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Spine/back Problems How the body is connected:

#21 User is offline   Kiwee 

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Posted 27 February 2004 - 10:23 PM

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Suicidal reaction to pain


A high proportion of people suffering chronic pain from spinal injuries have considered suicide, research conducted in Christchurch shows.

Thirty-nine per cent of people living with chronic pain said they had suicidal thoughts and 32 per cent said they had experienced major depression.

The findings come from a study by Otago University's Christchurch School of Medicine.

Study head Mark Turner said that of 122 people he had talked to who lived in Christchurch when they suffered the injuries, more than three-quarters (77 per cent) said they lived with chronic pain, which had a major effect on their lives.

Of those with chronic pain, 58 per cent reported greater psychological distress than those without pain and 26 per cent greater anxiety.

Many also said they had a poor social life.

Dr Turner said the study showed more attention should be given to the psychological impact of severe pain.

"In fact, in the present study one-third of people considered pain to be their primary problem when considering all aspects of their injury," he said.


ps I know this is in the wrong thread but i am a bit crook and cant find me way round at the mo

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Posted 28 February 2004 - 08:54 AM

how very true.

#23 User is offline   fairgo 

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Posted 28 February 2004 - 04:41 PM

I have been receiving info from this site for awile. It has some excellent
articles on chronic pain, rehabilitation, reducing back pain etc. Suggest
you take a look if back pain is your 'thing'

#24 Guest_donquixotenz_*

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  Posted 01 March 2004 - 11:15 AM

Peter Koscovic
Recommend Message 8 of 17 in Discussion

From: crowbay1 Sent: 28/02/2004 11:56 p.m.
There was a case mentioned on site some time ago. It was an Australian case and the person involved I think was named Peter Koscovic. Basically the judge ruled in this case that the best person to judge was the injured person. Especially in the face of contradicting medical opinion. Otherwise the court and the insurer might be jeopardising themselves and causing damage in the life of the injured person by accepting the wrong opinion.
This is where the ACCs medical assessments are so wrong. They are using under qualified assessors who wreak havoc in the lives of disabled policy holders causing suicide and at the least severe trauma and depression.
If you have the money these mostly absurd assessments for ridiculously inadequate job options are getting easier to overturn and in time we will see fair judgements that effectively close the door on this EXIT option. But will the assessors be taken to task. No they will have gone overseas, travelling first class to a brand new home and job on the money they made destroying the lives of people with disabilities.

Recommend Message 16 of 17 in Discussion

From: crowbay1 Sent: 29/02/2004 4:58 p.m.
Peter Koscovic case can be found AustL11 database site. South Australian workers compensation apeals tribunal. It takes a bit of hunting

Recommend Delete Message 17 of 17 in Discussion

From: flwrznz Sent: 29/02/2004 11:24 p.m.
Thats very interesting Peter Koscovic is working in Wellington as a psycological assessor for the courts.
I would be interested in the details of the south australian case but do not know how to find it .

Told you it was a hunt! Type Austlii in your search engine. click on SA. click on search database. click "any of these words" and type in Peter Koskovic. Then scroll down the cases listed it is there.cheers jocko
South Australian Workers Compensation Appeal Tribunal
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Workers Rehabilitation and Compensation Act, 1986.

In the matter of an appeal by PETER KOSKOVIC, the worker, against the determination of a REVIEW OFFICER dated the 30th day of June, 1992, which concerns THE CORPORATION (B.J. WALTERS PTY. LTD.) the employer.

(No. 104W of 1992)

TRIBUNAL: Judge H.W. Parsons - Deputy President

Mrs. L. Day - Member

Mr. P. Lord - Member


Appeal - Notice to discontinue weekly payments issued - Whether worker ceased to be incapacitated for work - Conflicting medical evidence - Credibility - Inconsistency - Whether Review Officer's acceptance of worker as witness of truth inconsistent with medical findings - Whether Review Officer correct in determining issue of capacity or incapacity by comparison of medical evidence - Review Officer's decision reversed - Appeal upheld - Ss.36(1), 97 Workers Rehabilitation and Compensation Act, 1986.


For the Appellant - Mr. D. Gray (Employee Advocate)

For the Respondent - Mr. T. O'Callaghan (of counsel)

This is an appeal pursuant to section 97 of the Workers Rehabilitation and Compensation Act 1986 as amended ('the Act') whereby the worker, Peter Koskovic, appeals against the determination of the Review Officer made on 30 June 1992. By that determination the Review Officer confirmed the decision of the Worker's Rehabilitation and Compensation Corporation ('Corporation') made on 17 February 1992 to cease weekly payments of compensation to the worker.

The relevant facts which are not in dispute are as follows:

1. At the relevant time the worker was employed as a brick paver by the employer B.J. Walters Pty. Ltd.

2. The worker suffered a compensable disability to his lower back in March 1989 while he was lifting a compactor at work.

3. The worker's claim for compensation was accepted and he continued to receive weekly payments of income maintenance for some time.

4. On 27 February 1992 the worker was served with a Notice of Intention to discontinue weekly payments pursuant to section 36(1)(B) of the Act. Although the actual notice was not before us the parties did not dispute that it was issued by the Corporation on the basis of its satisfaction that the worker had ceased to be incapacitated for work as a result of the compensable disability. The parties also agreed that the notice was accompanied by the certificate of Dr. Hone in the form of his medical report dated 9 September 1991 in which he expressed the opinion that the worker had ceased to be incapacitated as a result of the compensable disability.

The worker sought a review of the decision to discontinue his weekly payments and the issue before the Review Officer upon review was whether the worker remained incapacitated for work. The worker gave evidence before the Review Officer about the nature of his pre-injury work and his current physical condition. The Review Officer also heard the oral evidence of Dr. Hone and considered the medical reports of Drs. Hone, dated 9 October 1991 and 10 October 1991, Von der Borch, dated 20 June 1989 and 7 March 1990, Mugford, dated 11 July 1991 and Gower, dated 1 February 1990 and 14 July 1991.

The Review Officer found the worker to be a truthful witness who did not exaggerate his plight. He concluded however that the worker's view about his capacity for work was limited by the advice of his treating medical experts. Thus to determine the issue of incapacity the Review Officer turned his attention to a consideration of the competing medical evidence and in this regard he preferred the oral evidence of Dr. Hone based on his examination of the worker on 9 September 1991, that the worker was no longer incapacitated for work, to the opinions set out in the medical reports of Drs. Von der Borch, Gower and Mugford. Primarily the conflict was between the opinions of Drs. Hone and Von der Borch.

On appeal, the worker's essential argument was that the Review Officer erred in relying on the medical evidence of Dr. Hone for two reasons; firstly, that the oral evidence of Dr. Hone was equivocal and conflicting compared with the stated opinions of the other doctors and secondly, that the acceptance of Dr. Hone's opinion as to the worker's capacity for work was inconsistent with the Review Officer's acceptance of the worker as a witness of truth.

Before the Tribunal Mr. Gray, agent for the worker, called oral evidence from Dr. Von der Borch whose reports, as we have said, were before the Review Office in documentary form.

A consideration of Dr. Hone's oral evidence before the Review Officer and the medical reports of Dr. Von der Borch discloses a divergence of opinion between the two specialists on the topic on the worker's capacity to return to his pre-injury duties as a brick paver. We have now heard the oral evidence of Dr. Von der Borch and that divergence of opinion remains.

The question for us on appeal is whether, in the light of the worker's evidence before the Review Officer, and Dr. Von der Borch's evidence before the Tribunal, the Review Officer's preference of Dr. Hone's opinion was reasonably open to him. This issue involves a consideration of whether the Review Officer was correct in determining the issue of capacity or incapacity by a comparison of the medical evidence and whether he placed sufficient weight on the evidence which the worker gave on the topic.

In his determination the Review Officer summarised the worker's evidence as follows:-

'Essentially it was the worker's evidence that prior to the compensable disability he had experienced no physical problems and his general health had always been good. He had previously always worked in the building trade as a builder's labourer or plasterer's labourer and had been a brick paver for about five years. His position with B.J. Walters had been terminated on the basis of 'medical opinion' that he should not return to that type of work. He had participated in a rehabilitation scheme and had received certificates from two courses completed, one of which involved principally theory training for employment in the hospitality industry. He has undertaken some work (hardening) experience. He deposed to now having problems with his back only occasionally and doesn't believe himself to be totally incapacitated. He has extended periods when he has no back pain of any significance, but at other times, such as after attempting digging in the garden at home, he has had to lie down afterwards. He prefers not to use pain killers. He demonstrated at the hearing that he can squat (with his back maintained in a vertical position), but he said he cannot bend over pain free. He demonstrated and explained the physical aspects of the paving work he was formerly engaged in. His General Practitioner Dr. R.P. Gower continues to certify him as unfit to return to his former duties.'

Of the worker and his evidence it is to be noted that the Review Officer found him to be an credible witness and went on to say:-

'I did not perceive the worker to exaggerate or embellish his evidence which he gave in a straightforward manner, although it was clear to me from his evidence that he perceived and believed his capabilities as limited to only those work situations opined by his treating medical experts.'

It is necessary to consider carefully what the worker said in his brief evidence. He firstly described the work of a brick paver and it was on the basis of this evidence that the Review Officer made the finding that the work can be characterised as heavy labouring work requiring prolonged periods (up to six hours per day) of bending and stooping as well as short periods which could involve heavy lifting.

We would respectfully disagree with the Review Officer, that on the topic of his capabilities, the worker's evidence was limited only to the opinions expressed to him by his treating medical experts. Contrary to the submission of Mr. O'Callaghan, counsel for the respondent, the worker's evidence dealt with his ongoing symptoms, the movements which he continues to find cause an onset of such symptoms and his inability to perform his normal work. We refer, in particular, to the following passages of evidence. At p.45 the worker was questioned as follows:-

'Q. Do you contend that you are totally incapacitated for work.

A. No, not totally incapacitated.

Q. What symptoms do you currently suffer.

A. Well, I get periods when I'm all right and I don't suffer any discomfort. Then I get periods when I can hardly sort of move.

Q. Do you believe you're capable of undertaking some form of work.

A. Yes.

Q. What sort of work do you believe you would be capable of performing.

A. Well, I think I would be - work, for example, like what I have been trained for within the hospitality area which doesn't involve heavy work; most jobs where it wouldn't involve heavy industrial work like what I was doing before.'

(underlining added)

and further down that page:-

'Q. Just finally, do you maintain that your incapacity for heavy industrial work is as a result of your injury suffered whilst lifting the whacker in 1989.

A. Without a doubt.'

At p.48 of the transcript the worker was asked the following question and answer:-

'Q. You have also described to us some periods when you have said you can hardly move. What do you mean by that. Can you move at all.

A. Well, there have been two cases that I can remember where I have just gotten up and all of a sudden I just cannot move and I have been couch-ridden for anything up to 2 weeks. I can't even sort of move around to have a shower in some cases, but that's not like that all the time. It has just happened two times in the last 3 years.'

At pp.51 - 53 of the transcript the worker was asked questions as to the extent to which his back symptoms interfere with certain activities as follows:-

'Q. ... How often are you having problems.

A. Well, it could vary.

Q. Could you go for a few weeks at a time.

A. I could go for a few weeks at a time.

Q. Any longer than that.

A. Yes, in cases. I can go longer. I can shorter. There's no sort of - - -

Q. How long would the longest have been.

A. That I haven't had any problems with my back?

Q. Yes.

A. I would say a month would be about the longest I have not had any problems.

Q. Around the house, what sort of duties do you do there. Do you do any gardening outside.

A. I have tried it, yes.

Q. What sort of gardening would you do. It's a fairly general term.

A. Lawn-mowing.

Q. Lawn-mowing.

A. Yes.

Q. Digging.

A. No.

Q. You say you don't use a pick or a shovel in the yard or anything like that.

A. I have at times just to try myself out - my capabilities and that - but I have gone all right for a while, but once I have finished then I sort of tend to sort of have to lay down for a while.

Q. How long would you, say, go into the garden, for example, and use a pick or a shovel for. How long would you be confident to work for. Is it minutes or hours.

A. Well, that's sort of hard to say. I would say maybe an hour.

Q. An hour. So you are okay to go out and dig for an hour.

A. I don't say I'm okay. I sort of like to think that I was okay.

Q. But you can do that.

A. Possibly.

Q. Have you done it.

A. Yes.

Q. You have. So you can do it.

A. I can do it, but I can't do it any longer.

Q. You can't do it for any longer than an hour, but an hour is okay. Is that what you're saying.

A. Yes.'

The questions on this issue continued as follows:-

'Q. Can you squat down fully at the moment - fully to the ground without any problems.

A. I can squat down, but I couldn't bend down.

Q. I see. So what sort of limitation - you can squat down, but you can't bend down. What do you mean by squatting down then.

A. What do I mean by bending and squatting down?

Q. Yes.

A. I will just give you an example. It's easier to explain. Squatting down I can do that, if you asked me to bend over an touch my knees, I couldn't bend.

Q. So with your back more or less vertical, you're saying that that's okay.

A. Yes.

Q. It's your lower back that you're complaining about. Is it tender at all to touch or to lean on.

A. It is when Dr Gower - for example, I was there last week because I was complaining about it, and when he sort of finds out exactly where it is, it is very tender, yes.

Q. But only when someone is actually working on it like that.

A. Yes.

Q. Otherwise it's okay.

A. Yes.

Q. Walking, for example - do you have any trouble walking at all.

A. No.

Q. Do you drive a car.

A. I can drive. I haven't got a car, but I can drive all right.'

(underlining added)

To a large extent the effect of the worker's evidence on this topic has been underestimated by the Review Officer. Although at p.2 of his decision he does say that the worker cannot bend over pain free and he indicates that after attempting digging in the garden the worker has to lie down, he has described the worker as having problems with his back only occasionally. This does not accurately reflect the worker's evidence. The worker described a situation where, although he has only been couch-ridden twice in the last three years, he experiences problems with his back more often than monthly and cannot dig in the garden for more than one hour. It is true that the worker referred twice in his evidence to Dr. Von der Borch's opinion expressed to him that he could not go back to brick paving however, he has given his own evidence about his ability to do his normal work, the restrictions upon his movements and has described the kind of work he thinks he would be capable of performing. In our view the Review Officer has placed insufficient weight on the worker's evidence of his symptoms and the effects which those symptoms have on his ability to perform movements which, on the evidence, are much less strenuous than the heavy labouring work requiring prolonged periods of bending and stooping and short periods of heavy lifting which the Review Officer found to be involved in the worker's normal duties. The worker's evidence of his symptoms and the difficulties described by him are central to the issue of the worker's capacity for work, and in circumstances where the worker has been acknowledged to be a credible witness should have been given greater weight.

Turning now to Dr. Hone's evidence before the Review Officer; essentially it was his opinion was that there was no physical reason why the worker could not return to his job as a brick paver. Dr. Hone took a history that the worker said he did not think he could go back to being a brick paver and that although at the present time viz. at the time of examination, he was not in pain he would get pain on activity. Dr. Hone said, however, that he based his opinion on his physical examination of the worker. He found on physical examination that the worker had recovered from a genuine injury to his lumbar-sacral disc. He did not find any physical signs to suggest that there was anything wrong with the worker's lumbar spine.

This opinion was, as we have indicated earlier, different from that expressed by Dr. Von der Borch. It seems that the Review Officer expressed some reservation about the acceptance of Dr. Von der Borch's medical opinion because he took the view that it was to some extent out of date. This was, in our view, a valid reservation as Dr. Von der Borch's last report dated March 1990 was based on several examinations of the worker, the last of which was in October 1989, more than three years before the purported discontinuance of weekly payments. Dr. Von der Borch's opinion on the issue of incapacity as expressed in his report of March 1990 was:-

'I believe that his future working capacity will be in the light to medium category. In particular I don't think he will be fit to return to brick paving as a full time occupation.'

Before the Tribunal he explained the basis upon which he reached this opinion from which he did not resile. Essentially he said that although his findings on examination were consistent with those of Dr. Hone they had reached a different conclusion. His explanation for this was the reliance which he placed on the complaints of pain by the worker whom he regarded as a straightforward person.

Given the time which had elapsed since Dr. Von der Borch had examined the worker, the Review Officer cannot be criticized for placing greater weight on the more current opinion of Dr. Hone. We do however consider that the Review Officer erred in accepting Dr. Hone's evidence where it differed from that of the worker. In the light of the evidence which the worker gave about his symptoms and his ability to perform certain movements and on the basis that the Review Officer accepted the worker as a witness of truth he should have found that the worker was incapacitated for his normal duties. There is an intrinsic inconsistency between the Review Officer's acceptance of the worker as a credible witness and his acceptance of Dr. Hone's opinion. In this regard we refer to the approach taken by Bright J. in Dibbins v. Dibbins (unreported 23 October 1978) quoted with approval by White J. in the Full Supreme Court decision of Donjerkovic v. Adelaide Steamship Industries Pty. Ltd. (1980) 24 S.A.S.R. 347. When faced with an assessment of damages where there was a disagreement by the medical specialists about the worker's prognosis, Bright J. said:-

'This case is an example of the useful principle that where medical evidence is in conflict the primary consideration may be the credibility of the plaintiff. True, the medical specialists, with their skill and experience, can move parts of the body so as to test the range of involuntary movement. They can also, by means of diagnostic aids, detect the presence or perceive the apparent absence of physical abnormalities which might be the cause of claimed symptoms. They can also, with their knowledge of anatomy, give a valuable opinion as to whether claimed symptoms are consistent with each other or with a suggested physical cause. But ultimately we must come back to the symptoms. Of course, anatomical signs detected by the medical specialists or the absence of such signs may tend to establish that the patient is telling untruths about or is exaggerating her symptoms. But it is the symptoms that are central, not the signs. I hope that I am not being unduly idiosyncratic when I say that if reliable independent evidence clearly indicates that the patient is credible, one does not disregard his or her complaints merely because the signs suggest that little or nothing is seriously wrong. Failure to recognize this simple truth has, I should think, led to the death or invalidity of many patients. Medical science has advanced very far but it is still not always capable of producing unqualified and indisputable answers.'

The Tribunal reverses the Review Officer's determination that the worker is no longer incapacitated for work as a consequence of the compensable disability. The worker remains incapacitated for his normal duties as a brick paver. The appeal is upheld.




In accordance with the requirements of section 93 of the Workers Rehabilitation and Compensation Act 1986 we notify the parties that if a party wishes to apply to the Full Supreme Court for leave to appeal against any part of this decision which raises a question of law, such appeal must be instituted within one month after a person who is entitled to appeal receives notice of this decision.

#25 Guest_donquixotenz_*

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Posted 01 March 2004 - 11:22 AM

How very similar the tactics used to those of the New Zealand assessors.
One wonders if the have the same textbook and if they are copying ACC NZ.

#26 Guest_NoRehab_*

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Posted 04 March 2004 - 11:13 PM

could this site be useful?

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#27 User is offline   Tomcat 

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Posted 16 August 2004 - 07:28 PM

Another Spine/back pain site.


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Posted 27 August 2004 - 08:53 AM

Why back pain is hard to beat

Patients may find it difficult to recover from a back injury because they start using the wrong muscles to bend and lift, a study suggests.

This, in time, can cause further injury to the spinal column - and turn a short-term muscle injury into a long-term problem.

Back injury is one of the leading reasons why people need to take time off work sick.

Researchers from the Ohio State University looked at more than 20 patients with low back pain.

After back injury, people need to re-learn how to use their muscles naturally

Professor William Marras, Ohio State University
They were wired up to devices which recorded electrical activity in the back muscles - the signature of whether the person is using them or not.

These "electromyagrams" were compared with those from an uninjured person.

Low-back pain patients used many more muscles, and ended up exerting much more force on the spine, to which they are all anchored.

Protection team

Instead of employing the powerful back muscles themselves, many patients use abdominal or side muscles to try to make up the shortfall.

They are doing this to protect the muscle which was originally injured.

Professor William Marras, an expert in "systems engineering", said: "When people apply all those extra muscles, it's as if they're pushing down on the short end of a seesaw, and trying to lift something on the far end.

"They exert more force, and to little effect."

Over time, extra force on the spine can lead to more serious, and permanent injuries, such as disc degeneration.

Professor Marras suggests that physical "retraining" of patients may be required to correct the problem.

"After back injury, people need to re-learn how to use their muscles naturally."

Job problems

Employers should also face stricter rules about protecting employees who have suffered a back injury from further harm.

They should never be allowed to lift heavy objects - even if they are relatively pain free, he says.

In addition, he recommended that patients with back injuries should make every effort to lose weight.

#29 User is offline   layresearcher 

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Posted 12 June 2005 - 04:01 AM

I emailled all the rheumatologists in this country asking what alternative health research they do into pain.

Only one answered and said that nothing worked and the discussion was closed.

These are the worse than useless rsouls we've got running the hospitals.

Arrogant minds as closed as a clam.

#30 User is offline   doppelganger 

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Posted 18 April 2007 - 10:38 PM

Just found this site

#31 User is offline   greg 

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Posted 19 April 2007 - 07:58 AM

Also on from this site above

Some of these aids are brilliant Does any one know of any stockist
:D :D

#32 User is offline   not their victim 

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Posted 29 May 2012 - 09:37 AM


#33 User is offline   doppelganger 

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Posted 16 July 2012 - 11:01 PM

New In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life

Hans–Joachim Wilke, PhD,* Peter Neef, MD,† Marco Caimi, MD,‡ Thomas Hoogland, MD,§

Table 1. Intradiscal Pressure Values for Different
Positions and Exercises
Position Pressure (MPa)
Lying supine 0.10
Lying on the side 0.12
Lying prone 0.11
Lying prone, extended back, supporting on elbows 0.25
Laughing heartily, lying laterally 0.15
Sneezing, lying laterally 0.38
Peaks by turning around 0.70–0.80
Relaxed standing 0.50
Standing, performing vasalva maneuver 0.92
Standing, bent forward 1.10
Sitting relaxed, without backrest 0.46
Sitting actively straightening the back 0.55
Sitting with maximum flexion 0.83
Sitting bent forward with tight supporting the elbows 0.43
Sitting slouched into the chair 0.27
Standing up from a chair 1.10
Walking barefoot 0.53–0.65
Walking with tennis shoes 0.53–0.65
Jogging with hard street shoes 0.35–0.95
Jogging with tennis shoes 0.35–0.85
Climbing stairs, one stair at a time 0.50–0.70
Climbing stairs, two stairs at a time 0.30–1.20
Walking down stairs, one stair at a time 0.38–0.60
Walking down stairs, two stairs at a time 0.30–0.90
Lifting 20 kg, bent over with round back 2.30
Lifting 20 kg as taught in back school 1.70
Holding 20 kg close to the body 1.10
Holding 20 kg, 60 cm away from the chest 1.80
Pressure increase during night (over a period of 7 hr) 0.10–0.24

Good article to illistrate the force on disc while working.

#34 User is offline   unit1of2 

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Posted 17 July 2012 - 12:27 AM

View Postlayresearcher, on 12 June 2005 - 04:01 AM, said:

I emailled all the rheumatologists in this country asking what alternative health research they do into pain.

Only one answered and said that nothing worked and the discussion was closed.

These are the worse than useless rsouls we've got running the hospitals.

Arrogant minds as closed as a clam.

:( A wee while back I was attending Professor Shiptions (Muscular/skeletal) off-sider, for quite sometime. The off-sider told me that whilst they know folk suffer particular injuries from particular types of accidents, the fact is they the professionals actually do not know exactly what is envolved in the areas damaged, they also don't have a clue how to resolve these issues. I was also told that the research would mean operating and taking biopsyes but folk would wound up in a pine boxes afterwards... Unfortunately the technology is sadly not here yet... However as he said, (I repeat) they are well and truely aware of the injuries/the pain issues and the limitations on folks physical due to injuries.
tsk tsk... and ACC spin the bull

#35 User is offline   doppelganger 

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Posted 18 July 2012 - 01:46 PM

Just another medical Journal document that proves back injuries do not heal due to no pain.


Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain

David MacDonald a, G. Lorimer Moseley b, Paul W. Hodges a,*
aNHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences,
The University of Queensland, Brisbane, Qld 4072, Australia
b Department of Physiology, Anatomy & Genetics & fMRIB Centre, Le Gros Clark Building, Oxford University, South Parks Road, Oxford OX1 3QX, United Kingdom

Web page

a b s t r a c t
Approximately thirty-four percent of people who experience acute low back pain (LBP) will have recurrent
episodes. It remains unclear why some people experience recurrences and others do not, but one
possible cause is a loss of normal control of the back muscles. We investigated whether the control of
the short and long fibres of the deep back muscles was different in people with recurrent unilateral
LBP from healthy participants. Recurrent unilateral LBP patients, who were symptom free during testing,
and a group of healthy volunteers, participated. Intramuscular and surface electrodes recorded the electromyographic
activity (EMG) of the short and long fibres of the lumbar multifidus and the shoulder muscle,
deltoid, during a postural perturbation associated with a rapid arm movement. EMG onsets of the
short and long fibres, relative to that of deltoid, were compared between groups, muscles, and sides. In
association with a postural perturbation, short fibre EMG onset occurred later in participants with recurrent
unilateral LBP than in healthy participants (p = 0.022). The short fibres were active earlier than long
fibres on both sides in the healthy participants (p < 0.001) and on the non-painful side in the LBP group
(p = 0.045), but not on the previously painful side in the LBP group. Activity of deep back muscles is different
in people with a recurrent unilateral LBP, despite the resolution of symptoms. Because deep back
muscle activity is critical for normal spinal control, the current results provide the first evidence of a candidate
mechanism for recurrent episodes.
 2008 International Association for the Study of Pain. Published by Elsevier. B.V. All rights reserved.

Discussion extract.
This study has clear clinical implications. First, it is clear that resolution of back pain does not imply a return to normal control of the
deep back muscles. This finding corroborates data that show that reduced cross-sectional area of the deep back muscles remains insome patients following an acute episode of LBP despite the resolution of symptoms [12]. Notably, a clinical trial suggested that therapeutic exercise designed to improve the control of the deep trunk muscles in people with acute/subacute LBP can both restore the symmetry of the cross-sectional area of the back muscles and reduce recurrence [11]. Furthermore, a similar therapeutic exercise programme reduced pain and improved functional measures in patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis [37]. Second, it is clear that spinal dysfunction is associated with these changes in muscle morphology and control. Using an animal model, rapid segmental atrophy of the lumbar multifidus has been observed following experimentally induced injury to the lumbar intervertebral disc [14]. However, it remains to be
determined if changes in morphology and control contribute to persistence or recurrence of pain. Third, the current findings also suggest that the sole foci on symptoms and functional performance as outcome measures following an acute episode of LBP need to be reconsidered. Perhaps a clinically viable measure of back muscle control is required as an outcome measure of recovery following an acute episode of LBP. Preliminary investigation suggests that high resolution ultrasound imaging may be useful in this regard [24], but further work is required.
In summary, the current experiment presents evidence that even though they are pain-free and thus between episodes of LBP, recurrent unilateral LBP patients do not control their back muscles in the samewayas their healthy counterparts. These findings raise the possibility that this abnormal pattern of muscle control, in the absence of pain, may leave the spine vulnerable to (re)injury and hence predispose to recurrent episodes. Finally, this finding implies that pain and functional performance should not be the only outcome measures of interest after an acute episode of LBP.

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#36 User is offline   practioner123 

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Posted 20 January 2013 - 03:48 AM

While disk injuries are quite real, there is a complex inter-play of all structure involved with pain, both locally (due to tissue damage, causing "nociception") and "gate theory" type pain. The gate theory explains why your back hurts, but once you walk around, you feel better. When you have stimulation coming from the "good" nerves in your body, such as those involved in movement, it has the effect of shutting off the pain signal. However, there are other things at play, like the function of the spinal cord and nerves, as a single unit. Here is a copy and paste from another post discussing the covering of the spinal cord, where the nerves exit. What is commonly heard is "the disk is pushing on the nerve." What may be actually causing the problem is not necessarily pressing, or squeezing on the nerve, but rather stretching the nerve, like stretching a piece of string. That will cause its function to shut, more than squeezing will.

Interesting that I find a discussion about arachnoiditis. I didn't even think people knew what it was, so interesting to find it on this site. Dr Burton has a great website about this very real condition.

I do a technique that I think helps relieve it. Arachnoiditis refers to the arachnoid layer, surrounding the spinal cord. It represents an inflammation of the spinal cord fibers, themselves, and can be visualized on MRI. The technique I use was based on the research of a neurosurgeon from Sweden, Dr Alf Brieg. After learning this technique (only taught in the States, as for as I know), my first patient, who could hardly walk for 14 years, had her first pain free day in 14 years, following 6 months of regular treatment. Another, who came in with an MRI, showing obviously inflamed cauda equina, had his first day free of low back pain in years after 10 treatments (was on holiday). I could go on and on.

What's interesting about the technique is that it involves function of the entire spinal cord, not just in the low back, but the neck and skull, because the entirety of the brain and spinal cord is covered in a continuous ligament called the "dura mater." It's as if your brain and spinal cord is encased in a flexible steel sheet, and it all moves as one unit. One of the fascinating discoveries of that neurosurgeon, working on fresh cadavers, cut in half, was that when the neck loses its curve, it pulls the spinal cord all the way down tot he tailbone, and the cord itself loses up to 7 cm of slack. That means, if you pull the collar of your shirt, does it not pull all the way down to the bottom, where you have it tucked into your jeans? Your spinal cord functions the same way. You pull the neck, by simply pushing your head forward, you also pull your low back region of the spinal cord, pulling on the nerves, that get stretched and no longer function (there's your bowel issues, pain down the leg, etc).

The sad thing is that while I got accolades from one claims officer at ACC, and said she would send what I was doing up the flag pole at ACC, for further recommendation, it seems the rest of ACC doesn't seem to give a s-it. Nothing ever came of the officer's accolade, after having helped someone with a serious head injury. It's sad, because a lot of people who are injured could get better with this technique. Some people take longer than others, but I'd have to say, the only ones who didn't get better are usually the ones who quit, and/or don't follow the dietary recommendations (cut everything made from seeds, especially breads, cereals, and margarine, and increase your animal fat intake).

This is the problem with a system that is designed to fail, like ACC. It's a symptom of the condition of our so-called 'healthcare" model, as well. There is no real intention on fixing things, I feel, but rather "management" of pain, and injured parties. While I can appreciate ACC's position that there are plenty of "dole bludgers" out there who would like nothing more than to sit back and collect ACC for the rest of their lives, there are plenty that would love nothing else than to carry on with their lives, the same as it was before the injury. Instead it appears there is no search for an increase in quality in the health of the individual, or genuine research into what works and what doesn't, and I find it sad. People suffer. When they get to my office they are often broke or destitute, like the one above, who after 14 years of not being able to work, and seeing over 50 specialists, including psychiatrists, and having been cut from ACC, had to borrow the money to pay for my treatment. It makes you angry.

How many other people could be helped? What is ACC doing to research what works and what doesn't? I believe their official stance is to push people off the system once they believe they have done all that known medical science can do for you. It becomes your problem, not theirs, and selfish humans as we are, that bonus is due. Gotta meet that quota. It is why I came here. I am looking for any information about bonuses for ACC staff. Anything you have. Do they use "hay points?" KPI? Or did they do away with that, and replaced it with something else, that you must specify in your Official Information Act request? Does the investigations department receive any incentives? It seems that ACC finds it easier to accuse a person of fraud than to actually do their duty and help the person get better. If they don't think they can, then instead of admitting defeat, or exploring different options (like what I'm doing), they make it your problem. It's such short term thinking. "The purpose of government is to prevent injustice, except for the injustice caused by the government itself." Ibn Khalduhn, father of economics and sociology.

So many people would not need surgery if they had this technique, I believe. A lot of the "pain management" programs would become un-necessary, not to mention surgery. I've had patients who had been through those programs, and were no better when they were done. Yet, they were told "it's all in your head," which I can understand be made out of frustration, when you don't know what to do, but if a person has tension on their spinal cord, pain is a very fair conclusion. Drugs will not fix a mechanical tension in the spinal cord brought about by physical injury. And no, this is not just another "manipulation." I hate that word. This technique involves stretching of the dura in a way that you cannot do yourself. It's rather intense, and can be uncomfortable. However, this must be measured against having a life of pain. These stretches are painless for a person with no issues, and eventually you reach that stage, depending on how messed up you are, how many injuries you've accumulated over your lifetime.

After what I've seen, I would never have back surgery- ever, if I could help it, because I think most of them can be fixed without surgery, and surgery is irreversible, whereas with this, the worst that can happen is it will delay surgery. Also, people in pain are under the mistaken belief that surgery will give them the miracle they seek, and "do something!" Sadly it doesn't work out that way. One surgery often (if not usually) leads to another, later. There is a structural/bio-mechanical reason why this is. When you fixate a lower joint with surgery (usually at L5-S1), then your L4-L5 disk must carry the new burden for what was once a moveable joint at L5-S1, so it too blows out. Surgery at L5-S1 begets surgery at L4-L5 about 5 years later.

I will say this, I have never met a back pain patient who didn't have a neck injury first. Fall off the horse, or get in an auto accident today, and 15-20 years later you can't get away from your low-back pain. This is typical, and there is a structural reason why. All of this effects the flow of the precious fluid that nourishes your spinal cord, and if it is impeded, the cord can't receive nourishment or flush out toxin. This is "cerebra-spinal fluid." If the dura mater is stretched, it's like stretching a hose. It becomes thinner. The fluid flows in the space between the spinal cord and the dura. If the space becomes thinner, then the fluid can't flow, and you get arachnoiditis, essentially. This is a simplistic explanation, but a major factor. There is also tension on the filum terminal, affecting the cauda equina, as well. All of this is mechanical tension.

The tension works both ways. A person with tension in their low back will also have tension in their neck, because the cord is continuous. I've had tremendous results with migraine headaches using this technique, and we work on the low back as par tof the treatment. It's intense, and I've had several people quit. It's not easy for some people, especially those that have really old injuries, fibromyalgia, etc, however, the ones that stay with it usually do get better, in my experience. The ones that don't get better is usually because they quit, or they really don't want to get better (they've come to identify with their injury, or use it as a means to curry sympathy from a spouse, etc). The ones intent on getting better usually do. Some take longer than others, well, because they are more messed up than they think. Surprisingly, some of the most messed-up people I've treated have been health practitioners, and I've treated a few. You would think that they would have the healthiest spines, but sadly they don't. I myself had a bit of pain, having been through 2 auto accidents in succession, and I'm happy to say I am pain free now.

As an aside, I treated that guy who climbed to the top of Christchurch tower to protest his ACC treatment. He's much better now. Talked to him a year after his treatment, and he says he's still doing well. His problem was missed by about a dozen practitioners of various types. He did receive injections, and ACC refused his surgery. He didn't need surgery or injections (injections are a waste of time IMO). Have to catch up with how it's going with his home. Destroyed in quake.

I came to this forum while doing a search regarding incentives for ACC employees. I did not post because I thought that ACC controlled the board, and I did not hear back from someone after I requested some information, so I thought maybe the communication got ambushed by an ACC employee. Now I understand that this board is handled by members of the public, so I can speak more freely.

I'm in a bit of a different situation, as a treatment provider. I have my own problems with ACC. If you have any information that proves ACC staff, especially the investigation department, receives bonuses for doing certain things, it would be most appreciated. I get the impression that they are trying some of the same tactics now, against successful clinics, as they employ against "expensive" patients. The sad thing is, that a lot of these "expensive" patients, I think can be fixed, and a successful clinic should be left alone to do its job, and ACC would, in fact, do well to send all of their trouble patients to us because we can probably get a lot of them back on their feet- and "rehabilitate" them for real, instead of sending them to some medical whore who says they can drive a tractor. Our average patient has "been everywhere else, tried everything." Have heard it all before. One of our biggest challenges is the medications. My gosh, some people have a lot, all fixing nothing, making the patient dependent. It slows down progress greatly, plus withdrawl issues. A little challenge there, especially the cholesterol meds.

#37 User is offline   Sparrow 

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Posted 23 January 2013 - 08:33 AM

ACC staff are encouraged to be ruthless and cruel and the rewards are KPI's that can lead to a rise in pay or promotion.

They have to be 125% successful so the encouragement to be ruthless is an incentive to promotion. They deny a paid bonus but that may be left to speculation!

Your post regarding Arachnodits is interesting.
do you know if there is still a Support group for these sufferers?
The Gp's just dont want to know and some have never heard of it. It is apalling how these victims of this accidental disaease are treated.

What are your qualifications and branch of Alternative medicine?

Posts like this are informative and thanks for posting.

We need more of this type of info and that is what this site is all about.

#38 User is offline   Compassion 

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Posted 23 January 2013 - 11:40 AM

Perhaps these alternative therapies are best to be advertised regardless if acc pay or not. Even if you have to save a few dollars of your weekly comp each week, if it helps it is certainly worth it.

Is this technique the same as what chiropractors do? I think to be acc registered you need to be registered is a reputable professional body with NZQQ standards qualificaitons. You need to provide acc case studies too, it is on their website how to apply to be funded by them. Hope this helpf.

#39 User is offline   Mark 

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Posted 23 January 2013 - 01:25 PM

View PostSparrow, on 23 January 2013 - 08:33 AM, said:

Your post regarding Arachnodits is interesting.
do you know if there is still a Support group for these sufferers?

Any more info on arachnoditis you'd have to ask the accforums resident guru on the subject gaffa09

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