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
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
Unparalleled treatment from Barry and his team. I've sifted through many physiotherapists and osteopaths for disc related problems in the past two years before being saved by Barry; an erudite and scholarly practitioner who draws on his immense, esoteric knowledge and experience to inform sessions. Barry precisely and effectively reads/listens to my body; no session is the same and I'm always in awe of the variety of techniques he uses to diagnose and pinpoint areas of concern. His methods are subtle yet sublime: he often releases and manipulates muscle/tissue/joints from a number of points in my body where a link to the referred pain perhaps appears tenuous for a layperson like myself...I've been redirected from possible surgical intervention to non surgical treatment and management where I finally feel more stable and strong. Gareth and Jason have also played a significant part in treating me over the year and I honestly couldn't recommend them enough!
B
B
1641503952
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
The team is very welcoming and supportive with all your needs. I see them every 2 weeks just get my body sorted out to help with any niggle that come up. I would definitely recommend kinesis Clinic and there team to help you with any problems your having. Weather is sports related or your haven’t any past injuries this the team to help you.
omololu abiodun
omololu abiodun
1625807758
Jason is a professional, friendly and brilliantly talented osteopath. I started treatment at the clinic for upper back/shoulder pain and migraines a few years ago and I have experienced a significant improvement in pain levels/migraines since then. Initially I had regular appointments but now I just book when needed. I get immediate relief with each session, and the positive effects often last for weeks afterwards. Out of all the treatments I have tried, Jason’s osteopathy practice at Kinesis Clinic is by far the most effective. I am so glad I found the clinic and I would now not go anywhere else. Highly recommend.
Kate M
Kate M
1625091952
Gareth at the Kinesis Clinic is an amazing Osteopath. He has helped me to provide effective solutions for over 2 years with different muscular and neural issues I have had as an elite athlete. He is extremely knowledgeable in his field and can expertly used different treatments such as manual and laser therapy for rehabilitation. He always adapts his approach and provides personal home programmes to follow which greatly help too. I would definitely recommend him for anyone who wants to use the Kinesis clinic for the first time.
Olumide
Olumide
1624814371
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Barry Harpur

Principal Osteopath

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