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Part 3 of 3
Exercise Therapy
What exercise should back pain patients perform? A group of scientists called
the "Cochrane Group" reviewed 43 randomized controlled trials of chronic back
pain sufferers (symptoms lasting longer than 12 weeks). They made the following
recommendations. A successful chronic back pain program should contain the following
elements: (1)
1) Individually designed and supervised programs
2) Stretching
3) Strengthening
4) Improvement in pain and function
A key component of the Cochrane report is the strong recommendation for exercise
and its implications. A supervised exercise program is recommended because it
is safe and does not increase the risk for injury. Think of exercise as a tool
to increase endurance, flexibility, and strength. Exercise also improves pain,
mental status and behavior.
In a systematic review of the literature, James Rainville, MD and other spine
researchers reported that exercise therapy in rehabilitation accomplished three
important goals:
1) Elimination of impairment by increasing patient function
2) Reduction of pain intensity
3) Reduction of pain related disability
Doctor Rainville's review showed these three goals could be accomplished without
increasing the risk for future episodes of back pain. (2)
Strengthening Exercise
Apart from general exercise, strengthening exercise is important to rehabilitation
success. The most successful rehabilitation programs understand movement and
function require strength. Therefore, such rehab programs make strength training
central in their overall treatment plans. Patients who perform strengthening
exercise in a supervised clinical setting gain confidence to increase their
daily activities when away from the treatment facility.
Strengthening exercise using resistance machines during rehabilitation is helpful
because activity levels can be accurately measured. Therapeutic exercise can
be likened to a medication, and patients should be given a 'prescribed' dose
to accomplish the most in their personal rehab programs. The therapeutic 'dose'
of prescribed exercise is best measured in an objective clinical setting. The
dose can thus be safely increased with increasing strength.
Strength Training Pioneers
In the United States, Thomas DeLorme, MD was a strength training pioneer for
back pain patients. Doctor DeLorme developed a series of Progressive Resistance
Exercises (PRE) to rehabilitate injured military personnel. He provided the
first results showing the importance of strength training as a rehabilitation
tool. (3) Other scientists and clinicians conducted studies and reported their
findings about the importance of strength training in back pain patients.
In the 1960s, Arthur Jones introduced the first variable resistance exercise
machines. This was the first time exercise machines isolated specific muscle
groups and challenged them through their full range of motion. Mr. Jones took
his ideas further and, during the 1980s, formed a company to specialize in the
testing and measurement of back and neck strength and range of motion. His successes
lead to the development of the MedX™ lumbar and cervical extension machines.
For the first time, MedX™ equipment measured back and neck strength. A distinctive
feature of these machines is their unique ability to isolate back and neck extensor
muscles. More than 50 published scientific articles prove the value these machines
offer in spinal strengthening, increased functional capacity, greater range
of motion, and pain reduction. The MedX™ lumbar and cervical extension machines
have helped to quantify the importance of strength training in a clinical setting.
Preventing Episodic Back Pain
What about preventing back pain? Strength training is important to build and
preserve functional capacity while reducing the risk for future injury. Although
the value of aerobic exercise cannot be discounted, strength is the fitness
element critical to maintain function throughout life. Regular strength training
should be considered a priority to anyone working toward optimal functional
capacity.
Cybex® and Nautilus® are exercise machines available at most health clubs and
are designed to help maintain a good level of overall strength. MedX™ Corporation
has continued to be innovative in the field and created a group of machines
used by Core Spinal Fitness Systems™. These exercise machines isolate the back
and neck musculature for overall core strengthening to increase function and
protect against injury risk.
Healthy Backs
Do you fall into the group of 85% of people who will experience episodic back
and neck pain? You may not be able to avoid back pain, however - the spine strengthening
strategies summarized in this article could be your first step toward a stronger
and healthier back.
References
1. Hayden JA, VanTulder, et al. Systematic review: strategies for using exercise
therapy to improve outcomes in chronic low back pain. Ann Intern Med
142(9): 776-85, 2005.
2. Rainville J, Hartigan C, et al. 2004. Exercise as a treatment for chronic
low back pain. The Spine Jour 4: 106-115.
3. DeLorme T, Watkins A. 1948. Techniques of progressive resistance exercises.
Arch Phys Med 29:263-273.
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