13 Aug Treating Low Back Disorders Current Best Evidence
Low back pain continues to pervade our world regardless of all of the attempts to cure the problem. Evidence indicates that for all of the new treatments developed for this condition, the problem continues to plaque our world. Treatment approaches and social behavioral changes should be based upon the current best evidence available. Both Australia and Scotland have national campaigns to “de-medicalize” back pain. They emphasize remaining active, trying simple pain relief and pursue medical advice if necessary. These campaigns have changed the attitudes regarding the care of LBP an impressive 20%.
Three important questions have repeatedly been investigated. 1) Does exercise increase the risk of back pain among individuals without symptoms? 2) Does the prescription of exercise for people with back pain lead to an increase in recurrence rates? and 3) Does an early return to work complicate back problems? The answer is “no” in all cases. If this is the case, why doesn’t a scientific and logical approach to conservative care exist? Caring for LBP is a management issue and individuals should be empowered to care for themselves through an effective movement and behavioral education program.
Evidence exists regarding loading limits and dangerous actions of the spine, muscle activity and motor control during specific movements and strength, endurance and muscle balance norms for the muscle system. This information can guide a scientifically based program. No one program is a panacea. Each individual seeking advice must be examined to determine their physical capacity and symptom provoking actions, and then apply accurate information regarding age and gender differences and spinal function. For example, females tolerate approximately 2/3 the spinal compression of males, and 60 year olds tolerate approximately 2/3 of the compression of a 20 year old.
OPTM emphasizes endurance and muscle balance over strength. We instruct everyone to use a muscular bracing technique to prevent spinal buckling while performing specific movements. Our program is direction specific to avoid exacerbating symptoms. Typical muscle balance ratios are based on trunk extension endurance. Trunk flexion should be approximately 80% and side bending 60%. People are trained to transfer loading to the hips and spare the spine. A sample of a beginning program, which maximizes muscle activity and minimizes spinal compression loading, might include squats or lunge with abdominal bracing, isometric trunk extensions in quadruped, side bridging and a specific form of a curl-up.
Proper exercise prescription considers the biomechanics of the trunk and lower extremities and the individual’s physical status. The approach of the movement program at OPTM is both cognitive and physical. We advocate that people remain active and teach safe movement patterns and integrate them into daily use. These patterns must become ingrained and subcortically controlled through many repetitions to be effective.