At 18:16 25/02/99 -0000, you wrote:
>Question
>
>Why do we need to absolutely and specifically identify pathology in order to
>assertain if a therapy is effective in LBP ? Kevin.
>-------------------------
Depends on what you mean by 'pathology'. I base my own practice on a general
concept of movement pathology, which incorporates tissue pathology such as
wound healing and inflammation, movement dysfunction, disability, handicap,
but expectations of outcomes will be influenced by a range of issues which
determine changing physiological states such as age, terminal disease, other
chronic disease etc. This is why a clinical hypothesis needs to be developed
in every case. Otherwise defining an appropriate movement diagnosis for
research is an ongoing challenge. From my experience, astute reasoning of
movement pathology and potential 'corrective' agents such as careful
retraining of movement, strength, flexibility, will mean that the vast
majority of clients will have straightforward recovery of low back pain
across all age groups. Will these clients get better without this
intervention. My experience of working with clients in remote Australia who
may not have the opportunity of early intervention, tells me that lack of
intervention means a persistence and complication of movement disorder and
pain. I have seen good results with a few clinical sessions and custom made
home programs for clients who have had several years of pain following
injury. There does seem to be a need to define through research, more about
who and what in terms of low back pain and treatment.
There are a minority of complex client who many physiotherapists will
recognise as extremely challenging. Multidisciplinary approaches are
necessary for these clients and sometimes the goals need to reconsidered at
a different level of the disability paradigm.
Owen Allen
Atherton Hospital
P.O. Box 183
Atherton 4883
Queensland, Australia.
Ph: 07 40910261
F: 07 40913502
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