Low Back Pain: A Review | 2026 share.google/L0bfDsPPziRXR3p…

Lumbar spinal stenosis is primarily a clinical diagnosis rather than a radiographic one. In the Wakayama Spine Study by Ishimoto et al (see illustration), only ten percent of the cohort were symptomatic despite 77.9 percent having either moderate or severe canal stenosis. pubmed.ncbi.nlm.nih.gov/2279… Terming it neurogenic claudication, in the same way that we use painful radiculopathy as a clinical presentation would make more sense. Even in the presence of radiographic changes, considerable uncertainty remains regarding whether laminectomy /- fusion provides benefit for people with neurogenic claudication, and if so for whom, and when. These operations are lengthy and carry non trivial risk, usually in a maturing population. pubmed.ncbi.nlm.nih.gov/2682… As is usually the case, treat the (Wo)Man, not the Scan.

This is not to say that 80% of people with low back pain should raise suspicion of serious pathology. Jeez. Rather, these are signs or symptoms that have historically been considered relevant and should therefore pique the clinician's interest, prompting them to sit up and ask more questions. Most have limited diagnostic utility in isolation. Take sleep disturbance, for example. On its own, without context, it is very common and a rather blunt indicator.

'Consent ✅' Sneak preview of 'contents' of the first book You'll probably be able to tell I've had a lot of fun putting this together 😆 All proceeds going to My Name5 Doddie Motor Neurone Disease foundation

Contributors list - i’m in good company here! 🤩🤓 @Seth0Neill @PeteOSullivanPT

Finally released! It was a real labour of love completely re-writing and updating the ‘Buttock Pain’ chapter (a special interest of mine) for the latest edition of ‘Clinical Sports Medicine’ I’m really proud of what @TheHipPhysio , @SteffanGriffin and myself have achieved

Nocebo effects in long-term health conditions: a systematic review of experimental studies frontiersin.org/journals/psy…

The influence of chronotype on pain: a systematic review and meta-analysis journals.lww.com/pain/abstra…

🧵 Exercise for low back pain — what does the latest evidence say? 3️⃣ systematic reviews/network meta-analyses published in the last year. Here's what they found free full text links👇

Dear X Friends, recognizing & treating #circadian rhythm disruption in chronic #pain during 2-day in-company training for an interdisciplinary & very passionate team of #expert pain clinicians @realhealth @maartenskliniek Berg en dal, the Netherlands thelancet.com/journals/lance…

The efficacy of strength exercise dosage on pain and disability in people with low back pain: a systematic review of randomized controlled trials pubmed.ncbi.nlm.nih.gov/4211…

Neurogenic Claudication Territories in Lumbar Spinal Stenosis. 📚 Young JJ et al. Digital pain diagrams to identify common lumbar spinal stenosis pain distribution patterns: a cross-sectional latent class analysis. European Spine Journal. 2025. researchgate.net/publication… Preliminary investigation. More atypical & heterogeneous than you might think Authors used digital pain diagrams in 2,379 patients with LSS. 6 clinically recognisable pain distribution classes rather than one classic “textbook” presentation. 📊 Pain distribution classes: ⭕️ Class 1 (11.4%) → Bilateral posterior leg pain ⭕️ Class 2 (8.7%) → Bilateral posterior anterior leg pain ⭕️ Class 3 (26.1%) → Unilateral posterior leg pain ⭕️ Class 4 (21.0%) → Unilateral posterior leg pain low back pain ⭕️ Class 5 (22.9%) → Unilateral anterior posterior leg pain ⭕️ Class 6 (9.9%) → Multisite pain Clinical take aways👇 ⚠️ The “classic” bilateral posterior leg pattern was less common. ⚠️ Unilateral presentations were more common than bilateral ones. ⚠️ Anterior thigh/leg symptoms were common, challenging the idea that LSS is predominantly a posterior calf/buttock condition. ⚠️ Low back pain severity was relatively similar across groups, questioning how diagnostically useful back pain itself may be. ⚠️ Multisite pain presentations existed So not so neat, entirely fits my biases and observations. ⚠️ Drawbacks: cross-sectional study only, preliminary data, secondary care sample, based on clinical coding rather than imaging-confirmed standards, no symptom-quality mapping or imaging correlation, several common co-morbidities/masqueraders excluded.

Interventions to enhance work participation in people with chronic pain: A systematic review and meta-analysis including analysis of complex psychological intervention components pubmed.ncbi.nlm.nih.gov/4210…

Cardiorespiratory fitness and pain severity: Longitudinal associations from the general population-The HUNT study pubmed.ncbi.nlm.nih.gov/4207…

Can exercise snacks alleviate musculoskeletal discomfort in prolonged sitting? A systematic review of randomized controlled trials pubmed.ncbi.nlm.nih.gov/4206…

Virtual reality based-rehabilitation for chronic neck pain: an overview of systematic reviews with meta-analysis of randomized clinical trials link.springer.com/article/10…

Physiotherapy with integrated virtual reality for patients with severe chronic low back pain: cluster-randomized controlled trial (VARIETY) link.springer.com/article/10…

A widely used knee surgery may not just be ineffective — it may cause harm. 10-year results from the FIDELITY trial, now in @NEJM. 🧵

Dear X Friends, integrating #motivational interviewing with #pain science #education into the multimodal #lifestyle approach 4 chronic pain: today during 3-day course in Bucharest, Romania 🇷🇴. Superbly hosted by @StepbyStepEd. Free 🔓manual here: academic.oup.com/ptj/article…