Hello again,

Thanks for the references, that is useful. The evidence based guidelines in the UK, and the opinion of the leading pain researcher (Uni of leiscster Dr Paul Watson) suggest that non specific back pain is a common cause of work related absence, and that chronic pain issues need to be evaluated as either a true physical problem, or whether psychosocial issues are of concern.

I never like to share comments without backing up with evidence, but this time I have to draw on something from personal experience:

Having previously suffered back injuries myself, I do not agree that pain control is everything. If that were the case for me, I would have simply had doctors inject and drug me up with everything they got and become a sedentary lifeless bag of mostly water and protein.

As well I was not specifically referring to Dr Wadells book, I was refering to the previous post dated: 18-01-2008 04:04 PM, in which I described a story related to me by a researcher from Aus. In his case, low grade repetitive stress injuries resulted in a significant chronic problem. There are indeed microscopic, and even macroscopic changes that do occur that can significantly effect the biomechanics, tissue viability, strength, bone density, hydrostatics, of the complex low back area. I feel for 'chak' that it will be important to monitor and manage the problem, while find ways to continue to increase activity without aggravating the low back. Whether this correlates with what is observed on radiograph or not, is obviously difficult to say for sure.

Hmm... I am not going to completely criticize the research around genetics, but I will look into it and report back what I find. Regarding genetics in general, we know that everything from what we eat, how we exercise, what we think, sleep, and feel influences our genes. Whether this research shows that certain allelic version of a gene contribute to back pain or not can not be used to confirm a hypothesis. The results of their study may not distinguish between gene activation, and gene presence.
For example recent research surrounding the French Paradox: . Looking at the the obvious (Americans eat 70g of fat/day in diet, get 50% more cancer vs. French eat 100g of fat/day have less cancer, diabetes etc.). If scientist A discovered that in French gene X was more common, it is absolutely a ridiculous statement to simply report the difference in mortality on genetics alone. The reason being that scientists have deduced how certain food compounds can directly activate what is now termed as 'longevity' gene SIRT-1. It is the influence of the frequent consumption of the food compound that activated gene SIRT-1 over time, not an inherent genetic difference that can explain the difference between the 2 groups.

Myth Number 1: Genes Are Everything

The so-called twin studies have proven that beyond a doubt. In those research studies it was revealed that when identical twins - those with the exact DNA - were separated, they did not develop the same health issues.

It's what your genes are exposed to that determines the level of health that one has. It's the signals that you send to your body by the food you eat, the thoughts you think, and the life-style choices that you make that affect the health of your genes.

Your actions, not only your genes, influence your life to a very large extent.

People who lead mentally stimulating lives, through education, occupation, and even leisure activities, have a reduced risk of a variety of diseases. Some unscrupulous researchers fail to take lifestyle into account when attempting to explain the cause of diseases such as Alzheimer's, Arthritis, Obesity and others.

The same explanations have been given to explain obesity (which surely must be genetic right?) and that is why some researchers are hard-driven to find the 'obesity' gene, failing in attempts to understand the role of leptin, ghrelin and other molecules, as well as the genes that are activated more often in obese individuals. Is there a link between obesity and OA, how about family history?.

This is a condensed attempt by me to try to explain the reason why I am weary about any 'genetic' findings in relation to incidence of anything in particular.

I will discuss this further without hesitation of course.

I absolutely agree that this patient needs help, and indeed I agree the advice you have given is very much important.

I hope whatever I have said will be looked upon with an open mind, and mind my criticism it is not meant to be aggressive in any way

Regards