tag:blogger.com,1999:blog-6193043695356712843.post2468354268997473541..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Manual handling techniques and back painDr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-6193043695356712843.post-36031641739935746712014-05-10T18:11:32.842+10:002014-05-10T18:11:32.842+10:00Hmmm. Faster than what? Use of a comparative word ...Hmmm. Faster than what? Use of a comparative word implies a comparator. Given that most back pain recovers your treatment may not work directly, but indirectly by making use of the time taken in treatment for the back pain to resolve.<br />Also, your webpage is dull and unrelated to the topic at hand. I accuse you of being a spammer. What say you?Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-41889635818068744942014-05-09T21:43:53.354+10:002014-05-09T21:43:53.354+10:00Age - Muscles and bones age which can result in le...Age - Muscles and bones age which can result in less support for the back muscle's.<br /><br />Dorsiflex the ankles by pulling your toes up and back towards <br />you while pushing your heels down. Although not backed <br />by scientific evidence, there have been cases where physical treatments have resulted in faster recovery from lower back pain.<br /><br /><br />my webpage <a href="http://www.storenvy.com/alisonwhitson" rel="nofollow">กระดูกทับเส้น</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-18989790561120257152013-01-06T12:27:24.367+11:002013-01-06T12:27:24.367+11:00Thanks Claudio,
The idea that the body strengthens...Thanks Claudio,<br />The idea that the body strengthens in response to the demands/loads placed upon it is well accepted. It gets tricky when we start to modify the loads. The science behind the actual loads we get in certain positions is poor, and isn't there a problem with under-loading the body? Everything has unintended consequences. Sounds like the historic view of the future where we hardly need to lift a finger.<br />The other point you raise is a good one, particularly for this topic: that of efficacy versus effectiveness (explanation here: http://www.amhd.org/cebp/concept3.html). I hate that use of language, but that is what is currently accepted. Is the advice good, but just not taken correctly / adhered to? I am a pragmatist, so my argument is that if people will not / can not use it correctly, then it won't work. Efficiency wins out over efficacy.<br />I will challenge your last paragraph though. In my experience, if something is not effective in randomised trials, then it is rarely a matter of doing the trial a little differently to tease out the hidden effect. With all the bias out there making every intervention look good and every trial have favourable results, if you have a negative result, it is likely that you are sitting on a dud.<br />Thanks for the comment and keep reading. Might write on ergonomics soon.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-10838483737618307202013-01-06T11:37:56.467+11:002013-01-06T11:37:56.467+11:00Hey Dr. Skeptic,
I was so focused on writing the ...Hey Dr. Skeptic,<br /><br />I was so focused on writing the reply to your article that I adressed it to mmv. My bad. It was meant as an answer to your blog post, not mmv's message.<br /><br />Thanks,<br /><br />ClaudioClaudio Mesquitahttps://www.blogger.com/profile/04407601622719979346noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-35150678347810596652013-01-06T11:33:14.737+11:002013-01-06T11:33:14.737+11:00Hello mmv,
it's a tricky topic, let me see if...Hello mmv,<br /><br />it's a tricky topic, let me see if I can add to the discussion.<br /><br />Well, I like the theory that the more strong (physically, structurally) you are, the better you are able to tolerate loads that you face, be it in sports, daily living, work, whatever. And this hypothesis is more specific if you consider muscle strenghtening, as you are not only developing strength, but your bones, cartilage, tendons, well, you musculoskeletal structure gets tougher, more able to receive any kind of loading without "breaking" or developing any kind of pain.<br /><br /><br />Therefore, regarding weightlifters, their strong structure protects them against overloads, so that doing "incorrect" movements (movements that generate some extra load onto the structures of your body) they are much less prone to developing pain or tissue damage than, say, a sedentary man of the same age.<br /><br />Regarding the manual handling techniques, what they usually try to show is the way that generates less overload on your structure (usually low back). However, on that I don't have a lot to say about their effectiveness, other than I teach my patients to usually load their backs without bending too far forward and keeping the straight spine.<br /><br />At the same time that I agree with you regarding evidence based medicine/physical therapy/put any health profession here, I don't think that we really control every factor when we develop research. It is very hard to say if the manual handling folders work or do not work. How to know if people really read them, really followed them, really fololowed them correctly, etc. However, other factors may come first in relation to the manual handling skills, as adequation of overload to the persons strenght/size profile, individuals physical conditioning, amount/frequency of load the person may be exposed to, etc.<br /><br />I would not say just because there is evidence that because evidence suggests that manual handling advice and training are useless, they really are. I think that they may be useful, but that usefulness has not been quantified o examined.<br /><br />Regards,<br /><br />ClaudioClaudio Mesquitahttps://www.blogger.com/profile/04407601622719979346noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-66068009788964577672012-08-24T16:27:26.059+10:002012-08-24T16:27:26.059+10:00This comment has been removed by a blog administrator.Liza karenhttps://www.blogger.com/profile/14360182280694733896noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-13520693238398229582012-08-09T13:27:28.269+10:002012-08-09T13:27:28.269+10:00I enjoyed reading your articles. This is truly a g...I enjoyed reading your articles. This is truly a great read for me. I have bookmarked it and I am looking forward to reading new articles.<br /><br />http://www.totalbodynj.comback pain treatment njhttp://www.totalbodynj.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-80077371708255950152012-08-06T10:28:29.167+10:002012-08-06T10:28:29.167+10:00... and I would estimate that most of them do not ...... and I would estimate that most of them do not provide relief beyond their placebo effect.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-81528930161212166012012-08-06T03:20:59.119+10:002012-08-06T03:20:59.119+10:00There are more than 60 medications currently being...There are more than 60 medications currently being offered to back-pain patients. There are well over 100 different manual techniques in chiropractic, physical therapy, osteopathy, and massage therapy. More than 20 different exercise programs exist. There are more than 9 educational and psychological therapies and more than 20 different injection therapies. In addition, there are a variety of minimally invasive interventions offered as an alternative to surgery, and many surgical approaches. Finally, there are a large number of lifestyle products such as braces and beds, and a constantly changing variety of complementary and alternative medical approaches.nj physical therapyhttp://totalbodynj.com/noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-52674632741240999152012-07-24T22:52:08.438+10:002012-07-24T22:52:08.438+10:00Thanks mmv,
I take your point about the disconnect...Thanks mmv,<br />I take your point about the disconnect between efficacy and effectiveness. Smoking may be bad, but that doesn't make quit smoking programs effective. Similarly, we don't know if manual handling techniques really work, only that implementing them doesn't work.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-49978181866185920912012-07-24T21:09:18.711+10:002012-07-24T21:09:18.711+10:00That may be true - but the example of weight lifte...That may be true - but the example of weight lifters is not exactly accurate. A weight lifter will train over long a period of time in order to be able to lift heavy things safely. Just like other sports there is a lot of technique involved - so there is probably a reason why they don't hurt their backs. <br /><br />The techniques listed for "safe lifting" may well work with time and training, it's just that the posters dont work, any more than the "no smoking" signs outside hospitals stop smoking. <br /><br />The benefit of the hovermats and similar devices is that a group of very small people can move a ridiculously heavy patient with ease, and with the increasing size of our patients I can only see more such things being used!mmvnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-15876878687013480102012-07-20T23:54:32.795+10:002012-07-20T23:54:32.795+10:00Thank you for sharing about back pain, NJ. Great p...Thank you for sharing about <a href="http://www.empowereddoctor.com/1003/back-pain-treatment-nj/" rel="nofollow">back pain</a>, NJ. Great post, good job.taherahttps://www.blogger.com/profile/00354298346359956039noreply@blogger.com