Short video demonstrates limitations of anterior-posterior spinal mobilisation for herniated discs.

The latest dynamic spine models allow us to see the effects of forces on intervertebral discs.

Manual therapy typically uses an anterior-posterior directional mobilisation to treat spinal segments.

IDD Therapy treatment comprises a targeted longitudinal distraction, with a longitudinal oscillation/ mobilisation at the point of maximum joint distraction.

IDD Therapy 25 minute treatment graph

This decompresses the discs and works soft tissues simultaneously in a way which is not possible with the hands alone.

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.steadfastclinics.co.uk

Low Back Pain Treatment – Inflammation, IL-6 and the new FAR infrared treatment connection.

I recently posted an article regarding drug-based Rheumatoid Arthritis treatment targeting the IL-6 protein.

I was interested in the potential implications of a study by Wong et Al (1), showing that as well as pain relief, post knee surgery patients treated with FAR infrared exhibited reduced levels of the proinflammatory IL-6 protein.  I raised the question whether the new FAR infrared modalities be an effective treatment aid for Rheumatoid Arthritis.

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

Working so heavily with low back pain and IDD Therapy spinal decompression treatment, this got me thinking about inflammation, IL-6 and low back pain.  What are the potential applications of new infrared modalities as a cost-effective tool to ease inflammation and reduce low back pain … without the need for steroid injections and anti-inflammatory medication?

With regards to Low Back Pain, we observe on many occasions that patients using Thermedic infrared pads report pain relief beyond what might be expected from a standard conductive heating aid.  I have written at various times that the humble “heat pad” offers more profound benefits than we might think, see evidence.

Looking at some of the research into IL-6 and back pain, Heffner et al (2) show that higher levels of IL 6 are associated with chronic low back pain (CLBP) and sleep disturbance:

“Individuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the 2 groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports.”

Burke et al show that there are high levels of proinflammatory IL-6 in the nucleus pulposus of painful intervertebral discs:

“We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.”

Kraychete et al (4) show that:

“…  patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.”

Thus whilst looking at the Wong et al study showing reduced levels of IL-6 for knee pain post surgery using infrared,  we can also see that elevated levels of IL-6 are associated with CLBP.

Could Wong et al help us to explain more fully the observed benefits of FAR infrared for relieving low back pain?

TherMedic is a new technology which uses a mains powered carbon-fabric element which emits FAR infrared.   It replaces lamps.  Worn against the body TherMedic provides a localised constant infrared heat/energy source.  Evidence shows both thermal and non-thermal effects from the resonant energy for pain reduction for a variety of conditions.

Most of the evidence comes from Asia where the technology is developed and being applied to many medical conditions.  We expect that European academic interest will develop as awareness of the new technology and its applications spreads.

PW140-Lower-Back-Thermography-heat-only   l220103-heat-pad_jpg   l220103-temp-control_jpg

Regular users of Thermedic for low back pain report “not being able to live without their TherMedic” infrared pad.  Patients with sciatica report that their pain has disappeared which is surprsing for something viewed as a simple heat pad and used on the lower back.

PW140-TherMedic-Lower-Back-PackShotRather than simple pain relief from heat and increased blood flow which “feels nice”, might Thermedic infrared have a deeper effect by helping to reduce levels of inflammation-causing IL-6 in LBP?

There is clearly a lot to explore, but as you look into the new FAR infrared fabric application for low back pain relief, you will see that there is a lot more than meets the eye.

Convention has it that heat should not be applied when there is inflammation.

Having heard from people suffering with inflammation but reporting relief when using TherMedic Infrared, could the new infrared turn some of that conventional thinking about heat and inflammation on its head?

Author: Stephen Small
Director www.steadfastclinics.co.uk  www.thermedic.co.uk  www.iddtherapy.co.uk

1) Wong CHLin LCLee HHLiu CF. The analgesic effect of thermal therapy after total knee arthroplasty.  J Altern Complement Med. 2012 Feb;18(2):175-9. doi: 10.1089/acm.2010.0815.  http://www.ncbi.nlm.nih.gov/pubmed/22339105

2) Heffner KLFrance CRTrost ZNg HMPigeon WR Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain. 2011 Jan;27(1):35-41. http://www.ncbi.nlm.nih.gov/pubmed/21188850

3) Burke JGWatson RWMcCormack DDowling FEWalsh MGFitzpatrick JMIntervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002 Mar;84(2):196-201. http://www.ncbi.nlm.nih.gov/pubmed/11924650
4)  Kraychete DCSakata RKIssy AMBacellar OSantos-Jesus RCarvalho EMSerum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. Sao Paulo Med J. 2010;128(5):259-   62. http://www.ncbi.nlm.nih.gov/pubmed/21181064

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

muscle mass degenerationSarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

The Number 1 Mistake Clinicians Make When Seeking To Establish Relationships With GPs

For most clinicians getting GPs, or indeed any other clinician, to refer to them seems highly desirable.  However I consistently hear the age-old complaint from clinicians that ‘GPs just aren’t interested in them’.  Why is that?

GP consultationThe answer is not that GPs are interested per se, rather the fundamental problem is that most clinicians simply fail to establish relationships with their local GPs.

In this post I will tell you the Number One mistake clinicians make when seeking to establish relationships with GPs and outline 3 steps which MAY create the relationships you seek (and in turn get you referrals).

So if you want to engage GPs there are two important questions –

1/ Why should they be engaged by you? 
2/ How are you going to get your message to connect with them?

To begin with I’ll assume you have a compelling reason for GPs to be interested in you, but if you don’t, you can still establish a connection as the first choice treatment provider in your field.

Whatever your engagement means, the number one mistake clinicians make is to give up on establishing a relationship too soon.  

So many clinicians have the unrealistic expectation of getting an instant response or, for one or two letters (or other communication means)  to lead to the establishment of a meaningful relationship with their GPs.   Relationships don’t work like that.

The three pillars of any relationship are well documented – Know, Like, Trust. 

My brother-in-law is a GP and so are some of my old school friends.  They are snowed under with paper work, sales messages, drug company reps, government initiatives and of course patients!

If you want to engage GPs, you have to let them get familiar with you over time.

Here are 3 simple ways for you to engage GPs:

1/ Case History – If you successfully treat a patient, write to their GP with a brief case history. You should have their GP name in your notes, but if you don’t then make sure you get it! This will really set you apart from your competitors and the GP will remember your name and respect you.

Include a business card since whilst we tend to throw away mail, if we like the essence of a letter we will keep a business card.  Include an open invitation for them to visit the clinic at any time (they may need treatment themselves!).  So start by producing one patient case study a month and build from there.

Add the contacts to your database of “influencers” and send them a Christmas Card or Happy New Year card.  They get hundreds of Christmas cards so why not be different – send a Happy New Year card as in all liklihood yours will be the only positive message in the new year mail … be different!

2/ Newsletters – A 2 sided A4 newsletter sent quarterly should not be too much to ask of any clinic to produce.  All your contact details will be there and over time you will create familiarity if you have some interesting content.

3.a/ GP Talks – GPs need CPD and regularly get together.  If you have a compelling service, programme or something you are particularly good at, they will be interested in a short presentation (offer to bring lunch, they expect this!).  The talk is a great way to engage GPs but if what you offer is not discernibly different to what anyone else is offering, then you will probably get knocked back or more likely – ignored!

3.b/ Consistent marketing – If you can’t do talks, remember that GPs are residents of your community.  Whatever marketing you do in your community will be seen by the resident GPs.   Plus, patients go along to their GPs with information from the internet or newspaper so put interesting content out there consistently and people will notice you and talk about you.  That includes your community of GPs and healthcare providers.

Need a database of your local GPs, go to www.nhschoices.uk enter your postcode and you will get a list of all your GPs.

Some clinics will do better focusing on patients but if you do have something special to offer, then you have a good chance of being heard if you apply these principles.  PLUS, there will be very few, if any, of your competitors doing anything to engage with GPs.  

It’s an open field for you and yours will be the only voice heard!

Author: Stephen Small, ‘Mr IDD’ – Director, Steadfast Clinics Ltd
International distributor of IDD Therapy Spinal Decompression for herniated discs and sciatica plus Thermedic FAR infrared therapy systems for joint pain relief and soft tissue rehabilitation.
www.SteadfastClinics.co.uk