A year is a long time in the physiotherapy world. A year ago I started working in a specialized physiotherapy clinic, with 75% of all my patients coming into the clinic with back or neck complaints. Over the past year, being immersed with all sorts of back and neck issues, I have learnt many valuable lessons. Here are my top 3 lessons I wish I knew before starting my job. Lesson 1: There is NO such thing as “non-specific” back pain At university we are taught that back pain can fall under one of three categories – specific pathology (e.g. cancer, scoliosis etc), nerve root compromise; and non-specific back pain. Whilst these basic categories are a good framework for inexperienced therapists that aid in the diagnosis of the patient’s problem, it becomes quite apparent the lack of definitive diagnosis this framework has when communicating with general practitioners, specialized physicians, orthopaedic surgeons and fellow therapists. Non-specific back pain therefore becomes a blanket category to cover specific dysfunction such as muscle spasm, facet joint degeneration, lumbopelvic impingement, or sacroiliac joint dysfunction. In my experience, the framework taught at university and to entry-level therapists should be adapted as the therapists experience grows. Currently the framework I use is based around medical pathology, neurological compromise, specific musculoskeletal dysfunction and psychological flags for the patients back pain. Lesson 2: Images (scans) are a fantastic tool however they do not always correlate with the clinical presentation This week I was fortunate enough to tutor a few medical students and one of the topics we covered was the assessment of the spine. One of the discussions we had was on imaging specific to back pain, and how they are being taught at university not to fall into the trap of sending their patients for unnecessary scans of their spine. One of my colleagues beat me to writing this lesson in her article “If you look for problems, you’ll find them” (http://www.linkedin.com/pulse/you-look-problems-youll-find-them-shana-lee-abkin?trk=prof-post). Lesson 3: Muscle spasm does not always associate with “I’ve injured my disc” A few weeks ago one of my friends messaged me after performing deadlifts at the gym. Now I won’t go into my professional opinion about deadlifts as that is for a different discussion. My friend was performing a series of heavy deadlifts before having their back ‘lock up’. As a therapist, my friend immediately thought “I have blown my disc”, probably due to the fact there is a higher risk of discogenic-related issues when power lifting. From there, my friend went to work and had a colleague perform some soft tissue work to relieve the muscle spasm. This only made the muscle spasm worse with the increased spasm placing more compression forces onto the nerve, which resulted in the development of sciatica pain. Once I finally got a chance to assess my friend, they were convinced that there was damage to their disc. On examination, there was considerable muscle spasm, with the facet joint being unable to unlock thus causing compression forces onto the nerve and sciatica pain. A few sessions of extension based exercises, reducing compression on the nerve, and unlocking the facet joint, my friend was back performing all tasks without pain, discomfort or limited range of motion.

Written by David Cohen, Physiotherapist at UprightCare]]>

Larry is a highly skilled physiotherapist who specialises in treating back and neck pain, postural issues and scoliosis. He is certified in Schroth and SEAS methods and through the Egoscue University. Larry has a background in elite gymnastics and springboard diving and also has many years experience in endurance running and triathlons. His specialist knowledge and techniques have seen him appointed as a gymnastics coach and physiotherapist at both the Olympics Games and Special Olympics.

His passion and driving philosophy is about achieving the best outcomes for his patients utilising an amalgam of the latest techniques and theories while recognising there may sometimes be a need for invasive procedures. Where deemed appropriate Larry will then refer to a specialist. To further his holistic understanding and approach, Larry is currently undertaking a Ph.D. in Spinal Deformity and regularly attends and speaks at international conferences and courses and clinics.

Fun fact: Larry is learning how to surf - so be careful next time you go to the beach! Qualifications: B.Sc (Physiotherapy); M.Sc. (Exercise Physiology); Advanced Certificates in Schroth (BSPTS) and Egoscue (PAS) and SEAS Larry is Level II certified (advanced) in the conservative treatment of Scoliosis based on the Schroth method. The training was conducted by Dr Manuel Rigo of the Barcelona School at Scoliosis Rehab Inc in Wisconsin. He has completed his SEAS scoliosis treatment training at ISICO in Milan. Larry has also spent time working with Dr Rigo in the Barcelona clinic. Larry also has advanced certificates in shoulder treatment, posture alignment therapy and acupuncture.