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The Old Swayback , a Tired Horse, Still being Whipped.

Dr. Herbert H. Nehrlich   (2 February 2005)

Help for Back pain and lordosis

Isobel Knight   (28 January 2005)

The Old Swayback , a Tired Horse, Still being Whipped. 2 February 2005
Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507	As an immediate step toward improving the patient's symptoms I would skip the antiinflammatory drugs (as they have no place in this setting and have been found to be as damaging as the steroids) and would find a good podiatrist, ask him to recommend a good shoemaker and order a pair of "negative heel shoes". In most cases, a lift of the front of the foot of about 1-1 1/2 cm, which allows the heel to drop down, will cause an automatic "correction" in how the person perceives his/her pelvis and will result in a flattening of the lumbar lordosis. Manipulation as a temporary measure (I prefer old-fashioned chiropractic) would be appropriate and a program of abdominal exercise, such as the simple crunch, curl ought to be started immediately the patient is out of pain. In most cases the patient can be left to his exercises and should not require any further intervention. Negative heel shoes are making a come-back, mostly due to demand by practitioners who were around in the USA in the 70's, one company even offers them under a label called (down to) ... shoes. I have found them very expensive and difficult to deal with. The cost for converting a pair of ordinary shoes to negative heel shoes need not exceed $ 100.00 Aussie dollars. Competing interests: None declared
Help for Back pain and lordosis 28 January 2005
Isobel Knight, Bowen Therapist London/Cambridge	I would like to suggest the follow ways in which to treat a 50 year old with back pain and lumbar lordosis. Firstly, she could initally try the use of NSAIDS - the traditional anti-immflammatory drugs to help with the pain before then going on to attend some pilates classes or attend some physiotherapy sessions that would help address the essential issue of core stability and strengthen the probably weakened abdominal muscles. This would then give her a natural muscular corset and would greatly assist in supporting the back, especially the lumbar curve. Weight is an important issue in patients with back pain. If the patient is overweight, it would be worthwhile suggesting that she loses some weight. This would help to ease pressure off the spine and other joints and might greatly reduce the pain. The techniques used in Pain Management programmes would also be helpful - such as relaxation, meditation, pacing of activities and goal- setting. It is also important for this woman to do some exercise and not remain confined to bed or remain seated for prolonged periods. Little and often is best - gentle walking is highly effective and is an underestimated form of exercise. Keeping the muscles active is important and will significantly help with recovery. Finally, I would like to recommend the Bowen Technique, which is a gentle soft tissue therapy that was founded in Australia by the late Tom Bowen. It works on the muscle feedback mechanism through a series of gentle 'rolling-type' moves across the muscle and tendon fibres. It is generally a rapid-working treatment and benefits are often rapid and long- lasting. Further research work continues in all areas to explain the benefits of this subtle yet highly effective therapy. It did help my back pain and I would highly recommend it to others. Other therapies that can also help with back pain are osteopathy, chiropractic, massage and accupuncture. Competing interests: None declared

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