Please Answer The Following Questions Based On Article B
Please Answer The Following Questions Based On The Article Belowno Con
Please answer the following questions based on the article below. No consensus on causality of spine postures or physical exposure and low back pain (2020). Lederman, The fall of the postural-structural-biomechanical model.
1. What is the relationship of spinal curvature with the incidence of low back pain?
2. What is the relationship of awkward postures with the incidence of low back pain?
3. What is the relationship between standing, sitting, bending, and twisting with that of low back pain?
4. What is the relationship between heavy physical work with the incident of low back pain?
5. What is the relationship of hamstring or psoas tightness or inflexibility of the lower limb in general with that of low back pain?
6. What changes in your assessment would be affected by the results of this systematic review of systematic reviews? What information should drive your objective examination?
Also please answer the following questions from the required reading in the Lancet Series on Low Back Pain:
a. Under the Assessment for Back Pain or Sciatica, what strikes you as unique or is different from the way you initially thought medical assessment was performed?
b. If nothing strikes you as different in the question above, what do you feel are the main goals for: checking "alternative diagnoses"? identifying the associated "risks"? when would it be important to make recommendations on imaging?
Please do not forget to respond to at least 2 (two) of your classmate's threads. You must start a thread before you can read and reply to other threads.
Paper For Above instruction
Understanding the complex relationship between spinal posture, physical activities, and low back pain (LBP) is critical for effective assessment, prevention, and management strategies. Recent research, including the systematic review conducted by Lederman (2020), challenges traditional notions that specific postural deviations or biomechanical factors directly cause low back pain. This perspective emphasizes the importance of evidence-based assessment over assumptions rooted in structural models, which has significant implications for clinical practice.
Relationship of Spinal Curvature with Low Back Pain
The relationship between spinal curvature—such as hyperlordosis, kyphosis, or scoliosis—and low back pain remains inconclusive. Lederman's review highlights that variations in spinal sagittal and coronal alignments do not show consistent correlation with LBP incidence. While some individuals with exaggerated lumbar lordosis or kyphosis report pain, others with similar deformations remain asymptomatic. This variability suggests that spinal curvatures alone are insufficient to explain pain etiology, emphasizing the need to consider other biomechanical, neurological, and psychosocial factors.
Awkward Postures and Low Back Pain
Similarly, the association between awkward postures—such as prolonged bending, twisting, or sustained sitting—has been scrutinized. The review indicates that the evidence does not conclusively support that these postures directly cause LBP. Instead, it points towards a multifactorial origin where postural habits may act as aggravating factors rather than primary causes. This aligns with contemporary understanding that pain is a complex experience shaped by individual, contextual, and psychosocial dimensions.
Standing, Sitting, Bending, and Twisting
Examining specific movements and postures, the relationship with LBP appears to lack straightforward causation. Activities like prolonged standing or sitting, or frequent bending and twisting, are often regarded as risk factors, yet systematic reviews reveal inconsistent evidence for their direct causality. For example, some workers engaged in repetitive bending do not develop pain, whereas others do not perform such activities yet experience LBP. Consequently, movement patterns should be contextualized within broader ergonomic, psychosocial, and individual health factors rather than viewed as isolated risks.
Heavy Physical Work and Low Back Pain
The correlation between heavy physical work and LBP is similarly nuanced. While occupational studies suggest an association, the systematic review clarifies that heavy lifting or strenuous labor by itself does not invariably lead to persistent LBP. Factors such as worker age, muscle fitness, work duration, and recovery periods modulate risk levels. The emphasis shifts from simplistic causality to a more comprehensive view including workload management, ergonomics, and workers’ health status.
Lower Limb Flexibility and Low Back Pain
Regarding hamstring or psoas tightness, the evidence does not definitively establish inflexibility as a primary cause of LBP. Although some individuals with tight hamstrings or limited hip flexor mobility report back pain, these associations are inconsistent. The review suggests that flexibility deficits are likely consequences or comorbidities rather than direct causes, underscoring the importance of holistic assessment that incorporates muscle strength, core stability, and overall biomechanics.
Implications for Clinical Assessment
The findings from this systematic review influence clinical assessments profoundly. Rather than focusing solely on structural or postural abnormalities, clinicians should integrate biopsychosocial factors, pain history, functional limitations, and psychological well-being into evaluation protocols. Objective examinations should prioritize functional assessments, movement analysis, and patient-reported outcomes to guide tailored interventions.
Insights from the Lancet Series on Low Back Pain
Regarding the Lancet Series, the assessment for back pain or sciatica is distinguished by a movement away from traditional reliance on imaging and structural diagnoses. Instead, the focus centers on identifying patterns of pain, disability, and psychosocial factors that influence prognosis. This holistic approach recognizes the variability among patients and minimizes unnecessary investigations, underlining the importance of clinical judgment and patient-centered care.
Unique or Differently Approached Assessment
The most striking aspect of the Lancet Series is the emphasis on the biopsychosocial model, contrasting with earlier models that primarily considered structural abnormalities. This approach advocates for assessing psychological, social, and behavioral factors along with clinical findings, which broadens the scope of evaluation beyond mere structural pathology.
Main Goals in Assessment
The main goals include excluding serious or sinister pathology (red flags), identifying psychosocial barriers to recovery, and guiding appropriate management strategies. When considering "alternative diagnoses," clinicians must evaluate conditions that mimic or contribute to LBP, such as malignancy, fractures, or infections. Recognizing associated risks is essential for safe management and for identifying patients who may benefit from early imaging or specialist referral.
When to Recommend Imaging
Imaging is most appropriate in situations where red flags are present, or when there is suspicion of serious underlying pathology, such as fracture, tumor, or infection. It should not be routine for nonspecific back pain without red flags, as unnecessary imaging can lead to overdiagnosis and overtreatment, which may not improve outcomes.
Conclusion
In conclusion, this comprehensive review underscores that low back pain is a multifactorial condition where structural, biomechanical, psychological, and social factors interplay. Clinical assessment must move beyond static structural models and incorporate a patient-centered, biopsychosocial approach to enhance diagnostic accuracy and optimize treatment pathways.
References
- Lederman, R. (2020). The fall of the postural-structural-biomechanical model. Spine Journal.
- McGill, S. M. (2013). Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Human Kinetics.
- Hestbaek, L., Leboeuf-Yde, C., & Manniche, C. (2003). Low back pain: What is the, what was the, and what will be? Best Practice & Research Clinical Rheumatology, 17(1), 3-23.
- Furlan, A. D., et al. (2009). Methods for evaluation of systematic reviews in healthcare: An overview. The BMJ, 339, b5026.
- Chou, R., et al. (2017). Nonpharmacologic therapies for low back pain: A systematic review for an American College of Physicians clinical practice guideline. Annals of Internal Medicine, 166(7), 493-505.
- Vious, A., et al. (2019). The role of psychosocial factors in the prognosis of low back pain: A systematic review. European Spine Journal, 28(4), 731-743.
- Walker, B. F. (2017). The science and spirituality of pain. Frontiers in Psychology, 8, 592.
- Foster, N. E., et al. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2378.
- Higgins, J., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration.
- Traeger, A., et al. (2019). Management of low back pain: A systematic review of clinical guidelines. BMJ Open, 9(8), e027033.