MDT has the bases covered when it comes to what the research recommends for treatment of lower back pain.
- education
- self treatment
- manual therapy
- prevention!
This post was inspired by a patient who I covered on the blog last year as an acute lumbar lateral shift. She facebook messaged me over the weekend, saying "I threw my back out again." Instead of panicking, she asked me quickly what she should be doing. I told her shift corrections against the wall and progress to extension as soon as they are no longer painful/blocked.
That was 4 days ago. When she came to me in the same acute state last year, she was moderately shifted away from the painful side, and had high fear avoidance. This time, due to self management, she was only 3-4/10, mildly shifted and ready to get moving. Here were the main differences between this year and last year
- she was extremely compliant with avoiding prolonged postures and her simple HEP from last visit
- she knew exactly what to do before she verified it with me via facebook
- instead of panicking and avoiding all movements, she found her directional preference and started self treatment only 1 hour after onset
- she noticed at first she had full movement, THEN lost movement due to pain
- this was key and a good observation... normally upon onset, we do have full movement and as the CNS takes over and perceives a threat, we rapidly lose movement
- she worked diligently at restoring her SGIS to correct her shift
- she took two days off of work instead of struggling to get to work, only to get written up for wearing sneakers instead of high heels (which are a requirement at her job - yes, this happened last year when she could barely stand upright)
- during these two days, she religiously performed her HEP
- I still used IASTM on her paraspinals, did some quick psoas release (new pain free version coming up on the omptchannel.com this week) to restore her blocked extension
- she will be following up in two days, but she went from severely limited extension to mildly limited extension and full SGIS bilaterally with no shift in one visit
Thanks to the education the patient received, there was a big difference in not only her pain, function, and movement this year versus last year, but also her fear avoidance levels. Several years ago, she was one of those patients that when told to bend forward, needed a hole in the ground to reach her end range. After restoring full function and returning to marathons and yoga last year, she was STILL afraid of lumbar flexion, even though I reinstated it into her recovery of function phase. This year, she was ready to move and be moved. Last year, since she was shifted and had higher fear avoidance, it took 8 visits to reduce and another 4 to get her in running shape. This year, I think it will be maybe 3-4 visits.
The joke in PT school was of the 80% of the population who get LBP at some point in their lives, 80% also resolve within 4-6 weeks. So odds are, you're going to get the patient better. Research presented in MDT courses also looked at similar population in terms of recurrence, and those recurrence rates were somewhere between 60-70%. So what's the difference between MDT and traditional OMPT - the education and empowerment the patient typically has with a simple HEP that can be used to make rapid changes. OMPT can make a difference as well, both methods in the long term, as seen in this study. However, will the patients getting basic movements/advice/stabilization be able to self treat and improve rapidly as well as a patient with a MDT HEP? I am not so sure. Ow, I threw my back out... time to do some bird dogs to restore timing!
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