Spine Lumbar

The physical therapist I am seeing right now doesn't seem very interested in finding out what's wrong with my back. She just wants to analyze my movements and come up with a plan of activities and movements that won't cause pain. That doesn't really get down to the bottom of what's wrong with me. Should I go shopping for a different therapist. If yes, what should I look for?

Based on the results of many studies over the last 10 years, physical therapists are trying to categorize low back patients into subgroups. These groups are based on patient characteristics and recognition of certain pain patterns and movement patterns.




I am an American working for a U.S. company in Canada. I live too far away to travel to the States for my medical care, so I went to a regional rehab center here for help with my back pain. They want to shuttle me off to a clinic on another campus because I somehow fall into a subgroup of patients who should be treated differently than others. Does any of this make sense to you? I've never heard of such a thing in the U.S. and wonder if I should make a trip home for this.

When it comes to the treatment of mechanical low back pain, physicians and physical therapists have taken a different approach in the last few years. Research has shown that certain subgroups of patients seem to do better with one form of treatment over another. So, efforts are being made to develop a classification system that will help identify which subgroup a patient should be placed in for the best results.




Narrowing Down Treatment For Low Back Pain

When it comes to the treatment of mechanical low back pain, physicians and physical therapists have taken a different approach in the last few years. Research has shown that certain subgroups of patients seem to do better with one form of treatment over another. So, efforts are being made to develop a classification system that will help identify which subgroup a patient should be placed in for the best results.




TLIF Popular Spinal Fusion Technique Has Some Major Problems

In this study, spinal surgeons from The Rothman Institute at Thomas Jefferson University Hospital in Philadelphia take a look at the transforaminal lumbar interbody fusion (TLIF) technique for spinal fusion. They focus on its safety, effectiveness, and compare complications using two different grafting techniques.




When I had sciatica back a few years ago, I remember one of the tests they always did was to raise my leg off the table while I was lying down and see if that caused my pain. This time when I went in to see the doctor, they also did the test with me sitting up. There was no pain in the sitting position, but it did hurt lying down. What does that mean?

You have just described the supine straight leg raise test and the sitting straight leg raise test. Both put tension on the sciatic nerve and test to see if the nerve is being compressed or pinched as a cause of your pain. The sitting straight leg raise test is also known asthe flip test because some people back when tension on the nerve starts to cause pain.




I read the orthopedic physician's assistant's report on me after I went in for sciatica down my leg. There was mention of the flip test being negative. Could you tell me what this test is for?

The sciatic nerve is a large nerve that starts in the low back and goes down the back of the leg from hip to foot. As it travels through the buttocks area, it passes out of the pelvis through the a hole called the greater sciatic foramen. Pressure on the nerve in the lumbar spine area can cause pain called sciatica that travels from the buttock down the leg.




Validity of the Flip Test as a Sign of Nerve Root Tension

Generations of orthopedic surgeons, physical therapists, and sports specialists have used the flip test (also known as the sitting straight leg raise) to confirm sciatic nerve root compression. The technique has been presented in texts books, articles, and other publications for the past 50 years.




I heard that they proved discography doesn't work. I had two back surgeries based on the results of my discography tests. Did I have the surgery for nothing?

Discography is a provocative test that is done by injecting a dye into one or more discs suspected of causing painful back and/or leg symptoms. Damaged discs are chemically sensitive and react to the dye. The test reproduces the patient's back pain right away -- if the disc is causing the problem and if the right disc was injected.




I was all scheduled to have a dye injected into my spine to verify that my back pain is coming from a disc herniation. Then all of a sudden, some guy in California says that test could cause problems. So my surgeon says it's off for now. Where does that leave me? I want to get to the bottom of this pain and get rid of it.

You may be referring to the recent report from the Stanford Discography Project that showed some potential adverse effects of this test. It turns out that when the dye is injected into the disc, the tiny puncture wound damages the disc enough to cause future problems. Over time (seven to 10 years), the disc loses height and vitality. The risk of disc degeneration and herniation goes up. Maybe that won't matter if you end up having that disc removed anyway.




Latest Findings of the Stanford Discography Group

Surgeons attending the International Society for the Study of the Lumbar Spine (ISSLS) got the surprise of the decade. A group of researchers from Stanford University led by Eugene Carragee presented the results of 10 years of study on discography. Discography is a diagnostic test used to determine which disc in the spine is causing problems. A dye is injected into the suspected disc(s). If the injection reproduces the patient's pain, the test is considered positive.




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