RehabilitationExercise therapy is the most widely used type of conservative treatment for low back pain.  Van Middelkoop et al 2010 Conducted a Cochrane Back Review Group CBRG of 37 randomised- controlled-trials to find that exercise therapy improved post-treatment pain intensity, disability, and long term function.

There is evidence that exercise therapy is safe as a treatment for Chronic Low Back Pain CLBP.  A systematic review, by Rainville et al , reported that there is no evidence that exercise increases risk of additional back problems or work absence.  They found substantial evidence supporting exercise as a therapeutic tool to improve impaired flexibility and strength.  Most studies reviewed, observed reduction of global pain and pain behaviour effecting back pain syndromes.

Both motor control exercise (core stability) and graded activity (gradually paced increases from specific baseline) have been shown effective in rehabilitation from CLBP.

Functional activities are the things that we do in daily life, that often become compromised due to pain or disability.  Your osteopath can assess and help each patient determine baseline tolerances that are realistic, before pain starts.  A plan of graded activity will be commenced slightly below these tolerances. Exercises and activities are maintained at specific quotas before upgrading.  The aim is to reinforce ability and function. This positive reinforcement helps to build stability and confidence. Resist the temptation to upgrade too quickly or in large increments.  Evidence shows that gradual increases are more sustainable and setbacks are less likely.

Examples of functional activities are:

  • Walking
  • Sitting
  • Standing
  • Balancing
  • Cycling
  • Carrying
  • Lifting
  • Pushing, pulling

Others may be included that are specific to an individual’s work, home-life or other goals; e.g.:

  • Computer sitting
  • Ladder climbing
  • Driving
  • Gardening
  • Using tools or appliances

Pacing to quotas enables steady upward trending towards the goal.  Pacing and quotas can be used to help motivate and minimise re-injury with all aspects of the plan including general exercise, specific exercises (both stretching and strengthening) and functional activity.

Michael Mulholland.  Osteopath

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