Doctors education Seminar: Back Pain – A Paradigm Shift in Management.
Dr David Johnson, Brain and Spinal NeuroSurgeon, NeuroHAB Movement Therapist, Olympic Weightlifting Trainer, Nutrition Educator
Educating Doctor’s about Functional Movement and NEUROHAB. I think there were many “light bulb” moments for our doctors. See for your self.
Consider movement in the context of sport, requiring elements of skill, athleticism and training. Proficiency in the sport of movement with specific competence in the domains of coordination, mobility and strength is likely to impart an advantage in preventing and recovering from non specific low back pain (NSLBP). Conversely, if our modern industrialized society actively suppresses proficiency in the skill domains of this critically important, “sport of movement”, of which every individual mandatorily must participate, one could postulate that this may be the root cause of NSLBP and logically should be the primary first line therapeutic target. This theory has been tested prospectively with profound success at two Functional Movement Training Centres in Brisbane, Queensland, Australia, applying distinctive movement training techniques. The success therein justifies further robust research to affirm and replicate these promising results.
Movement Deficiency (MD) is hypothesised to be a significant contributor to the high prevalence of Non-Specific Low Back Pain (NSLBP) in our modern industrialized society. Treatment of low back pain symptoms is conventionally directed towards symptoms. This is clearly apparent by the misguided yet accepted diagnosis and commonly misused label of “Non-Specific Low Back Pain” which itself is not a diagnosis at all but an admission that the disease causing the symptom remains nebulous. This is unacceptable if progress is to be achieved in controlling the rising prevalence and economic burden of this condition. If the aforementioned hypothesis and authors are correct, in that the disease causing NSLBP is spinopelvic Movement Deficiency, a distinctive NSLBP management paradigm shift can be implemented with the treatment targets being those of neurologically corrupted motor patterns manifesting as movement deficiency with secondary musculoskeletal sequelae and back pain symptoms. If low back pain is considered to be a primary neurological movement disorder we can switch our focus away from common, expensive, invasive and often poorly efficacious strategies such as interventional nociceptor blocks, core stability, Pilates, exercise therapy, adjustments and deep tissue release toward restoring the primary condition of corrupted central nervous system controlled movement proficiency.
Low back pain is the leading cause of disability worldwide and its prevalence continues to increase despite a staggering explosion of treatment options, some considered conventional and many less so. Invasive technology including interventional pain blocks and back pain surgery refinements are advancing exponentially in an attempt to effectively treat the often desperate needs of the millions of back pain sufferers that ultimately resign to surgical intervention once physical, pharmaceutical and maladaptive behavioural measures fail to control symptoms. Sadly many of these patients still continue to suffer unrelenting symptoms remaining lost, bewildered and as helpless as their medical or allied health professional.
The long-term results of the Swedish Lumbar Spine Group’s 2001 paper on lumbar fusion versus non-surgical treatment  are finally available in Hedlund et al.’s follow-up study . Whereas the 2001 study reported significant decreases in chronic low back pain (CLBP) with spinal fusion surgery , the secondary outcomes measured at a mean of 12.8 years show that substantial disability remains within the surgery group when compared with non-surgical management .