Mark Hancock
speaker
55 appearances
1 recordings
1 series
first heard Jun 2018
last heard Jun 2018
Mark Hancock’s voice in public audio — every appearance, attributed to the second.
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Unfortunately, it's still widely recommended as a treatment, despite every international guideline now clearly recommending against bed rest and clearly recommending that actually staying active within sensible limits is the best thing you can do with an acute episode of back pain.
the evidence is largely that most of these forms of exercise are reasonably effective for back pain.
But things like Pilates, there definitely is evidence from a Cochrane review that Pilates is effective, maybe marginally more effective than some other types of exercise.
But at the moment, we don't have good enough evidence for that.
Now, good clinicians, despite that lack of evidence, will still try to give people the most appropriate form of exercise for them.
So if one person, for example, is clearly very weak in the muscles around their spine, then it makes sense that the exercise would be more focused around strength.
If actually they've got problems with how they move and the coordination or timing of their movement, then they need quite different type of exercise.
getting wrong.
It's quite logical that people would expect we can look on an image or on a scan and see the problem and then there should be a logical treatment to that.
There's a range of reasons why what we see on a scan may not explain an individual's person's pain.
We have really good evidence that a lot of these changes are just a normal part of aging.
So around about 90% of people, by the time they get to 80,
have the signs of degeneration, maybe disc bulges, these types of things on their scans.
So we know that they're actually relatively normal part of ageing.
The other reason is that pain is just really complex.
And we know pain is influenced by our brain, our interpretation of the threat associated with what we feel and many other things going on.
Absolutely.
There's no doubt you can see really quite substantial changes in the spine in people that have never had pain at any point in their life.
The recent increase in understanding of the brain in our experience of pain is really, really helpful and really important work that all clinicians need to understand.
I do, however, think there's a risk of going too far down that pathway and I guess ignoring the local factors that contribute to people's pain.
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