Lederman_The_fall_of_the_postural-structural-biomechanical_model

Sample Solution

Findings on Spine Posture and Low Back Pain (LBP)

Based on the two articles, "No consensus on the causality of spine postures or physical exposure and low back pain 2020.pdf" and "Lederman_The_fall_of_the_ postural-structural-biomechanical_model.pdf," here's a summary of the relationship between various factors and LBP:

1. Spinal Curvature: There is no clear evidence linking specific spinal curvatures (like kyphosis or lordosis) to LBP incidence.

2. Awkward Postures: Similar to spinal curvature, current research doesn't definitively establish a causal link between awkward postures and LBP.

3. Specific Movements (Standing, Sitting, Bending, Twisting): The studies don't show a direct cause-and-effect relationship between these movements and LBP.

4. Heavy Physical Work: While heavy physical work might be associated with LBP, the research doesn't confirm a causal link.

5. Tight Hamstrings/Psoas or Lower Limb Inflexibility: Similar to the above points, there's no clear evidence that tightness or inflexibility in these areas directly causes LBP.

Changes in Assessment Based on the Reviews

These reviews highlight the limitations of solely focusing on posture or specific physical exposures when evaluating LBP. Here's how my assessment would change:

• Holistic Approach: I would take a more comprehensive approach considering factors like psychosocial aspects (stress, job satisfaction), overall health, and individual risk factors.
• Focus on Function: The assessment would emphasize evaluating functional limitations caused by pain, rather than just focusing on posture or movement patterns.
• Movement Analysis: While specific postures might not directly cause LBP, a movement analysis can identify movement dysfunction that may contribute to pain.

Full Answer Section

Objective Examination Considerations

The objective examination should be guided by:

• Pain location, intensity, and duration
• Range of motion and functional limitations
• Neurological testing for signs of nerve involvement (radiculopathy)
• Palpation for tenderness, muscle tone, and joint integrity
• Strength testing of core and lower limb muscles

Points from The Lancet Series on Low Back Pain

Unfortunately, I don't have access to the specific Lancet Series reading you mentioned. However, I can address the points based on general principles of low back pain assessment:

a. Unique Aspects of Assessment:

• Focus on Red Flags: The assessment might prioritize identifying serious underlying conditions ("red flags") that mimic LBP, like infections, fractures, or cauda equina syndrome.
• Social and Psychological Factors: The assessment may explore social and psychological factors that can influence pain perception and recovery.

b. Goals of Assessment:

• Checking "Alternative Diagnoses": This aims to rule out conditions that might masquerade as LBP, ensuring appropriate treatment.
• Identifying "Associated Risks": This step helps predict potential complications or chronicity of LBP based on factors like work demands, psychosocial stress, or prior injuries.
• Imaging Recommendations: Imaging is generally not recommended for most LBP cases. However, it might be considered if red flags are present, neurological deficits are suspected, or pain persists despite conservative treatment.

This analysis highlights the importance of a comprehensive approach to low back pain assessment, moving beyond posture and physical exposures to consider a wider range of factors that contribute to pain and disability.