Patients will benefit from an innovative new approach to low back pain treatment, according to new guidelines published today by the National Institute for Health and Clinical Excellence (NICE).

Manual therapy, as practised by osteopaths, which includes spinal manipulation, mobilisation and massage, is recommended by NICE to assist clinicians improve the early management of persistent non-specific low back pain.  Low back pain: Early management of persistent non-specific low back pain focuses on patients who “have been in pain for longer than six weeks but less than one year, where pain may be linked to structures in the back such as joints, muscles and ligaments”.

“The GOsC welcomes recommendations that will improve patient access to sound, evidence-based care for a health problem that causes 2.5 million people each year to seek help from their GP,” says Evlynne Gilvarry, Chief Executive & Registrar of the General Osteopathic Council (GOsC), the UK Statutory Regulator of Osteopaths.

“Osteopaths are playing an increasingly central role in tackling this costly and debilitating condition.  These recommendations will help health professionals work together to provide each patient with effective care best suited to their needs.  NICE has provided the clear and consistent advice much-needed by patients and practitioners.”

The Health Equation is pleased to announce that we will now also be open for consultations in Buckinghamshire.

Gerry Gajadharsingh will be available by appointment at “Bowers Cottage” on Monday mornings & afternoons and Thursday afternoons.

We hope this will be of great benefit to our patients who currently travel into central London for appointments and who may wish to take advantage of the reduction in our professional fees.

We do hope that you will continue to use our excellent clinical team at The Health Equation, either in London or Buckinghamshire for all your healthcare needs.

1. Non specific low back pain.
2. Back pain with associated neurological compromise due to radiculopathy or spinal stenosis (trapped nerves).
3. Back pain associated with another specific spinal cause. Back pain can also be caused by referred pain from other associated structures (visceral structure such as abdominal or pelvic organs).

Patients with non specific low back pain, should not routinely undergo diagnostic imaging Patients with back pain with associated neurological compromise due to radiculopathy or spinal stenosis (trapped nerves) should only undergo diagnostic imaging if positive results would lead to spinal surgery or epidural intervention. MRI is the preferred type of imaging over CT and x-ray.

Back pain associated with severe or progressive neurological deficit or in whom the history would suggest other underlying pathology (disease) should undergo imaging and other appropriate diagnostic tests such as blood tests. The first line of intervention is usually drugs such as NSAIDS (Non steroidal anti inflammatory drugs) and self help and back care. (I also recommend a range of natural anti-inflammatories such as Celedrin, Quercetin, Bromelain, Tumeric & Glucosamine/ Chondroitin which have reasonable supportive evidence of efficacy, for those patients who
cannot/or choose not to take NSAIDS).

For acute low back pain the recommended nonpharmalogic category is spinal manipulation, such as osteopathy. For chronic low back pain intensive interdisiplinary rehabilitation is recommended, including spinal manipulation, massage, exercise therapy, relaxation, Cognitive Behavioural Therapy (CBT), yoga and acupuncture.

Increasing Physical Activity in Middle Age Eventually Lowers Mortality Risk

Medscape March 13 2009

“Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity,” the study authors write.

“This reduction is comparable with that associated with smoking cessation.”

• In the first 5 years after age 50 years, men who increased their physical activity had increased mortality rates by 2.6 times vs men with high activity at age 50 years, but by age 60 years, this group had similar mortality rates.
• The mortality rate after more than 10 years of follow-up was halved in men who increased their activity to a high level (more than 3 hours of recreational sport or heavy gardening) from both a medium level and a low level
• There was no significant reduction in men who increased their activity from a low to a medium level.
• As a comparison, smoking cessation was associated with a 40% lower mortality rate after 10 years vs current smoking and men who had never smoked had a 60% lower mortality rate vs men who were current smokers.

Last year NICE announced that a daily 1,000 mg fish oil capsule should be prescribed for anyone who has had a heart attack. The first of many studies, dating back to the 1970’s, showed that the Greenland Inuit people had a low incidence of cardiovascular disease and other inflammatory disorders such as asthma, rheumatoid arthritis, diabetes and psoriasis. This was put down to their very high fat diet, especially of fish oils.

One of the problems of western diets is that whilst they contain reasonable amounts of other essential fats such as Omega 6, these fats compete with omega 3 and generally encourage inflammation. Ideally we should have a ratio of 2 omega 6: 1 omega 3 (2:1). The UK average is more like 15:1.I have been routinely running EFA assessment profiles on select patients and have not been surprised to find that almost ALL are deficient in omega 3. This fits in with the most recent research.

It is important that the labs used to assay the blood samples look at the content in the red blood cells (which is where EFA and many nutrients are stored). Normal assays look at EFA in serum or plasma and are just not accurate enough. It is like wanting to know a patient’s iron status and not assaying Ferritin (where most iron is stored).

As with all diagnostic investigations this helps us decide on a treatment strategy and EFA assaying is no different. Perhaps you are next in to consult me and would like your levels of EFA assayed please let me know. If you are deficient, especially in Omega, and it is appropriate to recommend supplementation and dietary change, it may prove to be a very positive benefit for many of the health problems that I see in clinical practice.

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