Push Through the Pain
If you have chronic back pain, the best remedy is to rest and avoid strenuous exercise, right? Wrong. According to the team of experts at New England Baptist Hospital in Boston, MA, taking it easy is an outdated and ineffective approach.
With demonstrated effectiveness for improving function and work, exercise is a widely prescribed treatment for patients with acute, subacute or chronic low back pain. There is no evidence that exercise increases the risk of additional back problems or work disability and current studies demonstrate that exercise may reduce pain and disability.
“Years ago, bed rest was the common advice given to patients after an episode or exacerbation,” said Kristine Kono, PT, clinical supervisor of the outpatient center at NEBH. “Now we are encouraging patients to move, stretch and even lift very light weights during these episodes.”
One of the country’s foremost experts on exercise and back pain, James Rainville, MD, is chief of physical medicine and rehabilitation at New England Baptist Hospital. Dr. Rainville and Lisa Childs, PT, senior physical therapist, founded The Spine Center at NEBH in 1997. Affectionately termed Back Boot Camp by patients, the program has widened its scope of patients from those with chronic back pain to a variety of spine dysfunctions.
Back Boot Camp
The fast-growing program is offered in two Boston sites-Chestnut Hill and Dedham. The Chestnut Hill site is a training ground for various medical providers who practice across the country.
In addition to the typical components of a physical therapy evaluation, the PTs issue each patient an Oswestry Disability Questionnaire, measure the patient’s range of motion with an inclinometer and have the patient complete a back extension maximum strength test and lumbar and cervical maximum lift strength tests. The lumbar lift is performed as a floor-to-waist stoop lift. Following an evaluation, the patient is given an individualized program that focuses on improving overall flexibility, strength and function.
Treatment frequency and length of stay varies depending on patient availability. Patients generally attend treatment two times per week for six weeks. The initial 20 minutes of a session is a stretch class led by the primary physical therapist.
Patients may stretch on the floor or in a chair depending on their age, disability and fear level and are instructed and refined in the stretches that match the range of motion tested, Childs told ADVANCE. Patients who are able also participate in a 10-minute step-up class.
“The purpose of the step-up class is to assist patients in restoring their agility, becoming more confident to take gym classes and/or returning to a previous recreational activity,” Childs explained.
For the rest of the session-45 to 60 minutes-patients train in the gym. Under the direct supervision of a physical therapist, a physical therapist assistant and an aide, the patient completes a circuit of weight training equipment and lifting activities.
“It can be difficult to convince patients that although initially bending and lifting a weighted box from the floor may be painful, through desensitization, these activities will most likely become easier and more comfortable,” Kono stated.
Each patient has an individualized meeting with a physical therapist to assess pain, develop a long-term exercise plan, progress home or community function, set goals and meet educational needs. The treatment is team oriented under the leadership and direction of a physician and each team member has a defined role to allow for continuity of care, trust building and to ensure expected physical progression. The model offers patients a combination of group and individual treatment.
“The therapy team meets at the end of each session to review each patient,” Childs said. “The therapists look for what needs to occur to assist each patient attain his maximal functional potential.”
The PTs focus on reversing a patient’s range of motion, strength and lift deficits. Deficit improvement is achieved through goal-oriented therapeutic exercise.
“Therapeutic exercise has been shown to decrease pain and is primarily used to provide the patient with the experience to safely and effectively function despite back pain,” Childs said. “The treatment is successful when a patient makes the cognitive shift that his performance in physical therapy can be transformed into real life.”
According to Childs, the ultimate goal of the program is long-term independent function and self management of the individual’s back pain.
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