of chronic back or neck pain in the US to exceed $200 billion per year. And the economic burden is almost as unbearable as the pain faced by patients. This week on the program, we discuss the clinical and radiographic aspects of structural spine disease--or spondylosis--and expert recommendations on how to manage it. Produced by James E. Siegler. Music by Steve Combs and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making, especially not for back surgery. REFERENCES Baron EM and Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60:S35-41. Stino AM and LoRusso SJ. Myelopathies Due to Structural Cervical and Thoracic Disease. Continuum (Minneap Minn). 2018;24:567-583. Rindler RS, Chokshi FH, Malcolm JG, Eshraghi SR, Mossa-Basha M, Chu JK, Kurpad SN and Ahmad FU. Spinal Diffusion Tensor Imaging in Evaluation of Preoperative and Postoperative Severity of Cervical Spondylotic Myelopathy: Systematic Review of Literature. World Neurosurg. 2017;99:150-158. Witiw CD, Tetreault LA, Smieliauskas F, Kopjar B, Massicotte EM and Fehlings MG. Surgery for degenerative cervical myelopathy: a patient-centered quality of life and health economic evaluation. Spine J. 2017;17:15-25. Farrokhi MR, Ghaffarpasand F, Khani M and Gholami M. An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature. World Neurosurg. 2016;94:97-110.

It's time for another season of PT Inquest! This first paper does not bode well for the idea of seeing a PT early making much of a difference in long term costs and outcomes for acute low back pain in older patients. How was this study conducted? What does this mean for physical therapists? As a profession, are we promoting ourselves in spite of the research? Are there ethical implications? Is there a roadmap forward? Is JW becoming the weakest member of his family?! Subsequent healthcare utilization associated with early physical therapy for new episodes of low back pain in older adults. Karvelas DA, Rundell SD, Friedly JL, Gellhorn AC, Gold LS, Comstock BA, Heagerty PJ, Bresnahan BW, Nerenz DR, Jarvik JG. Spine J. 2016 Oct 17. pii: S1529-9430(16)31013-0. doi: 10.1016/j.spinee.2016.10.007. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

This episode presents the different groups within low back pain and looks at where statistics come from. This information helps you battle fear associated with the condition and validate your experience of pain. Facts about Low Back Pain (LBP) LBP is defined as pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain.1 LBP is categorized into acute LBP and chronic LBP, which is LBP lasting for longer than 12 weeks.2,3,4,5,6 LBP is the most common form of chronic pain,7 a leading cause of disability in people younger than 45 years old8 and has a lifetime prevalence of 70 % in industrialised countries9. LBP is among the top ten causes of long-term disability in every country and number one cause in 86 countries.10 LBP is the fifth most common reason for all doctor’s visits in the United States11 and the third most common diagnosis in German prevention and rehabilitation facilities.12 One year after a first episode of back pain 62% of people will still experience pain while 16% of those initially unable to work are still not working.13 What Back Pain do You Have? 80-95 % non-specific LBP 5% radicular syndrome 1 % serious spinal pathology What is Non-Specific LBP? Today it is widely accepted that the biggest group of LBP is non-specific-LBP. Non-specific LBP means that no anatomic structure can be identified that is at fault. You might be surprised to learn that this is the case with 80-95% of all people with LBP. 9,12,4,5,14,15 How Should it be Diagnosed? Almost all guidelines16,17,6 recommend that people presenting with an acute episode of LBP should be screened for: potential serious pathology (e.g. cancer, fractures, infections of the spine, cauda equina syndrome, systemic disease) that could cause pain in the back radicular syndrome (that means pain arises from the nerve roots in your spine) Potential serious pathologies for LBP are very rare (0,01% spinal infections, 0,7% cancer) and together with neurological impairment make up for approximately 1-5% of all LPB-Incidents.18 Nerve root pain (pain caused by the nerves in your spine) is considered to be present if there is pain radiating down the leg, together with a positive neurological examination (muscle strength, sensibility and deep tendon reflexes should be assessed). The neurological examination is positive when there is a palsy/weakness of a muscle in your leg that wasn´t there before, or if you experience incontinence or urinary retention that wasn´t there previous to your back pain, or if parts of your skin are numb.  If you have no confirmed serious disease and no radicular symptoms you have non-specific LBP. For LBP with substantial neurologic involvement (1-5 %), guidelines generally do not recommend conducting any further assessment until appropriate conservative management (which is rarely defined) has failed, after which MRI or CT (imaging of your spine) is generally recommended.6 Find out more: www.mybackrecovery.com Sources: Duthey BB, Ph D. Priority Medicines for Europe and the World “ A Public Health Approach to Innovation ” Update on 2004 Background Paper Background Paper 6 . 24 Low back pain. (March 2013). Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2(November 2004):192-300. doi:10.1007/s00586-006-1072-1. Savigny P Watson P, Underwood M, Ritchie G , Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough,C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. KS. Low Back Pain: early management of persistent non-specific low back pain. London Natl Collab Cent Prim Care R Coll Gen Pract. 2009;(May):1-235. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. doi:10.1016/j.spinee.2010.03.032. Froud R, Patterson S, Eldridge S, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15:50. doi:10.1186/1471-2474-15-50. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283-298. doi:10.1007/s00586-006-0143-7. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-S168. doi:10.1007/s00586-006-1070-3. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;6736(15):1990-2013. doi:10.1016/S0140-6736(15)60692-4. Cowan P. Consumer Guidelines for Low Back Pain. (Kelly N, Chou R, eds.).; 2008. http://theacpa.org/condition/back-pain. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-165. doi:10.1007/s00586-002-0508-5. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-S191. doi:10.1007/s00586-006-1071-2. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176-185. doi:10.1016/j.jbspin.2011.03.019. Koes BW, van Tulder M, Lin C-WC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-2094. doi:10.1007/s00586-010-1502-y. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586-597. doi:10.7326/0003-4819-137-7-200210010-00010.