Dr Kieran Oâ€™Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips.
Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak.
1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load
2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one.
4.00 m Should we try to prevent all back pain? Listen to Dr Oâ€™Sullivan challenge the belief that itâ€™s important to never have back pain. He likens back pain to conditions like sadness, constipation â€“ not great but not a major problem as long as it doesnâ€™t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Donâ€™t pass on fear (of back pain coming on or persisting) to athletes.
5.00 m Screen for red flags of course, if the clinical picture warrants it â€“ but most long-term back pain is NOT due to something listed as a red flag.
6.00 m Reassurance â€“ being empathetic without inducing fear.
7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model.
9:00 m Donâ€™t just make the diagnosis but be practical. Patient sad? Donâ€™t just say â€˜You are sad, your back pain will go awayâ€™. Provide specific treatment for the specific threat.
10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems.
11:00 m Donâ€™t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case
12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler).
13:00 m The period at 4-6 weeks of pain can be difficult â€“ patient has not adapted to the contemporary model and may still be on waiting list for imaging.
14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries?
Links to previous podcast:
2015 â€“ Dr Oâ€™Sullivan on â€œEffective treatments for back pain: Kieran O'Sullivanâ€™s practical tips within a guiding frameworkâ€ http://ow.ly/4nepGu
O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers)
Manual Therapy paper:
Hurley J, â€¦., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111
Licence : All Rights Reserved