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Lower Back Pain: Orthotic Therapy or Core Strengthening?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Lorraine Munro, Aug 15, 2008.

  1. Lorraine Munro

    Lorraine Munro Active Member


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    I would like to ask peoples views on whether they believe orthotic therapy or core strengthening is appropriate in the treatment of someone who presents with lower back pain and a marked valgus resting stance position. In my opinion I believe that simply referring to a physio who specialises in pilates and core strengthening is the appropriate avenue for this person. I believe that by strengthening ones core and resolving increased anterior pelvic tilt good results should be seen and orthotic therapy may then not be required. I would also like to ask if practitioners have seen a connection with developmental delay or children with "behavioural" problems and core instability?
    Many thanks
     
  2. DrPod

    DrPod Active Member

    I would have thought you use core strenthening if that is contributing to the problem and you use foot orthoses if the foot is contributing to the problem. The challenge in the lack of good evidence is to determine if the foot is contributing. If the back pain is made worse by standing, then there is potential for the foot to be contributing
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Atlas

    Atlas Well-Known Member


    Might as well send them to a personal trainer who has done a 7-day course in pilates and core strength.


    If the patient's main problem is back pain, the podiatrist's main job is to address possible back influencing factors distally. Temporary measures such as heel-raises to neutralise LLD; or biomechanical changes etc. The short-term goal is to discover if there is a connection.


    My advice would be to send them to professionals OTHER than a:
    - physio who will dogmatically propose that the problem is core strength. (Read Brian Mulligan's recommendation to physiotherapists around the world)
    - chiro who will dogmatically suggest that 'subluxation' and alignment is the issue.



    Ron
    Physiotherapist (Masters) & Podiatrist
     
  5. nicpod1

    nicpod1 Active Member

    Hi Ron,

    I'm absolutely intrigued by your posting, advising us NOT to send to a Physio in these cases!

    I've found, over the years, that if any patient group is going to get a problem folowing orthoses therapy, it's those with a history of back problems, either as their primary or secondary pathological presentation.

    I work very closely with Physios and, generally speaking, if a patient presents with back pain as the sole reason for seeing me, and they have never seen a Physio, I would assess them to see if I could pick up the cause of their back pain and whether there's anything I could do to help and would only intervene minimally until they saw a Physio!

    However, as a Physio yourself, I see, you seem to be warning us off one of your own professions, including yourself, therefore, I would asume, as though all Physios think and act the same way in regard to back pain..........could you let me know more specifically why we should refer to a dubiously trained (perhaps) pilates 'person' rather than any Physio at all?

    It would be interesting to see what the Physios I work with would think about this mass generalisation of their treatments!

    Further enligthenment would be appreciated, given the amount of back pain patients I deal with every day!
     
  6. Atlas

    Atlas Well-Known Member

    Nicpod 1, the word you should focus on in my post is the word "dogmatically".


    Go back through the subjective history of your back-pain patients. Some will find that sitting is awful, and hence will prefer to stand....they may even enjoy a walk. Others will find sitting more tolerable than standing. Some will prefer to bed-rest to get some relief and deplore activities such as standing and walking.

    Back pain is not one problem; and nor is it one solution.

    Back pain has a number of different guises.


    The old physios of the past had more of an idea IMO. Their knapsack was full of hands-on-mobilisation (spinal and/or soft-tissue); traction; McKenzie extension/flexion; taping; bracing.

    Now, you have a generation of physios that have convinced themselves that core-strengthening, multifidus, transversus abdominus is the panacea for all back pain. One solution, means that you really don't have to diagnose or test one thing. One solution to THE back pain problem. Now we have lazy, hands-off, timid, suedo personal-trainers who prescribe exercises. These one-trick-ponies who dogmatically shout that braces are bad; that activity is great. And guess what, when patients have not got better, it is a lack of compliance!
     
  7. nicpod1

    nicpod1 Active Member

    HI Atlas,

    Yes, I see your point having gone through it myself with a neck problem and some sort of attitude that was coming from the Physio I first saw about 'hands off......it's a chronic pain patient!', simply because I'd had the condition for more than 6 weeks and despite the fact that I demonstrated no fear avoidance PSF factors at all (at least in my mind!)

    However, a lot of the really good Physios I deal with are almost 100% manual therapy based, with, like you said, strapping etc being used as well. However, some of them are young and not at all old school!

    I just think it may be a little misleading to the original poster to suggest that Physios should be avoided in relation to treating back pain.....? Given the reputation of my profession and orthoses, it would be like saying ALL Podiatrists treat everything with orthoses.......perhaps it would be more correct to say that if the Physio you're dealing with treats everything with core stability, then it might be better to try someone else?

    I only raise the point because I couldn't do what I do without the great teamwork from the really good Physios I work with!

    Anyway, you've only got to watch the athletics at the olympics for 5 minutes before you start to think that core stability and, even, gait re-training is all a load of tosh given the amount of lumbar lordosis and pelvic tilts I've seen see sawing around the track......and coming first!

    Best wishes!
     
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