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Dr Paul Mason www.orthosports.com.au 4749 Burwood Road, Concord 160 Belmore Road, Randwick Dr Paul R. Mason Sport and Exercise Medicine Physician FACSEP MBBS (Honors) University of Sydney Bachelor of Physiotherapy Latrobe University (Melbourne) Masters of Occupational Health Latrobe University (Melbourne) Evidence based management of low back pain – surprising findings from historical research

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Page 1: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul Mason

www.orthosports.com.au47‐49 Burwood Road, Concord 160 Belmore Road, Randwick

Dr Paul R. MasonSport and Exercise Medicine PhysicianFACSEP

MBBS (Honors) University of Sydney

Bachelor of PhysiotherapyLatrobe University (Melbourne)

Masters of Occupational HealthLatrobe University (Melbourne)

Evidence based management of low back pain – surprising findings from historical research

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Dr Paul Mason

“non-specific low back pain does not have a known pathoanatomical cause”

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non‐specific low back pain. The Lancet, 389(10070), 736–747. 

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Dr Paul Mason

Page 4: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul Mason

Page 5: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul Mason

Page 6: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul Mason

Page 7: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul Mason

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Dr Paul Mason

https://aneskey.com/intradiscal‐electrothermal‐therapy/

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Dr Paul MasonGunnar Wiberg (1949) Back Pain in Relation to the Nerve Supply of the Intervertebral Disc, Acta Orthopaedica Scandinavica, 19:2, 211‐221.

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Dr Paul Mason

“….touching the disc itself caused pain of

lumbosacral distribution in nearly all cases…”

Gunnar Wiberg (1949) Back Pain in Relation to the Nerve Supply of the Intervertebral Disc, Acta Orthopaedica Scandinavica, 19:2, 211‐221.

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Dr Paul Mason

Carl Hirsch (1949) An Attempt to Diagnose the Level of a Disc Lesion Clinically by Disc Puncture, Acta Orthopaedica Scandinavica. 

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Dr Paul MasonSciatica and the intervertebral disc; an experimental study. J Bone Joint Surg Am. 1958 Dec;40‐A(6):1401‐18.

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Dr Paul MasonThe tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991 Apr;22(2):181‐7.

Page 14: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul MasonThe tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991 Apr;22(2):181‐7.

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Dr Paul Mason

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Dr Paul Mason

January 2018

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Dr Paul Mason

January 2018 April 2018

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Dr Paul Mason

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Dr Paul Mason

Posterior interosseous nerve

Greys anatomy, 1897.

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Dr Paul Masonhttp://medicalency.com/nerves_2.htm

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Dr Paul Mason

https://clinicalgate.com/spinal‐cord‐and‐spinal‐nerves‐gross‐anatomy/

Teixeira, M. J., Almeida, D. B., & Yeng, L. T. (2016). Concept of acute neuropathic pain. The role of nervi nervorum in the distinction between acute nociceptive and neuropathic pain. Revista Dor, 17.

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Dr Paul MasonBove, G. M., & Light, A. R. (1997). The nervinervorum. Pain Forum, 6(3), 181–190.

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Dr Paul MasonBove, G. M., & Light, A. R. (1997). The nervinervorum. Pain Forum, 6(3), 181–190.

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Dr Paul MasonBove, G. M., & Light, A. R. (1997). The nervinervorum. Pain Forum, 6(3), 181–190.

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Dr Paul MasonSciatica and the intervertebral disc; an experimental study. J Bone Joint Surg Am. 1958 Dec;40‐A(6):1401‐18.

Page 26: Evidence based management of low back –surprising findings … › pdf-download › Low-Back-Pain... · 2019-11-18 · The tissue origin of low back pain and sciatica: a report

Dr Paul MasonSciatica and the intervertebral disc; an experimental study. J Bone Joint Surg Am. 1958 Dec;40‐A(6):1401‐18.

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Dr Paul MasonSciatica and the intervertebral disc; an experimental study. J Bone Joint Surg Am. 1958 Dec;40‐A(6):1401‐18.

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Dr Paul MasonSciatica and the intervertebral disc; an experimental study. J Bone Joint Surg Am. 1958 Dec;40‐A(6):1401‐18.

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Dr Paul Masonhttp://mullerchiropractic.com/

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Dr Paul Mason

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Dr Paul MasonGao, S., Geng, X., & Fang, Q. (2018). Spontaneous Disappearance of Large Lumbar Disk Herniation. JAMA Neurology, 75(1), 123.

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Dr Paul Mason

The Reduction of Chronic Nonspecific Low Back Pain Through the Control of Early Morning Lumbar Flexion: A Randomized Controlled Trial. Spine (Phila Pa 1976). 1998 Dec 1;23(23):2601‐7.

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Dr Paul Mason

The Reduction of Chronic Nonspecific Low Back Pain Through the Control of Early Morning Lumbar Flexion: A Randomized Controlled Trial. Spine (Phila Pa 1976). 1998 Dec 1;23(23):2601‐7.

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Dr Paul MasonThe Reduction of Chronic Nonspecific Low Back Pain Through the Control of Early Morning Lumbar Flexion: A Randomized Controlled Trial. Spine (Phila Pa 1976). 1998 Dec 1;23(23):2601‐7.

0

5

10

15

20

25

30

35

40

6+ months 12+ months

% mean pain reduction

No flexion avoidance Flexion avoidance

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Dr Paul Mason

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Dr Paul MasonSegmental Quantitative MR Imaging Analysis of Diurnal Variation of Water Content in the Lumbar Intervertebral Discs. Korean Journal of Radiology. 2015;16(1):139‐145. doi:10.3348/kjr.2015.16.1.139.

Morning

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Dr Paul MasonSegmental Quantitative MR Imaging Analysis of Diurnal Variation of Water Content in the Lumbar Intervertebral Discs. Korean Journal of Radiology. 2015;16(1):139‐145. doi:10.3348/kjr.2015.16.1.139.

Morning Evening

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Dr Paul MasonCircadian variation in human stature. ChronobiolInt. 1984;1(2):121‐6. 

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Dr Paul MasonCircadian variation in human stature. ChronobiolInt. 1984;1(2):121‐6. 

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Dr Paul MasonNew In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life.  Spine (Phila Pa 1976). 1999 Apr 15;24(8):755‐62.

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Dr Paul MasonNew In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life.  Spine (Phila Pa 1976). 1999 Apr 15;24(8):755‐62.

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Dr Paul MasonNew In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life.  Spine (Phila Pa 1976). 1999 Apr 15;24(8):755‐62.

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Dr Paul MasonNew In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life.  Spine (Phila Pa 1976). 1999 Apr 15;24(8):755‐62.

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Dr Paul MasonDiurnal variations in the stresses on the lumbar spine. Spine (Phila Pa 1976). 1987 Mar;12(2):130‐7.

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Dr Paul Mason

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Dr Paul Mason

Sandler, R. D., Sui, X., Church, T. S., Fritz, S. L., Beattie, P. F., & Blair, S. N. (2014). Are flexibility and muscle‐strengthening activities associated with a higher risk of developing low back pain? Journal of Science and Medicine in Sport, 17(4), 361–365.

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Dr Paul Mason

Sandler, R. D., Sui, X., Church, T. S., Fritz, S. L., Beattie, P. F., & Blair, S. N. (2014). Are flexibility and muscle‐strengthening activities associated with a higher risk of developing low back pain? Journal of Science and Medicine in Sport, 17(4), 361–365.

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Dr Paul Mason

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Dr Paul Mason

Pain Physician. 2017 Jan‐Feb;20(1):E45‐E52. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta‐Analysis.

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Dr Paul Mason

Pain Physician. 2017 Jan‐Feb;20(1):E45‐E52. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta‐Analysis.

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Dr Paul Mason

Pain Physician. 2017 Jan‐Feb;20(1):E45‐E52. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta‐Analysis.

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Dr Paul Mason

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Dr Paul Mason

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Dr Paul Mason

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Dr Paul Mason

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Dr Paul Mason

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Dr Paul Mason

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Dr Paul MasonLow Back Disorders, Second Edition 2nd Edition. Stuart McGill 

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Dr Paul Mason

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Dr Paul Mason

April 2018October 2018

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Dr Paul Mason

@DrPaulMason