Clinical Practice Guidelines
Who Do You Believe? The Experts? –
Some time ago I came across this article.
Here are some excerpts.
‘… researchers at The George Institute for International Health (in Sydney) proved that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90% of patients recover within four to six weeks, with or without treatment.’
It’s no wonder people aren’t getting better.
The clinical practice guidelines are about as useful as a hip pocket on a singlet, and so is any treatment that doesn’t also include a regular and systematic strength and flexibility training program. There’s a few equations that explain what’s going on here:
No strength and flexibility training program = back pain
Wrong diagnosis = wrong treatment
Wrong guidelines = wrong treatment = slow (or no) recovery.
In a nutshell, if you don’t know the cause of the problem, any treatment will do! It’s pretty much the same as ‘If you don’t know where you’re going, any road will get you there.’
‘… we found that recovery from low back pain was typically much slower than previously reported – nearly one third of patients did not recover from the original episode within a year.’
The reason? Wrong treatment.
What the experts thought was the best possible care was not the best care.
You don’t know who to believe, do you?
Well, it all depends on what is meant by ‘best possible care’. Going to a chiropractor, physiotherapist, chemist, or doctor isn’t the best possible care.
The experts still don’t know what the best possible care is.
One set of American clinical practice guidelines compiled by doctors Suarez-Almazor, Belseck, Russel, Skeith and Edworthy for the International Society of Technology Assessment in Health Care drew up this set of guidelines:
Practice patterns of interest encouraged by the CPG included more emphasis on the prescription of non-opioid analgesics vs. opioids or NSAIDS, & decreased bed rest recommendation.
Another set of recommendations from doctors Chou, Qaseem, Snow, MD; Donald Casey, Cross Shekelle and Owens, developed for the American College of Physicians’ Clinical Efficacy Assessment Subcommittee (ACPCEAS) and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel (ACPAPSLBPGP) stated: –
For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.
Reread it. It’s just gobbledegook. It’s nonsense. It’s only when the medication doesn’t provide a lasting fix that they recommend anything else:
For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
I can tell you one thing: When you hear the word ‘clinician’ being bandied around, you can be pretty sure someone is big-noting themselves. Medical snobs use this term to ignore the opinions of non-medical people, particularly people working in the fitness industry.
I can tell you another thing. Musculoskeletal pain is a fitness problem for most people, and you certainly can’t solve it with a medical (pharmaceutical) solution.
If you can’t see the words ‘strength’ and ‘flexibility’ in any solution for musculoskeletal pain, you’ll know someone is trying to blow smoke up the leg of your trousers.
You’ll notice in the excerpts above that they don’t say what exercise therapy is. It could be just sucking your abdomen in to strengthen multifidus. I bet it doesn’t include yoga, Pontius pilates, situps or press-ups or a workout in the gym.
But I’d bet on yoga every time. Those Indians knew what they were doing when they invented it, and they’ve been doing it for a few thousand years.
In Australia, the public health research body, the National Health and Medical Research Council, ‘s advice to people with back pain is just useless and uninteresting.
Here’s what they say: –
If your pain bothers you, it is important to see your health practitioner, to work with them to manage your pain, and to stay active.
This is medical-speak for ‘if pain persists, see a doctor and your chemist.’
‘Health Practitioner’ is a code word for ‘doctor’. What you’ve got is a fitness problem, not a medical problem, so why go to the doctor?
There is nothing there about strength and flexibility exercises—nothing to indicate what ‘stay active’ means. It could be ambling around the block for ten minutes, and that will do a fat lot of good for your back pain.
Though, it may be the case that 20% of musculoskeletal complaints aren’t fixable. This is one of the reasons why hip and knee replacements are a blessing for many people.
Then, it will take more than a couple of months for some. A few years ago, I tripped and fell and hurt my shoulder. It took 12 months to heal, mainly through strengthening and stretching. A similar thing happened with a sore hip. It took six months of strengthening the hip area in the gym for it to heal.
So the fact that a third of the complaints weren’t fixed within a year didn’t surprise me.
On the other hand, when my back was so bad it hurt to sneeze and cough, it got better in a couple of months—when I did the right exercises.
In the meantime, stay highly tuned and keep exercising until you get better.
Regards and best wishes
John Miller
If I can help you with more information, please feel free to contact me at this link https://www.globalbackcare.com/contact-us/
