Assessing patients with low back pain: What are we really testing?

Barry Harpur Principal Osteopath Kinesis Clinic
Barry Harpury
Principal Osteopath
Date Posted
September 19, 2019
Category

With an estimated 507,000 musculoskeletal disorders reported last year in the U.K. alone and 8.9 million working days lost throughout the same period, biomechanical prediction assessments are regularly utilised amongst physical therapists in an attempt to predict injuries in patients prior to their occurrence (‘Statistics – Work related musculoskeletal disorders’, n.d.). However, 6-9% of these reported visits are specifically related to low back pain at a cost in excess of £500 million to the NHS. Although most cases resolve within a short period of time, it is estimated 60%-80% of these patients still report symptoms a year later (Hill et al., 2008). With 85% of these episodes deemed as ‘nonspecific low back pain’ with no obvious causes, pathology or reason the dilemma of diagnosis results in challenging the central biomedical objective knowledge and measurable findings which can frustrate patients and practitioners alike (Hill et al., 2008, Lillrank, 2003).

Functional movement screens and biomechanical assessments have been developed and regularly utilised amongst physical therapists as an assessment tool in an attempt to record what Cook et al. (2014) refer to as a ‘movement competency baseline’ (Cook, Burton, Hoogenboom, & Voight, 2014). Screening methods incorporate movements such as pulling, pushing, lunging, squatting all of which are classed as signature tasks utilised in sport as well as daily living in an attempt to ‘identify deficient areas of mobility and stability in the asymptomatic active population’ (Cook et al.,2014). It is these key movements which are classed as ‘fundamental and the foundation of human movement in its entirety’ (Cook et al.,2014). However, many of these assessment and screens have been proven to be contradicting and ineffective in predicting injury and a general lack of sensitivity to numerical application observed. Dysfunctional movement patterns, muscular weakness and reduced flexibility have all been attributed as a precursor to general musculoskeletal injury (Bennett et al.,2017).

Plisky (2015) suggest that some of the misconceptions about movement screens relate to using these tools to perform something they were never intended or designed to do such as used as a holistic and comprehensive system for predicting injury, medical diagnosis or to specifically pinpoint where the problem is (Plisky, Rauh, Kaminski, & Underwood, 2006). Studies have
shown that prominent other premorbid factors such as sex, age and previous history of LBP have been seen as more comprehensive predictors of persistent disabling low back pain (Thomas et al., 1999). It is these premorbid factors that have now become popular amongst mainstream medical practitioners in the form of back pain related questionnaires such as the STarT back screening tool in an attempt to bridge the gap between subjective and objective outcomes.

One factor that musculoskeletal assessments and movement screen appear to have in common is that focus is weighted on whether an individual can or cannot achieve the required screen movement rather than how. This has resulted in an oversight by developers to arrive at a consensus on the minimum or acceptable level of muscle power, coordination, body weight, balance or flexibility required to achieve the individual screening task at hand of the screen (Sadler, Spink, Ho, De Jonge, & Chuter, 2017). Although the physical task of screening has been shown to have an economical improvement in the care of those who may suffer from acute low back pain (Mofidiet al., 2003) the individuality of each test gives us only a small insight into what is actually going on biomechanically. Many low back pain assessments have been designed in order to test specific muscular functions and postural restrictions from one another that pertain to low back pain. Further research would be needed in order to establish the overall validity and reliability of many of the commercial and popular tests being used today and whether there is and evidence to suggest there would be any benefit in combining certain elements of each such as the additional clinical tests in order to establish a comprehensive screening assessment or biomechanical test.

Osteopath Reviews

Keeping people active and pain free in Guildford
Jason treated a debilitating back injury that had left me in pain for more than a year. Prior to this, I had seen every specialist going and nothing seemed to be working, I had almost given up hope that it would ever get better. I am so glad that I came here on recommendation, as I am now almost completely pain free and can manage any twinges at home with the exercises provided.Jason was very well informed and knowledgeable, able to explain everything very clearly and talked me through treatment and what to expect every step of the way. He used a mixture of laser therapy, dry needling and manipulation and sent follow up exercises, amending my treatment plan as time went on - a completely tailored service that was adapted to my personal recovery. I felt in completely safe hands and couldn’t believe that finally, after such a long time I was seeing progress.If you’re considering seeking treatment and have tried lots of different avenues to no avail, I highly recommend giving this a try, I’m so glad that I did. The difference it has made to my day to day life is unbelievable, and I’m extremely grateful!
Lily Csombor
Lily Csombor
1717479382
Five years ago I had spinal surgery following a fracture. Whilst relatively successful giving a better range of movement initially, by year three years post op intense pain had returned. I could not walk very far and only with the support of a cane.On recommendation, I booked an appointment with Barry Harpur at Kinesis Clinic in October 2023. The scar from my spinal operation is approximately eight inches long and was, in Barry's word's, like concrete. No wonder I couldn't move much.Under his care and more recently Zaneta Kwiecien, things have much improved. Zaneta has a special interest in scar tissue and has worked hard on mine, additionally giving me exercises to improve my core and general mobility and introduced me to acupuncture which I believe has been beneficial.My mobility has much improved and the scar tissue itself has improved so much that it no longer restricts my ability to bend. I only wish I had attended the clinic sooner.Today I spent four hours walking around RHS Wisley Gardens, without once resorting to the support of my cane. It is difficult to express how this feels and how grateful I am to the Kinesis Team for getting me this far in improving both my physical and mental health. I have had a particular walking goal for the last three years, and I know that this year I will achieve it.I would encourage anyone with scar tissue that has an adverse affect on health and mobility to consider a consultation at Kinesis Clinic
Chris Costa
Chris Costa
1712779072
I injured myself weightlifting and my backpain was waking me up and preventing sleep. Jason was fantastic, very professional, calm and great at explaining everything he was doing and why, which made me feel very comfortable and literally 'in safe hands'. He not only manipulated the injured area but also used a laser therapy which felt amazing. He kept the exercises I needed to do at home simple, and sent a video for future reference. Having had an awful experience of another osteopath who literally sat behind his desk, lectured me and did nothing re actually treating my injury beyond a few at home exercises, Jason and Kinesis were brilliant. The pain gradually got better and now I simply come in for a top up if anything tweaks.I cannot recommend them highly enough.
Sally Davis
Sally Davis
1711782111
Six years ago I fell out of a raft whilst white water rafting, bouncing over some rocks I cracked some vertebrae.The following year having fallen again I started to have severe pains in my hip and leg making it painful to walk.Over the next years I tried all sorts of treatment, painkillers, injections and manipulation. Nothing seemed to work and I was beginning to give up.In October last year a friend suggested I try once again with a practice in Guildford called Kinesis Clinic.I made an appointment for an initial assessment and met Miss Zaneta Kwiecien. Having been assured that something could be done to lesson the pain I booked for treatment to begin.I could not believe it but after just a few sessions I began to feel an improvement. Now months on I walk my dogs for a hour or more a day with only a little discomfort and some days NO pain.The mixture of laser, aquapuncture, manipulation and most important designed exercises has changed my life.Many, many thanksRobin Gardner
robing
robing
1711465023
I came to Zaneta with severe lower back pain and symptoms of sciatica. She was able to quickly diagnose the root cause as weakness stemming from pregnancy and labour. The treatments provided significant relief from the pain and she has been equipping me with functional exercises to improve strength and ensure that it doesn't flare up again. I've been amazed by the results so far, Zaneta has been fantastic.
Hannah E
Hannah E
1700852974
I cannot recommend the Kinesis Clinic highly enough. Earlier this year I came to Barry on the recommendation of my son for muscle pain in different areas of my body. To date he has worked a miracle and seem to be relatively pain free. Throughout this process I have tried other practitioners and none compare with Barry and his in depth knowledge. One of the most impressive things is the knowledge of his individual patients and the attention he gives you. I must also add that Lucy on reception is a real asset and is always willing to help in any way for the benefit of the clients.
Maureen kulik
Maureen kulik
1700686071
There's simply no one better than Kinesis. If you're looking for an osteopath, you've found the answer! ⭐️⭐️⭐️⭐️⭐️
Marc Gorman
Marc Gorman
1700459240
I had been in pain for 7 years and thought that was what life had to be like, and then I found Barry! He worked out immediately what my issue was (a long list of people had failed!!) and in one session reduced my pain significantly. Over 4 sessions he has made significant progress on my hip and shown me what the plan is going forward. Finding Barry literally changed my life and I couldn't be more grateful to him.
Ellie Apperly
Ellie Apperly
1693281266
I went to see Barry for rehab after fracturing my spine. He’s an excellent Osteopath, taking time to understand the issues, and provide the right treatment and a tailored home exercise program. His YouTube exercise videos are also very helpful to follow. My mobility and strength improved significantly as well as much less discomfort. Thank you Barry!
Tom
Tom
1692120023
I had a reoccurring shoulder dislocation injury due to playing various contact sports and after numerous operations my shoulder was weak, the muscles trembled as I tried to strengthen it. After struggling with it for over 10yrs I went to see Zaneta in the clinic. The main problem for me was the trembling and shaking as I tried to exercise and lack of flexibility. Zaneta used some instrument (big stainless-steel spoon in my non-medical world) to breakdown the scar tissue. After a few weeks my shoulder was unrecognisable. I can now exercise without the shaking, meaning I can strengthen it. Interestingly, I now have a greater range of movement than my ‘good’ shoulder.
Richard Leader
Richard Leader
1692114852
Ms Zaneta helped me a lot, especially when my back was falling apart after pregnancy! Huge thanks!
Ola Dos
Ola Dos
1688457910
Gareth has provided to me a fantastic and very personal service regarding my shoulder and lower back problems. I would thoroughly recommend him – well done
Peter Craig
Peter Craig
1660667097
I can't praise Jason highly enough, I've been seeing him for a few months and he's helped me so much, he's much more than my osteo, he's also a counsellor, business coach and all round great listener.Whenever I leave our session I feel better inside and out.
Susan Walsh
Susan Walsh
1652885930
Cannot rate Barry and the clinic higher, I have met everyone there and they are all professional but very friendly. They have been great at fitting me in, supporting me and making me feel like a valued customer. Have recommended to a number of friends that have had the same experience.
Lisa Collins
Lisa Collins
1636450785
I am so grateful to the whole team at Kinesis Clinic for all of the treatment I have had with them over the past 2.5 years following an accident. For the past year, Barry has helped me to heal my neck, and the dizziness associated with the injury. I feel that he really cares about his patients' recovery, and has so much wisdom to share. He has helped me to see how my mind and emotions also play a role in recovering, and this has prompted me to change patterns in my life that were worsening my symptoms. His approach to treatment has been gentle, but very effective. I can't recommend Kinesis Clinic enough. Thank you :)
Megan McInnes
Megan McInnes
1632602100
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Barry Harpur

Principal Osteopath

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