Back and Pelvic Pain

Back and Pelvic Pain

  • Ali Fahir Ozer added an answer:
    Can herniated nucleus pulposus be cleaned by the body in some cases?
    Many studies have indicated that the immune cells, which infiltrate around the degenerated disc, could impact the situation. While these immunocytes can cause damage such as inflammation, can they also clean the herniated nucleus pulposus and reduce nerve root stress? At least to some degree?
    Ali Fahir Ozer · Koc University

    Dear Sun,

    It is well known  if herniated disc contact epidural fat tissue, it is removed by fagocytes for a while. The problem is herniation occured among the annullar layers. Because of poor vascularisation of annulus, fagocytes can not easly reach to death nuclear material among the annullar layers . Most of the patient who were operated due the disc herniation have this kind of herniation( Carrage classification type III, IV). Rarely it is seen spontenous regression in these type of hernations.  In my opinion in these rare cases, paravertebral muscle support is very important. If the patient has enough muscle support, spontenous regression incidance is increased. We notticed this reality after transpedicular dynamic stabilisation of the spine.We have a lot of such cases. Briefly in my opinion , there is strong relationship between the stabil spine( muscle support or enstrumantation) and spontaneous regression of a disc herniation.

    Ali Fahir Ozer

  • Nelson Elias added an answer:
    Can anyone cite a good article that reviews the pathophysiology and/or neuroscience regarding pain associated with menstruation?
    I'm thinking specifically about back pain but any article on the topic would be great.
    Nelson Elias · Rio de Janeiro State University
    Dear Fred
    This article may be useful for you
    J Vasc Interv Radiol. 2014 May;25(5):725-33.
    Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management.
    Phillips D1, Deipolyi AR2, Hesketh RL3, Midia M4, Oklu R
  • Paul Enthoven added an answer:
    Can the results of physical examination predict the clinical outcomes of patients with low back pain?
    Based on my literature search, it is apparent that depression and fear avoidance are the most important predictors for the development of chronic low back pain while the results of medical imaging or physical examination do not contribute much to the prediction of clinical outcomes of patients with low back pain. Have you read any articles that support the roles of physical factors (morphology or physical exam) in predicting the clinical outcomes of patients with low back pain?
    Paul Enthoven · Linköping University
    Dear Arnold

    We have performed a study in primary care looking at physical examination to predict long term outcome in patients with non-specific low back pain. Measured at a physical examination 4 weeks after the patients initial visit, several physical measures were predictive of future outcome. As in many other studies, physical facotors assessed at basline did not predict future outcome.
    We have published our results see reference below.

    sincerely,
    Paul Enthoven

    ref:
    Paul Enthoven, Elisabeth Skargren, Görel Kjellman and Birgitta Öberg
    COURSE OF BACK PAIN IN PRIMARY CARE: A PROSPECTIVE STUDY OF
    PHYSICAL MEASURES. J Rehabil Med 2003; 35: 168–173
  • Panayot Tanchev added an answer:
    What are behind Modic changes?
    While Modic changes are familar with most spine doctors, what is this phenomenon reflect? What exactly causes them?
    Panayot Tanchev · Medical University of Sofia
    To Dr. Duntsch: You state that MC on MRI are a common phenomenon "linked with low back pain". Is that always so ? I think there are patients with MC who are absolutely symptomless. On the other hand, you are right that "the etiology of MC remains poorly understood" . The clinical significance of MC is not clear.
  • Panayot Tanchev added an answer:
    Does diagnosis affect therapy treatment?
    When I see patients I really try to not look at any imaging or notes until I evaluate them first. I personally feel it adds too much bias into the picture and I don't want it to affect my clinical judgment.

    Are there any studies that show whether or not knowing the diagnosis changes the approach? It's obviously different here in the US because a diagnosis has to be coded by somebody so it's hard to be truly blind. Are there studies out there that look at whether being blinded to diagnosis affects treatment / therapy approach?
    Panayot Tanchev · Medical University of Sofia
    This question strives to complicate the general diagnostic and therapeutic algorithm.
    I would recommend to follow the classic formula which works for thousands of years: "Qui bene interrogat bene diagnostic, qui bene diagnostic bene curat". Unfortunately, many doctors of today look at the MRI-pictures, then at the CT-images, then at the X-rays, and at the end ask the patient about complaints, perform inspection, palpation, percussion, auscultation, etc. This is a vicious approach.
  • Sergio Lerma Lara added an answer:
    Why there is a prevalence of hamstring tightness in subjects with anterior pelvic tilt?
    In anterior pelvic tilt, lower cross syndrome exists, where hipflexors and spinal extensors get shortened while abdominals and hip extensors lengthen. This is what theory explains, but contradictorily I had seen hamstring shortening in subjects with anterior pelvic tilt. Can somebody clear this up for me?
    Sergio Lerma Lara · Hospital Infantil Universitario Niño Jesús
    We used to add kinematic and kinetic data for decission making. If you are familiar with Dynamic Muscle Length graphs psoas or rectors femoris spasticity or contracture could be in relation with "false hamstrings thigthness". Try with Modified Popliteal Angle test. (Keenan,WN et al. J Ped Othop, 2004).
    In other populations neural tissue tension mut be taken in consideration (SLR test).

About Back and Pelvic Pain

To facilitate discussion on issue of prevention, diagnosis and treatment of acute and chronic lumbar and lumbopelvic pain.

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