Lederman Thefall of the postural-structural-biomechanical
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The Fall of the Postural-Structural-Biomechanical Model and Low Back Pain
Based on the article "The fall of the posturalâstructuralâbiomechanical model in manual and physical therapies: Exemplified by lower back pain" by Lederman, here's a breakdown of the relationship between various factors and low back pain (LBP):
1. Spinal Curvature and LBP: The article suggests a weak association between spinal curvature (e.g., scoliosis, kyphosis, lordosis) and LBP. Most people with these curvatures do not experience pain.
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2. Awkward Postures and LBP: Similar to spinal curvature, the article challenges the direct link between awkward postures and LBP. There's limited evidence that maintaining specific postures necessarily causes pain.
3. Activities and LBP: While repetitive bending, twisting, and certain work postures may contribute to LBP in some cases, the article argues that these activities aren't the sole cause.
4. Heavy Physical Work and LBP: Heavy physical work can increase the risk of LBP, but the article emphasizes that many people performing such work don't experience pain. Individual factors and biomechanics likely play a significant role.
5. Tightness and LBP: Tight hamstrings or psoas muscles might be a consequence of LBP, not necessarily the cause. The article suggests focusing on addressing pain rather than solely targeting tightness.
Changes in Assessment: The review challenges the traditional postural-structural-biomechanical model of LBP assessment. Here's a shift in focus:
- Less emphasis on posture and static examination.
- More focus on psychosocial factors, red flags (serious underlying conditions), and a holistic approach.
The objective examination should be guided by:
- Patient's history and pain presentation.
- Identifying red flags requiring further investigation.
- Assessing functional limitations and overall health.
Lancet Series on Low Back Pain: Assessment
a. Unique Aspects of Assessment:
The Lancet Series emphasizes a more holistic approach to assessment compared to a traditional medical model. It highlights:
- Focus on social and psychological factors: Stress, anxiety, and depression can significantly impact LBP.
- Importance of identifying red flags: These are signs or symptoms that may indicate a serious underlying condition requiring further investigation.
- Limited role of imaging: Routine imaging (X-rays, MRIs) is generally not recommended for most LBP cases.
b. Goals of Assessment:
- Checking for alternative diagnoses: Rule out serious medical conditions that can mimic LBP.
- Identifying associated risks: Assess psychosocial factors, work demands, and lifestyle habits that may contribute to LBP.
- Imaging recommendations: Imaging might be necessary if red flags are present, but should be considered judiciously to avoid unnecessary radiation exposure and costs.
This approach aims to provide a more comprehensive understanding of the individual's LBP and develop a personalized management plan.