Why We Have Brains

Neuroscientist Daniel Wopert suggests that human brains evolved for ONE REASON ONLY.

To control movement:

 

Not thinking, not reasoning, not tool-making.

Movement.

Dr. Wolpert's findings may have implications for physical therapists.

If our human brain needed to evolve in order to control movement, then restoration of movement may take priority over classic, medical approaches. The medical paradigm attempts to "cure" the patient or the pathology.

For example, spinal pain patients are often told that their bulging disc is the cause of their lower back pain. They may then be told that bending, lifting or twisting their back causes further disc bulging and pain. Their typical response is to further limit their activities, especially bending, lifting and twisting.

Perhaps movement therapy should begin before the "cure" or in place of the "cure".

Watch Dr. Wolpert's video and add your comments below this post. Thanks.

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Primary Care Physicians Call for Exercises to Treat Lower Back Pain

Wiser words were never spoke in addressing the paradox of payment for lower back pain and physical therapy treatments. Read on...

"We physicians should refer our patients for exercise... 

...practitioners should work to standardize treatments...

...and payers should encourage these treatments through minimization of copayments for therapies that have both effectiveness and modest cost," 

...concludes a comparative effectiveness study on the benefits of yoga for chronic back pain.

 The study, published online October 24th, 2011 in the Archives of Internal Medicine found that yoga and stretching exercises were superior to education provided by a primary care physician along with a self-care book.

The outcome measure used in the Archives study was the Roland-Morris Disability Questionnaire (RDQ).

A seperate study in the Annals of Internal Medicine, published in November 2011, found that functional scores improved with yoga but chronic lower back pain scores did not improve.

I would like to see this study repeated with physical therapists providing the stretching and/or the yoga treatments.

Rather than studying the comparative effectiveness of branded treatments (eg: yoga) we should study the comparative effectiveness of branded professionals.

Disability Rising Due to Inappropriate Primary Care for Lower Back Pain

Would you go to see an emergency room doctor for treatment of your painful back?

I wouldn't.

Busy emergency room doctors don't want us there either. They are busy saving peoples' lives.

But, this recent report from the Healthcare Cost and Utilization Project at the Agency for Healthcare Research and Quality (AHRQ) indicates that more people are getting treatment for lower back pain in the emergency room than might be warranted.

Hospitalizations doubled from 1993 to 2008 for patients with back problems.

Hospitalized patients with back pain cost $14,338 while patients without back pain cost $9,055. This may be due to the outlier effect of increasing rates of complex, multi-level spinal fusion surgeries that cost $88,000.

"...hospitalizations for back problems in general were more expensive than all other inpatient stays..."

The aggregate costs for inpatient stays principally for back problems was over $9.5 billion in 2008, making it the 9th most expensive condition treated in U.S. hospitals.

Disability Rising

A study from North Carolina followed-up on 5,357 households to calculate the trend in disability due to lower back problems. From 1992 to 2006 chronic, impairing lower back pain rose in North Carolina from 3.9% to 10.2% of the population.

The study authors speculated the causes might be the following:

• Rising rates of Obesity: the number of obese people in North Carolina has increased from 13.4% to 26.6% of the population. Obesity is defined a Body Mass Index greater than 30.0 (weight in kilograms per height in meters squared).
• Increases in depression prevalence: rates of depression doubled from 3.3% to 7.06% through 2002. Chronic pain and depression are linked and individuals with depression are 3 times more likely to develop lower back pain.
• Medicalization of lower back pain: competing healthcare professionals, some advertising on the Internet, have increased public awareness of treatment possibilities despite the fact that many of these treatments are expensive and offer no better long-term improvement than no treatment.

The most at-risk group of North Carolinians are the age group from 45 to 54 years: they became chronically painful at the highest rate of any cohort. Their incidence increased from 15.2% to 26.7% over the time period.

Heavy, Sad and High Tech

According to a recent report in the Journal of the American College of Radiology up to 50% of diagnostic imaging tests are unnecessary and don't add to the patient's improvement.

Imaging scans cost $100 billion annually and these costs are growing 17% per year.

Physician could improve their targeted care of emergent conditions and better serve patient in need by reducing unnecessary imaging for lower back pain.

The following guideline from the American College of Radiology shows a clinical summary of imaging advice.

Further, physicians could reduce the medicalization of common, age-related physical impairments associated with lower back pain by encouraging their patients to exercise and take care of themselves before problems arise.