By Robin A. McKenzie, Stephen May
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Extra resources for The Lumbar Spine: Mechanical Diagnosis and Therapy 2nd Edition (2 Volume Set)
Example text
1 99 5a; Cherkin et al. 1 99 6a) . Studies have found that only 3 0 - 40% o f their sample are completely resolved at aboLll two to three months, with l i ttle further i mprovement at six or twelve months (Cherkin et al. 1 99 6a; Phi l ips and Grant 1 99 1; Klenerman eL al. 1 99 5 ) . Thomas et al. ( 1 9 99) i ntervi ewed patients who had p resented to primary care with new episodes of back pain - 48% still reported disabli ng symptoms at three months , 42% at one year and 34% were classified as having persistent disabling back pain at both reporting times.
In the first edition of 1 98 1 , there were few, if any, references to quote in support of the methods and theories I propounded. Prior descriptions of the use of repetitive end-range motion and its e ffects on pain location and intensity; the phenomenon of clinically induced centralisation and p e ri p h e r a l i s a t i o n ; the p rogn ostic value o f cent ralisat i on and non-centralisat ion ; t h e theore t ic a l m o d e l s ; identi fication of subgroup syndromes ; the progressions of therapeutic forces; and m ost i mport a n t l y sel f-treatment and man age m e nt strategies did not exist in the l iterature of the day.
Examples of each are given in Table 2. 1 (Bombardier et al. 1994; Frank et al. 1996; Ferguson and Marras 1997). 1 Three major classes of risk factors for back pain Class of rish factor Individual and lifestyle factors Examples History of back pain, age, sex, weight, muscle strength, Oexibility, smoking status, marital status Physical or biomechanical factors Lifting, heavy work, posture, vibration, driving, bending, silting, twisting Psychosocial factors Depression, anxiety, beliefs and attitudes, stress, job satisfaction, relationships at work, control at work Individual factors have in the past received most scientific attention, but in general their predictive value was low.