Category Archives: Health

Lower Back Pain linked to Chimpanzee Spine Shape?

Research Study 

 
A BBC article discusses a Research Study by scientists from Scotland, Canada and Iceland which has been published in the journal BMC Evolutionary Biology, which suggests that some peoples’ lower back pain may be caused by the shape of their vertebrae.
 
When the scientists studied the skeletons of ancient humans, chimpanzees and orangutans they found that some human skeletons that showed evidence of intervertebral disc herniation, had vertebrae more similar in shape to chimps than to other humans without disc damage. Chimps do not walk with an upright stance as we do and the argument put forward by the researchers is that in some people, the evolutionary development of the spine contains “pathological vertebrae” which “may be less well adapted for walking upright”.
 
 
Chimpanzee_knuckle_walking.jpg
Photo: BBC
It may well be that some people are genetically more predisposed to having lower back pain than others but there seems to be little mention in the research paper of the impact of our body-use and habits of mis-use that contribute to back problems such as a ‘slipped disc’, other than saying that they appear to be caused by strain and stress on the pathological vertebrae which cannot support the downward compression, so cannot protect the discs. If some people do have spines that are more vulnerable to the sort of compression and distortion that contribute to having a ‘slipped disc’, then it is surely even more important that they learn to use their bodies in the most aligned and effective manner, in order to protect the discs and prevent their herniation.
Habitual Mis-use
 
When we curl over, the vertebrae and discs contract down on one side and can push the soft tissue of the discs so that they bulge out, or herniate. This is not just a problem for the lumbar region of the back but we can get slipped discs in the neck and other areas of the spine as well, if they are continually compressed with habitual mis-use, or as the result of an accident. This wooden dummy does not have vertebrae but the discs of wood representing the torso can be seen to be angled, narrowed and compressed on one side, just as the vertebrae and the discs between them would be. 
 
Bending curling 2.jpg
Monkey Position
 
This research paper gives a new slant on F M Alexander’s concept of using ‘monkey position’ or ‘the position of mechanical advantage’ as he called it, which allows us to bend forwards from the hip joints, thus allowing the spine to remain lengthening – which protects the vertebrae and the intervertebral discs from compression and distortion. You can see in this photo which is illustrating ‘monkey position’ the wooden discs forming the body are more evenly spaced and opened out – if these were our vertebrae, you can see that this allows more space between them, which would not compress the discs in the same way as above.
 
Monkey model 1.jpg
Nature or Nurture?
 
This debate about the impact of our genetic inheritance and the impact of our learning throughout our lives will continue. I suggest that for most conditions, it is an interplay between both that we have to live and work with. Fortunately, most of us do have choices available to us about the way we live, use, mis-use or even abuse our bodies. As the BBC puts it ‘Back pain is a very common issue in humans’ – but many hours lost at work through back pain could be avoided, if people learned how to move differently, so that they protect their backs as they sit, walk and work throughout the day. It can be done, as the ATEAM Research Trial showed, which found that Alexander Technique lessons significantly reduced chronic lower back pain and was more effective than either massage or a Doctor’s exercise prescription.

Out and About with the Alexander Technique

The Alexander Technique is far more than ‘relaxation’ or stress management, although it can help us in both ways. When we include using the Technique during our everyday activities, it can help us unwind and to avoid slipping back into habitual reactions that create tension, distortion and discomfort in our bodies.

If you keep being aware of your use during activity and regularly practice the lying down procedure, your body- use is likely to improve and your movements will tend to become more free and easy than they have been for some time. It really can increase your wellbeing, so why not reward yourself.

Some people say that they don’t have time to practice this procedure, which is sad. If they allowed the time to do this regularly, they would realise just how enjoyable it can be useful it is as we unwind and come back to ourselves and they would also see just how much we can learn about ourselves in the process. We often work better afterwards, too.

Lying down and working on ourselves can become like a safe haven to return to in the middle of our hectic lives – or when out enjoying yourself but back pain threatens to spoil the day.
Semi-supine in the woods.jpg
The photo was taken in the New Forest, where this man suddenly lay down in semi-supine, right in the middle of the ride, to ease his back pain. He’d only had a couple of AT lessons and was not lying with the ideal height of support under his head, so his neck is still a bit contracted and arched – but we don’t have to be perfect, anyway! It was great to see the Lying Down Procedure being used so naturally – and in such a beautiful setting. It can only improve our health and the quality of our lives.
Now I shall lie down and work on myself……

Standing with Ease

Standing with Ease Using the Alexander Technique

In Alexander lessons, we really can learn how to feel comfortable when we stand for long periods of time, rather than ending up with back pain. 
 
When we allow ourselves to balance on our feet in a coordinated manner without bracing and locking our legs and backs, we can support the weight of our upper body whilst using far less effort. In so doing we reduce the downward pull of gravity – and we are less likely to sag.
I often used to have an aching lower back even when a child, as I trailed around shops or art galleries. Despite being trained in ballet, I still used to sink down into myself and put pressure into my lumbar spine. This would be worse when I was tired, or bored, or when I was trying to look shorter than I really was. Thankfully I changed these habits when I learned the AT, so I stopped getting that heavy back ache – and art galleries are far more enjoyable now!
This sinking down into oneself is graphically shown in a sculpture by Francesco Messina. Many people will just see a curvaceous young woman called Maria but I see a familiar distorted pose, with the body’s weight mainly taken on Maria’s left foot, which throws her off balance and displaces her pelvis. Her weight is pushed down into the lumbar area of her back which over-arches (Lordosis) and cannot properly support her upper back and head, so thrusts her neck forwards and curves her upper back, making a pronounced ‘S’ shape (which could develop into Kyphosis)
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Maria Grazia by Francesco Messina – Lugano
This posture of sinking down onto one hip is frequently used, particularly by women. Standing on one foot may look non-threatening, even vulnerable and is sometimes thought of as feminine. ( But do many women want to look vulnerable these days? )
If we just move briefly through this sort of off-balance position, little harm will be done – but if this is a habitual posture, we will probably end up with hip and lower back pain and problems such as Sciatica. By changing our habits in AT lessons, we can often avoid contributing to such conditions.
Maria Grazia by Francesco Messina 1967 front 10-08-2008.jpg
When we have to stand for long periods of time, as I have to as an Alexander teacher, it does make a huge difference to our general well-being to be able to stand freely and easily, sharing the body’s weight on both feet, with the head balanced on the neck, creating an alignment through the whole body from the ears right down to the ankle joints. In this way we can fine tune our balance, adjusting to even small changes in our body as we stand and move.
This balanced way of standing and using the body may be seen in the photo of an artist’s wooden model. I had fun trying to make it stand do so was when everything was in alignment and balanced. It underlined for me just how much we as humans pull ourselves and our skeleton off balance with our poor body-use, so that our muscles have to work extra hard in order to let us stand up at all.
Standing.jpg

Alexander Technique for Women ?

Why put on an Alexander Technique Workshop just for women?

 
Well, in the first place, some women just feel more comfortable attending this type of workshop if it is for women only and for some, their cultural background encourages them to attend classes in an all-female environment. 
 
Also, women do have some specific issues such as wearing high heels, pregnancy and childbirth, all of which can be thought about within the context of the Alexander Technique. For instance, many women experience back pain during pregnancy, or as the result of their habits or wearing stilettos  – all of these can compress the lower back, which can create an exaggerated lordosis, often leading to pain. By learning and using the Technique, which can help women use and carry their bodies differently, many such problems can often be alleviated.
 
Childbirth itself can be helped by using the Technique, as can carrying the baby once it is born – although this latter is (hopefully) not exclusively a woman’s activity! One pupil said this:
 
“I wanted to thank you for all that you taught me over the 9 months of my pregnancy. My weekly Alexander Technique lessons with you were so valuable and I feel contributed hugely to my healthy pregnancy and were so helpful in preparing for the birth”. 
 
A lovely little sculpture I saw in South Africa shows a baby being played with whilst the mother lies in semi-supine position, in a similar manner to how one uses it in the Alexander Technique (although the angle the woman is holding her head would probably be modified in an AT lesson). Lying in this position offers people a chance to let their spines lengthen and for their nervous systems to quieten down and this is a procedure that people are encouraged to practice every day as part of learning the Alexander Technique. (We don’t usually lift babies above out heads during the constructive rest procedure though!)
 
This position can also be used more casually as in the sculpture, allowing parents an easy way to be in close relationship with baby, whilst looking after one,s back. Older babies will climb all over you but this can add to the joy – and your back is still being supported and protected.
 
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Andrew Gibson – Woman and Child ~ The Annexe, Kalk Bay S.A.
 
Would you like to find out more about the Alexander Technique?
Individual lessons  ~ for both men and women ~ are available on a regular basis.
Next Workshop for Men and Women 25th April 2015

Are You Sitting Comfortably?

Are You Sitting Comfortably? No? 

 
Then your first step is to make friends with your Sitting Bones.
 
I had some fun setting up and taking these photos of Skelly, who usually hangs on a stand but I wanted him to sit, without an Xmas hat on this time.  Interestingly, the easiest way for me to set him up was balancing him right over his sitting bones, just the way I wanted him to be – which is the way our bodies are designed to sit. When Skelly was not put in an upright position, he just overbalanced. OK he’s only a plastic skeleton without muscles but he gives us a good idea about our bony structure and the way our bodies are designed to work. ( Not many arms will bend backwards like his though! )
 
However you can see the chunky rockers of the sit bones at the base of the pelvis, which are planted firmly on the surface so they can take the weight of the skeleton above. You can create an imaginary line through the skeleton from where the ear would be (near the hinge of the jaw), which is aligned above the shoulder and top of the arm, which in turn is lined up with the sitting bones. In this way the large weight of the head is balanced centrally and is supported, because it gets transferred through the spine and skeleton, right down into the sit bones.
 
An average adult human head weighs about 4.5 kg – 5 kg (9.14oz – 11lbs). It is heavy and it needs proper support!
 
Sitting Skelly 03-01-2015.jpg
 
I thought I would also try getting Skelly to lean – he cannot slump and collapse as real people do because he is too rigid but I did eventually get him to balance briefly, as if leaning backwards. One of the interesting things about this image is that it not only shows the sitting bones but clearly shows the tiny bone of the Coccyx at the tail end of the spine – which is not designed to take any weight but often is forced to do so because of the way the pelvis tilts when someone slumps in a chair. When this happens, the Coccyx is put under too much pressure and can be damaged, along with some of the vertebrae and discs. Also, the skull is left unsupported and the neck muscles end up by overworking in order to maintain some sort of balance and the breathing will be restricted….. and people wonder why they get problems such as neck and lower back pain
 
This is a good example of how our ‘use‘ or ‘mis-use‘ affects the way our body can function.
 
Skelly Leaning 03-01-2015.jpg 
 
 
So balancing over our sitting bones as we sit, allows our bodies to function more efficiently. One of the great things about Alexander work is that people usually do end up by sitting more comfortably, as they let go of habitual actions and reactions and learn a new way of using their bodies. 
 
This pupil quoted below was very grateful for her AT lessons but her rather sad words illustrate how many people experience being taught how to sit as a child. However, they do at least have the option of learning the AT,  and rediscovering the joy of sitting comfortably as an adult:
 
“I wish I’d been told about my sitting bones as a child instead of being hit and told to ‘sit up straight’. It’s so much more comfortable!”
 
Next Step?
 
If you would like to find out more about how the Alexander Technique can help you to sit, walk and move around more comfortably, individual lessons are available on a regular basis.
 
Next Workshop for Men and Women 25th April 2015

UEL Wellness Day ’14

University of East London Wellness Day 18 November 

 
I had an interesting afternoon helping out at UEL’s Wellness Day, on a stall run by STAT (the Society of Teachers of the Alexander Technique). There were three AT teachers promoting the Technique, plus Ilia, STAT’s manager – and of course there was Alex the skeleton!
The young man in the photo was running the next stall and it was good to be able to introduce the Alexander Technique to him, giving him some ‘hands-on work’ whilst he was sitting, standing and walking around. A good number of students, lecturers and staff kept us busy for the whole time we were there, asking questions and having mini AT lessons, which was great.
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Alex was rather tired by the end of the day……
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Allow Pain to be Your Teacher

As I Say to My Pupils – ‘Pain Can be a Good Teacher’


When we understand the significance of pain and recognise the different types of pain we can experience, we can use pain as a teacher and not just see it as negative. This is particularly true of injuries or aches and pains from tension, which we can feel powerless to change. However, when we listen to our bodies (without becoming obsessive about it) and develop an awareness of habit patterns which can contribute to or even be the cause of our pain, we can begin to make choices as to how we act and move, and so begin to reduce pain – which helps us gain some conscious control over the situation..
Of course, some types of pain are an indicator of serious illness or injury and medical attention will be required, but even here we can often use the Alexander Technique to ease the discomfort and to help manage the pain. 

Pain from a Broken Toe

Some years back I dropped a heavy piece of wood onto my right big toe and broke the end of it. Although the break was tiny, it was of course, very painful and I walked with a limp for some time, despite my efforts to minimise the distortion in my movements.
After a while, I began to notice that my left knee and right hip joints were beginning to hurt. Thankfully I was already an Alexander teacher and I knew these new pains were developing because of the imbalance created in my body-use from walking with a limp. I realised that I was continuing to limp even after my toe had stopped hurting – how quickly habits form! When I paid attention to stopping this habit, my joints stopped hurting. Any subsequent pain indicated to me that I had gone back into the protective limping habit, which I really did not need any more, so I reminded myself to stop that again.
Fear of Pain

After experiencing pain, we often develop a habit of reacting to the thought of pain by tensing up to protect ourselves ‘in case’ and this tends to be counter-productive. Often these reactions are quite sub-conscious but in Alexander lessons we can learn to recognise them and are then more able to consciously let go of them .
Reacting by tensing up at the thought of a dentist drilling a tooth for instance, just makes the jaw tighter, more sore and harder for the dentist to move. We can also give ourselves neck, back and head ache if we lie rigidly in the dentist’s chair. Going to the dentist’s is a great time to apply the Alexander Technique! Lying in the chair, reminding ourselves not to tighten our jaw, neck and back can make the experience far more comfortable – and it’s also a good distraction from the process in hand! 

RSI Pain
One condition that affects many people these days, including computer-users and musicians, is Repetitive Strain Injury (RSI) and this is a condition when people often tense up at the thought of being in pain – which just creates more pain. I have taught various pupils with RSI and one of the most helpful things they can do is attend to the pain they experience, rather than continuing to work through it and to avoid tensing up in reaction to the thought that they will be in pain if they perform a certain action. 
By developing an understanding as to which of their actions bring on pain and discovering what it is they do and how they have habitually performed those actions, helps them to realise how they have developed RSI. Then they can learn to avoid unhelpful habits and any pain arising during an activity can show them when they are falling back into the habits that cause problems. 
With the help of an Alexander teacher they are then able to learn to:
1) stop a habit and an activity just before any pain kicks in, so that they can avoid creating more pain. Then their bodies can have a chance to recover.
 
2) learn to modify how they perform tasks in a more free and easy manner, so they are more poised, using less strain and tension. 
3) learn to challenge the thoughts and attitudes that underlie the overuse patterns they have habitually fallen into. For instance, thoughts such as ‘I must finish this‘, ‘I must continue until I get it right’ or ‘I’m feeling stressed‘ tend to get us to keep pushing ourselves on until there is, consequently, yet more pain. At this point, the quality of our work often deteriorates, so it is far better to stop before this happens!
Completely stopping and lying down in semi-supine for 10 – 20 minutes can allow our minds and bodies to calm down, unwind and we can let go of our habits of tension that keep driving us on. It also helps injuries to recover and we usually work far better afterwards.
Pain Can be a Valuable Warning Signal
It can be a slow process to learn how to change our reactions and to see pain as a valuable warning signal but this process is one that pays off. It can be used with many conditions such as back and neck pain, many types of headache and a variety of other strains. An elderly lady came to me for AT lessons and she had bad arthritis in her knees, so that it was very painful to move into sitting or standing and her knees rather scarily crunched as she moved. However, when she refused to tense up at the thought of moving, she amazed herself by standing up with very little pain – and virtually no noise!  When there is deterioration to our bones, the AT cannot change that but when we allow the joints to move more freely, there can be a reduction in the pain experienced. Pain can help remind us to stop, think and then move thoughtfully, freely and much more easily.
In this way, people find they gain a tool they can use to learn from pain, so that they can avoid those habits that help to create pain, This gives them more choices, helps people to regain some power over the situation and often frees them from some or all of the pain that has been one of their teachers.

Research into Balance and the Alexander Technique

Study: Can the Alexander Technique Improve Balance and Mobility in Older Adults with Visual Impairments?


Yet another interesting piece of research has been published which provides further evidence as to the effectiveness of the Alexander Technique. 

Researchers at the Sydney Medical School, Sydney University, Australia, have investigated the impact of taking Alexander Technique lessons on the mobility and balance of 120 subjects, who were all over 50 years old and had visual impairments. The intervention group were given AT lessons plus their usual care, whilst the control group just received their usual care.

Primary outcome measures of physical performance were taken at 3 months, with secondary outcome measures of postural sway, maximal balance range and the number of falls experienced by the subjects, taken at 12 months. 

Conclusion
The results showed that there were no significant changes in the the primary outcome measures. However, the intervention of taking Alexander lessons indicated there was a ‘significant impact’ on the secondary outcome measures one year later.

The results showed benefits in postural sway for the group that had AT lessons, compared to the control group who did not. This group also had a trend towards fewer falls and fewer injurious falls. Some people who had previously experienced multiple falls, also showed an improved level of mobility.     

This is very encouraging and, remarkably, these changes in outcome came about after having just 12 weeks worth of half hour long AT lessons. Unfortunately, the research team had to reduce the number of lessons from the recommended 20-25 lessons, down to 12 lessons, because of financial restraints. How much more significant might the outcomes have been, if the subjects had been able to have a greater number of Alexander lessons, possibly of 3/4 hour in length, as I and many AT teachers offer?

The research paper states that the findings ‘suggest further investigation of the Alexander Technique is warranted’. It is good to see that amongst the references cited, there are a number of papers relating to prior research into the Alexander Technique, such as the ATEAM Trial re back pain.  Let’s hope more funding is available to develop this research. Further research into this and other relevant topics, will be much welcomed by the Alexander community!


Pregnancy, Childbirth and the Alexander Technique

Pregnancy and Back Pain

Women’s bodies go through dramatic changes during pregnancy and, as the NHS Choices website states, many women experience back pain, particularly during the last weeks of pregnancy. As the baby grows, the woman’s ligaments become more stretchy and the extra weight of the baby tends to drop forwards and down, tilting the pelvis, so that the pregnant mother often loses the length and strength in her lower back, increasing the lordosis and compressing the lumbar vertebrae.  This extra tilting of the pelvis can also contribute to pain in the pelvic area, as in Symphysis Pubis Dysfunction (SPD).

However, as can be seen in the photos of this young women at 271/2 weeks pregnant, using the Alexander Technique can help women to maintain the length in the lower back. This AT student had virtually no back pain despite the large size of her baby and she was still able to practice lying on her back in semi-supine, right up until childbirth. She was also riding her bike throughout her pregnancy!
Pregnant Mother Sitting .jpg
Childbirth and After
 
Practicing ‘monkey position‘ was one of the ways the AT helped Erica to maintain the length in her lower back during pregnancy and it was particularly useful both during labour and after giving birth. The photo below shows Erica using a very ‘shallow’ monkey position but in her AT lessons, we also explored how she could use a deeper monkey with her knees more bent, which helps encourage the baby to move into a good position for giving birth and will be useful when bending to pick up baby from the cot or floor, for instance. Bending the knees still further takes the movement down into a squat, which can be great to use during labour.
 
Erica kindly allowed me to share her experience of using the Alexander Technique to help her during labour, childbirth and after. She gave birth in hospital and ended up by needing a C Section, as her baby was very large for her small frame. 
 
“During the time I was labouring naturally (before it was clear I would need an epidural and caesarean) my husband and I used a lot of AT techniques, such as always coming back to a free neck, using the exercise ball to relax my hips through contractions, watching out for tension in the jaw and shoulders and accepting the sensations and contractions rather than fighting them. These were invaluable tools for the long hours of labour and I had to use lots of ‘whispered ahs‘ in theatre, as the drugs made me feel very shaky.”
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Monkey Position can also be Used During Recovery
 
“My recovery has been very speedy. After the caesarean I was up and about the next day as monkey helped me to be mobile around the ward – so the hospital were happy to discharge me the next day. The doctors said I was a great advertisement for having a caesarean and the body bouncing back! 
 
Using monkey is absolutely vital for recovering from a caesarean, given the pain and weakness of the tummy muscles. It is the only way to get up from a chair!  Thank you for all your guidance as monkey is saving me a lot of pain throughout the day.”
 
Of course Erica had worked hard at learning and practicing the Technique and she used it in her daily life, even before she became pregnant. This meant that she could call on her understanding of the AT and use it effectively when she really needed extra help.
 
Many thanks to Erica for sharing her experience and these photos, which were taken on the spur of the moment. I am glad to say both Mother and baby are doing well.
 
Next Introductory Workshop for Women and Teenage Girls ~ 7 March 2015
 
An International Women’s Day event
 
 

Paracetamol Doesn’t Help Lower Back Pain

Millions of Days Taken Off Work for Back Pain!
According to the NHS, work-related back pain caused the loss of 7.5 million working days during just one year in 2010 – 2011 ~ and this figure is not unique, it is similar for many other years as well. That is a lot of time off work and must have a big impact on the economy, so treatments for back pain are constantly being researched.

The Lancet has just published the results of a research trial that took place in Australia, which looked at the efficacy of prescribing paracetamol for people with acute lower back pain (24 July 2014). This research was a randomised, controlled trial with over 500 subjects in each group, taken from primary care centres in Sydney and the results show that paracetamol is no more help than taking a placebo at aiding recovery from acute lower back pain! 

The findings of this research therefore ‘question the universal endorsement of paracetamol in this patient group’. This traditional way of dealing with acute back pain is shown, for instance, in the NHS Choices website which mainly advocates ‘keeping active and if necessary take over-the-counter painkillers‘.  No wonder the pain often lingers.

Causes of Back Pain

Some back pain is caused by illness or an accident but the NHS states that the majority of problems are caused by ‘bad posture while sitting or standing, bending awkwardly, or lifting incorrectly’ – what F M Alexander called ‘habits of mis-useAddressing such habits and learning to improve our body-use is a cornerstone of the Alexander Technique and it is now recommended by the NHS as a method of reducing long-term back pain. This recommendation comes as a result of the major ATEAM Research Trial in 2008 that showed lessons in the Alexander Technique were more helpful for people with chronic lower back pain than were either massage or an exercise regime prescribed by doctors.

Prevention is Surely Better than Cure.
I suggest that it would be far more helpful to use the AT sooner, in order to help reduce acute back pain before the problem becomes chronic and therefore a long-term problem. 
Even better is to learn and to use the Alexander Technique in order to let go those habits of mis-use of which we are mainly unaware, until an AT teacher can help us to recognise them, and help ourselves prevent back problems from developing in the first place.
Update

The British Medical Journal, BMJ, have published another paper by the Australian Research Team 31 March 2015. This is an overview of 15 randomised controlled research trials exploring back pain and the effectiveness of using paracetamol. 

The outcomes showed that paracetamol did not help back pain, caused liver toxicity and did not improve the quality of people’s lives! – and this is what is usually recommended as the first line of defence to help back pain!

You can read an ouotline of the findings below, as reported in the BMJ. As a result of this research, the medicines safety regulator is assessing the safety of over-the-counter drugs and the National Institute for Health and Care Excellence, NICE, is awaiting the results of the review before making any decisions about whether or not to continue recommending paracetamol for lower back pain and arthritis. It may recommend exercise instead. 

Some of this research has been in the public domain for over a year. However the ATEAM Research Trial which showed that the Alexander Technique was more helpful than exercise for lower back pain and improved the quality of people’s lives, was published back in 2008. How long will it take NICE to understand the implications of this research into the effectiveness of the Alexander Technique and to act on it by recommending AT lessons for back pain, instead of toxic drugs?


You may see the outline of the findings below:
Published March 2015 BMJ 2015;350:h1225

‘What is already known on this topic

  • Clinical guidelines recommend paracetamol as first line a
    nalgesic drug for both spinal pain (neck and low back pain) and osteoarthritis of the hip and knee

  • The evidence base supporting these recommendations has recently been called into question

What this study adds

  • High quality evidence suggests that paracetamol is ineffective in reducing pain and disability or improving quality of life in patients with low back pain

  • There is high quality evidence that paracetamol offers a small but not clinically important benefit for pain and disability reduction in patients with hip or knee osteoarthritis

  • Though high quality evidence shows that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests compared with those taking oral placebo, the clinical relevance of this is unclear.’