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Focus on Function: Our Treatment Philosophy

This article is a revised version of a post published on January 07, 2013. We have updated the article so that it is easier to read for most web visitors. This article was updated on January 16, 2017.

We believe that if we focus on pain and structure alone, patients suffering from chronic back pain are led down the wrong road, often leading to unnecessary treatment with little improvement in outcomes.  Reducing the surgical incidence of low back pain, and being the leader in non-surgical treatment of low back pain is PDR Clinics’ vision. The primary goal of our treatment approach is to restore a patient’s function so that they may avoid costly surgical interventions, ongoing use of medications, and continued use of medical services. To do this, our focus is on functional restoration both of the spine and of the whole body.

Our Focus on the Pain Cycle

When a person experiences low back or neck pain, the natural response is muscle guarding and compensation.  An initial “disc injury or back strain” becomes a widespread neuromuscular problem. This leads to more problems and more pain. Altered muscle activity leads to systemic and predictable patterns of muscle and postural imbalance. Persistent imbalance to the motor system creates tissue changes, particularly inhibition and atrophy of the supporting multifidus and transverse abdominus musculature, and chronic spasm and tightness of other muscle groups such as the psoas or piriformis. Connective tissue fibrosis also results from abnormal movement, leading to more pain and dysfunction. Weakness and decreased range of motion change joint mechanics and place abnormal stress to the spinal segments.  As a result, more pain and inflammation ensue. [i][ii][iii][iv][v]

Our Focus on the Recycle Cycle

For recovery to occur, the treatment must focus on both spinal function and whole body function. In the recovery or treatment cycle, we introduce isolated MedX exercise to focus on improving the mobility (range of motion), stability, and strength of the spine (spinal function). The MedX exercise literature demonstrates superior isolation in strengthening the supporting spinal muscles and discourages the typical compensatory movement patterns. [vi][vii][viii] Research has clearly demonstrated patients with low back pain develop wasting of the multifudus muscles of the spine which correlates with onset of low back pain. [ix] Furthermore, the muscle wasting occurs early and does not reverse automatically, even when symptoms resolve. [x] Isolation and strengthening of the multifidus and related spinal muscles with MedX equipment results in improved spinal function and a reduction in pain and future episodes of low back pain. Concurrently, we begin to progress around the treatment cycle with home based activities and patient education. Mobility, stability, and strength activities are introduced along a progression, based upon concepts of lumbar stabilization. [xi][xii][xiii] Training the patient in stretching, core initiation and progression into trunk stabilization and strength is a key to regaining normalized motor patterns. PDR’s training and education in protective and proper body mechanics with movement helps restore whole body function.

 


[i] Langeven H, Sherman K.  Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms.  Medical Hypotheses 2007: 68: 74-80.
[ii] Kader DF, Wardlaw D, Smith FW.  Correlation between the MRI changes in the lumbar multifidus muscles and leg pain.  Clinical Radiology 2000: 55: 145-149.
[iii] Danneels, L, Vanderstraeten G, Cambier D.  CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects.  Eur Spine J 2000: 9: 266-272.
[iv] Kjaer, P, Bendix T, Sorensen J, et al.  Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?  2007. www.biomedcentral.com/1741-7015/5/2/prepub.
[v] Flicker,et. al. Lumbar muscle usage in chronic low back pain.  Magnetic resonance image evaluation. Spine. 1993 Apr;18(5):582-6.
[vi] Graves J, Webb D, Pollock M, et al.  Pelvic stabilization during resistance training:  Its effect on the development of lumbar extension strength.  Arch Phys Med Rehabilitation 1994: 75: 210-215.
[vii] Carpenter D, Graves J, Pollack M, et al.  Effect of 12 and 20 weeks of resistance training on lumbar extension torque production.  Physical Therapy 1991: 71: 580-587.
[viii] Russel G, Highland T, Dreisinger T, Vie L.  Changes in isometric strength and range of motion of the isolated lumbar spine following eight weeks of clinical rehabilitation.  Presented at the North American Spine Society Annual Meeting,Monterey,CA, 1990.
[ix] Kamas et. Al.  CT measurement of trunk muscle area in patients with chronic LBP. Diag Interv Radiol. 2007 Sep;13(3):144-8.
[x] Hides, J. , Richardson, C, Jull G.  Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.  Spine 1996: 21: 2763-2769.
[xi] Richardson C, Hides J, Hodges P.  2004.  Therapeutic Exercise for Lumbopelvic Stabilization:  A Motor Approach for the Treatment and Prevention of Low Back Pain.  Elsevier Science Health Science
[xii] O’Sullivan et al. 1997. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:2559-2976
[xiii] Risch et al. 1993. Lumbar strengthening in chronic low back pain patients. Physiologic and psychologic benefits. Spine 18:232-238