When to have an MRI? An Osteopath can advise you

     Do you really need an MRI for your back pain?

The evidence for usefulness of scans

A turning point in understanding the value of magnetic-resonance imaging (MRI) came in 1990 when researchers (Boden and colleagues1) investigated an important question: “How do the spines of people with no symptoms of lower back pain or sciatica look on MRI?”Before then, researchers had mostly looked at scans of people who had symptoms.

What they found was surprising. The older the person, the more common it was to have spinal degeneration in the lower back. 57% of subjects over 60 years of age had abnormal scans of their lower back such as a herniated (bulging) disc or degeneration of the spine. Of the people under the age of 60, 20% showed disc herniations. Only a third of the subjects were found to have no abnormality on MRI. And these were people without any history of back pain or sciatica!

These findings were supported some 8 years later by researchers in Japan (Matsumoto and colleagues2)who looked at the MRIs of the necks of 497 people. None of these people reported ever having neck pain. The Japanese researchers found it was common to have degeneration of the neck: 86% of men over the age of 60 and 89% of women over the age of 60 showed signs of degeneration in their cervical spines. Even in those people in their 20s there was degeneration on MIR: 17% of men and 12 % of women.

How do we make sense of this information? From this and other research, it is known that degenerative changes of the spine as viewed on scans such as MRI are common, often not causing pain and are part of the normal ageing process. For this reason, osteopaths avoid routinely requesting imaging.

What is the Osteopath’s view?

In osteopathic practice, it is common for the osteopath to be presented with a white folder of X-rays and/or MRI scans, which the patient’s GP ordered for them. Osteopaths use their clinical skills and keep themselves informed of the evidence. Thus, they can decide when scans are useful and when they are not. If the patient has not already had a scan, they may not need to spend time and money getting one.

Where imaging would be useful is in situations where it would change the way the patient’s symptoms would be managed. Imaging may be useful when a patient is not recovering from acute back pain as expected or when surgery is a likely pathway. In some cases of chronic pain, imaging may be helpful. Osteopaths also may refer for further imaging when there is evidence of other contributing factors to the presentation of back or neck pain.

When is imaging not useful?

Most acute episodes of back or neck pain tend to settle within 1-2 months with skilful osteopathic management and active recovery. Evidence-based osteopathic practice guidelines do not recommend imaging as it can potentially have a twofold effect. Firstly, we now know that changes to the spine are common and may exist prior to the acute episode or injury and so are not relevant. Secondly the results could confound the recovery process potentially doing more harm than good. This is evident with chronic back pain where we now understand complex neuroplastic changes occur both in the brain and nervous system.

As always, if in doubt, have a conversation with your osteopath.

By Vincent King – Sydney Osteopath, Wholistic Medical Centre

https://www.hotdoc.com.au/medical-centres/surry-hills-NSW-2010/wholistic-medical-centre/doctors/vincent-king-b-app-sc-m-ost

References

1 Boden, S., Davis, D., Dina, T., Patronas, N. and Wiesel, S. (1990). “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation”. The Journal of Bone & Joint Surgery, 72(3), pp.403-408.

2 Matsumoto, M., Fujimura, Y., Suzuki, N., Nishi, Y., Nakamura, M., Yabe, Y. and Shiga, H. (1998). “MRI of cervical intervertebral discs in asymptomatic subjects.” The Journal of Bone and Joint Surgery, 80(1), pp.19-24.

Are you debilitated by chronic persistent pain? Turn the volume down with osteopathy

chronic persistent pain

Turn the volume down on chronic persistent pain

When persistent pain is part of daily life

It is only recently that the complexities of chronic pain have been the subject of investigation. As a result, pain medicine is moving into a new era with the deeper insights that are emerging from this research. See the resources listed below.

If you are debilitated by persisting pain, Sandra’s* experience may resonate with you.

Collision course

Sandra brought a multitude of investigations, images and tests to her first osteopathic appointment. As Sandra’s personal story unfolded, it became clear that she had been living with such pain and disability that it had taken over all aspects of her life.

It began when Sandra was 20 years old. She was involved in a car accident as a passenger in the front seat. The collision left her with severe lower back pain. Scans at the time did not indicate structural damage. Her injury significantly improved over the years although there were occasional episodes of acute sharp pain if she sat too long or bent a certain way.

Early last year while skiing, some 2 years after the motor vehicle accident, Sandra fell onto her back, re-aggravating her lower back pain. Ever since that fall her pain would not settle easily. The only way she could get some relief was with strong prescribed pain medication.

Sandra was no longer able to exercise or work full time due to her now persistent pain. She was also unable to have a refreshing night’s sleep. An MRI indicated spinal arthritis and disc herniation in the lower back.

She had been to see “everyone” with no improvement. Her doctor told her it was all in her head. Surgery was recommended by a specialist.

Understanding chronic pain

After a more detailed history and a routine physical movement assessment, it was explained to Sandra that all signs were pointing to the fact that she was suffering from persisting, chronic pain. This is very different to acute pain and therefore requires very different treatment. Continued persisting acute pain signals confluence with our past experiences, cultural underpinnings and meaning of pain to affect changes to the spinal cord and brain. These signals lead to plastic changes to the central nervous system which is the mechanism behind chronic persisting pain.

Turning the volume down

Sandra’s reduced engagement with the world due to her now chronic persistent pain, such as cessation of exercise, cutting back her work hours along with her poor sleep, is common in those suffering from chronic persisting pain, but was also contributing to turning the volume up on her symptoms.

So, in the osteopathic consultation, strategies to turn down the volume on pain were outlined and discussed. These involved continued self-education on chronic pain, returning to paced / dosed general exercise and building her “support dream team”. A support dream team, for example, could include a GP, an acupuncturist to help with pain management, an osteopath to keep the muscles free of spasm and joints mobile and a psychotherapist to explore barriers to the road to recovery.

Was the persistent pain all in Sandra’s head?

When her initial doctor said: “It is all in your head”, he was partially right and partially wrong. It is right in one regard as discussed above, as plastic changes do occur in the central nervous system, but he was incorrect to say “it is all in your head” without contextualising, as it infers blame. Blame does not enable change.

Through pain education, pain management, improved sleep, dosed exercise and building a recovery support team, the outcomes are much more powerful and positive.

Sandra is now swimming and bushwalking again. And though she has bouts of pain, she feels she has the tools now to turn down the volume on her pain and so in doing, turn the volume up on living again.

Vincent King. Osteopath at Wholistic Medical Centre

* Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

RESOURCES

1) The pain toolkit

www.paintoolkit.com

Great starting point and practical strategies for implementing the road to recovery plan.

2) Tasmanian Persistent Pain Booklet

http://knowpain.co.uk/wp-content/uploads/2014/05/TazzyPersistentPainBooklet.pdf

3) Pain Australia

Education hub for patients and health professionals on the emerging research of pain.

4) Ted Talk: “Why things Hurt” by Lorimer Moseley

https://www.youtube.com/watch?v=gwd-wLdIHjs

An entertaining exploration of the physiology of pain.

5) Chronic Pain Australia

www.chronicpainaustralia.org.au

Osteopathy is available on Saturdays

Is your work week so busy you are finding it had to make an appointment to attend to your back pain or headache?

Wholistic Medical Centre offers osteopathy on Saturdays from 9am to 2pm.

Osteopath available:

Vincent King, Dip H.Sc (Massage) B. App. Sc. M.Ost

 

 

Tension headaches

Suffering from tension-type headaches? How osteopathy may help

tension-type headaches

Many of us experience headaches from time to time.

Yet often at peak times of stress in our lives – like tight deadlines at work – they can be impossible to shift for days and even weeks at a time. These tension-type headaches can be incredibly debilitating and limit our ability to function properly in our day-to-day lives.

Osteopathy may help.

Whilst patient responses to osteopathic treatment can vary from patient to patient – due to patient sensitivity to treatment and other lifestyle contributing factors – many people experience positive outcomes after osteopathic treatment.

Joseph* came to the clinic complaining that he had been suffering ongoing headaches for three weeks. He didn’t report any migraine-type symptoms such as nausea or sensitivity to light; rather he had a feeling of pressure and tension from the back of the head to the temples on both sides. He felt the longer the headache continued, the neck and shoulders increasingly stiffened up, causing an aching and burning sensation.

Joseph worked as a web designer and was currently finishing a stressful project. He was working 10 hour days and weekends to meet the upcoming deadline.

Assessment of Joseph’s neck, shoulder and jaw muscles found these to be very tender to touch. Lightly pressing the joints of his neck and base of the skull reproduced his headache symptoms at the forehead and behind the eye.

Joseph was diagnosed as suffering from a tension-type headache, caused by tension in the structures of the neck. This diagnosis was made through physical assessment; the ability to reproduce his headache with light pressure; the exclusion of symptoms related to other headache forms and from an understanding of his stressful work situation.

Contributing factors were both physical – long periods of computer use and lack of regular physical exercise – and emotional – heightened stress levels at work in getting his project finalised to deadline.

Joseph’s muscles and joints in his back, neck and head had tightened and needed to be released for the headache to shift.

Osteopathic treatment combined manual therapy to the tight muscles and joints of the back, neck and head with self-management strategies such as stretching and regular whole body exercise.

By the second treatment, Joseph reported a significant reduction in the intensity and episodes of the headaches and by the fourth treatment, he stopped having headaches and stopped taking painkillers altogether. Joseph continued treatment every 6 weeks to progress his exercises and further prevent a return of his symptoms.

Joseph’s experience is a common one. For many of us, our day-to-day working life involves prolonged sitting (often with poor posture) and periods of high stress.

*Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

Vincent KingOsteopath, Wholistic Medical Centre