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My Back Recovery: Recovering from Chronic Low Back Pain

In every episode we share valuable insights from systematic research and clinical guidelines, as well as advice from experts dedicated to helping people recover from chronic low back pain. My Back Recovery promotes evidence based treatment options, safe training and expert strategies to help you make smart decisions about your rehabilitation process.
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Dec 19, 2016

Training and activity is your no1 option when recovering from low back pain. 

This episode introduces two of the most important exercises for building up strength within your lower back and practice movement control.

 

Strength Training for People with Low Back Pain 

Always check with your medical professional if it is save for you to exercise! This exercises are not a substitute for individual medical treatment but aim to complement and support your recovery process.

Find all videos for this episode on:

http://mybackrecovery.com/resources.page

video episode 07

 

The exercises we are going to explore on this episode build up on your basic movement control skills and are both:

  • challenging your movement control skills
  • helping you building up strength and strength endurance within your back muscles

 If you have listened to episode 06 you already have come to learn that clinical guidelines recomend therapeutic exercise and activity with strong supporting evidence for the management of chronic low back pain.

A recent review concluded that: "The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported." meaning: weak back muscles could cause LBP.1

It further says: "It is by no means the only causative factor and further research should more rigorously test this hypothesis (...) however specific exercise may be a worthwhile preventative and rehabilitative approach."

 

In this episode i will share some of my most favorite exercises for building up strength within your back extensor muscles and practice movement control. These classis exercises will give you more options with your training, and will take your training to the next level.

 

Training introduced on 'my Back recovery' so far:

Episode 03:

Easy and back specific circle training with save loading profiles in terms of exercising. A first step in starting to work on strength and strength endurance as well as stability. Also a great way of improving blood flow in your muscles.

video

 

Episode 05:

Movement control exercises - basic skills for exercising - moving your pelvis/hip influences the posture of your lower back - being able of keeping a neutral position during certain exercises.

video

 

As you learned the basics for movement control (ep 5) and started to get familiar with a back specific circle training (ep 3) it´s time for you to take the next step!

 

'Good Morning' & Squat

Video

The good morning and the squat are static exercises for your back. This means no movement in the back while you are doing the exercises. They are more difficult to perform than the exercise-set from episode 03.

 It really pays of focusing on doing the good morning and the squat with correct posture! Once you got this you can do most of other exercises in a correct way and will have more options to adjust exercises to your own needs. Remember to always adjust your exercises to your individual situation so that you are able to perform pain free and without aggravation of your symptoms.

Good Morning

The 'good morning' is great for building strength2 and movement control. Actually the 'good morning' is also used as a part of a validated test series used to detect impaired movement control within people with LBP.3

It works the gluteus, hamstrings and lower back.

 

Basically the 'good morning' is about bending forward with a straight (neutral) back.

Remember the last movement control exercise from episode 05: sitting and rocking forward and backward while keeping a moderate arch of your lower back with no movement in the back. The good morning exercise is the same in a standing position.

 

Stay upright, bend your knees slightly. This will help you doing the movement from your hips (because your hamstrings are not that much stretched when you are bending your knees).

Bend forward while you are keeping a straight back (remember straight means slightly curved, we wanna see a moderate arch (like a weightlifter) at the lower back, if your back seems to be flat, it is already flexed, we want to trigger those back extensor muscles and keep a neutral position thats why we need that arch!

 This exercise should be pain free! So if you are doing it correctly and start to experience pain while leaning forward, remember the golden training principles. Adjust the exercise. Don´t go so far. Maybe you can do it leaning fwd 45 degrees out from the vertical position and will feel fine, and pain starts only if you go further. So respect your pain and adjust the exercise.

Most people who hadn´t done this kind of exercise will find it difficult to perform in the beginning.

Here is how i teach the 'good morning' to my clients:

 

First i start with all the exercises from episode 05. If you havent mastered these go back and work on them until you feel comfortable with them.

video - basic movement control skills episode 05

Most of the time the problem is that people don´t know how to keep good posture in their lower back. The movement you need to do is 'push your bum out while leaning forward'. This will result in hip flexion and back extension and result in a moderate arch in your lower back. Again some people could experience discomfort when arching to much. So experiment and find a position that is comfortable and pain free. The basic movement control skills from episode 05 will help you with that!

 

Than i let my clients sit on a high chair or at the edge of a table with their feet standing on the ground. Now it´s like a mix of the rocking forward and backward exercise we did at the end of episode 05, and the good morning. It´s a bit easier than in the standing position. If you feel fine proceed to the standing position.

 

It´s natural that when leaning forward to much, you will loose the arch in your lower back. So just go as far as it is pain free and you can keep correct posture.

Even when you are doing only a small movement like 10-20 degrees forward bending you still train your muscles and start to practice movement control.

 

One thing i experience quite often when people are doing the good morning is that they are squatting simultaneously. Although there is nothing harmful with this i suggest making two exercises out of it and not mixing the good morning and the squat. With this strategy you will gain better movement control and have more variability in you training options. So keep your knees slightly bent but try not to squat while leaning forward, and check this in a mirror from your side! You have to actively work for not bending your knees while leaning forward.

 

Squats

Absolut classics! Squats also work your back extensor muscles. Squatting is a typical everyday activity. Besides working all major muscle groups in your body and helping you stay fit, good form/posture with squatting will help you becoming more aware of your posture in everyday activities. The squat is almost the same as the good morning but with knee-movement and less dynamic leaning forward and backward.

 Starting position: Standing upright, having your weight evenly distributed to both of your feet, leaning a bit forward and squatting down. Again keep that lower back arched when leaning forward.

If you can control your back already let´s check your knees. When squatting down look to your knees and feet: have your toes pointing straight forward and try to keep your medial border of your kneecap outside of your big toe. This will result in proper hip knee ankle alignment and less stress and strain on your knee. 4, 5

You can do the squat in a narrow stance or a wide stance. But keep your feet pointing forward and mind your knee position!

 

 

find more information at www.mybackrecovery.com

 

Literatur: 

  1. Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin. 2014;30(January):1-47. doi:10.1185/03007995.2013.875465.
  2. Steele J, Bruce-Low S, Smith D. A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain. PM R. 2014;(OCTOBER 2014):1-18. doi:10.1016/j.pmrj.2014.10.009.
  3. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskelet Disord. 2008;9(Mc):170. doi:10.1186/1471-2474-9-170.
  4. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33(11):686-693. doi:10.2519/jospt.2003.33.11.686.
  5. Koga H, Nakamae A, Shima Y, et al. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball. Am J Sports Med. 2010;38(11):2218-2225. doi:10.1177/0363546510373570.

 

 

 

Nov 8, 2016

The second part of episode six takes a tour into the scientific world of clinical research, exploring how clinical guidelines are created and looking at why they are important.

Clinical guidelines promote evidence-based practice by giving out recommendations according to available evidence from systematic research and can therefore have a great impact on your recovery plan.

 

How is a guideline formed?

Firstly a vast amount of scientific literature is systematically searched from within clinical databases and then checked for relevance.

The next step critically grades all the studies according to their methodological quality (a very good study has more impact than a study with potential for bias).

These steps are usually all undertaken parallel by at least two people and then the results are compared. These findings are then finally summarized and recommendations are drawn.

If you want to take a closer look into the world of research, I recommend you check out the Grade Handbook on the gdt.guidelinedevelopment.org webpage. This is a good in-depth explanation how guidelines are created.
The handbook can also be found through the Internet by searching for "Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach".

 

Selecting the best information available when creating a guideline

Every single study that contributes to a guideline or systematic review, is a scientific piece of work with high standards (some higher or lower, hence the grading system).

Therefore scientists and researchers try hard to control every little detail within their studies and here are a couple of examples of how they do that:

 

If you want to find out if strength-training works for people with LBP you can’t just ask people with LBP to sign up for a strength-training class because this could result in selection bias: Only people who believe in strength training would participate, and this group of people is not representative for the average LBP-patient.

The group has to be selected from real patients with LBP ideally randomly assigned to one of two groups, a strength-training group and a control group.

In order to control the study results for a placebo effect, both groups should undergo active intervention of equal activity time. For example the control group could undertake a stretching routine.

Wherever possible the patients should not know which group they are in (this is called blinding of patients). The therapists should also not be aware which group is which, this is because it could also have an effect on the treatment outcome! (Don’t believe me? Check out the "rosenthal- or hawhorne- or helo-effect). This is however not always possible, but would be the ideal.

The ‘blinding’ should also include those recording and adjudicating the outcomes for both groups.

Furthermore the endpoint of the study should be defined in advance. The study must always continue up to the predefined end, neither lengthened nor shortened as this can lead to a distortion of the results.

As positive study results are more likely to be published, researchers searching of systematic reviews try to evaluate possible publication bias. For example, if a study is sponsored by a specific company or industry the results could be considered biased and the evidence is down graded.

 

Why is it important to read guidelines?

Researchers know about all the problems mentioned above, and they also try to tackle them in the best possible ways.

I think it is really important to be informed and know about the limitations of research and at the same time value its results, since it’s the only real evidence, along with your own personal experience, and the personal experience of the medical professionals trying to be of service to you, that you have in helping you make an informed decision about which treatment to take.

 

All in all a lot of effort goes into the creation of a guideline!

Find out more: www.mybackrecovery.com

Nov 8, 2016

Recommendations based on current available evidence helps you combine your personal experience and expectations with research to form an individual treatment plan and find treatments with the most promising results.

 

What treatment should I consider for my back pain? 

There are many guidelines regarding LBP and some even especially for chronic LBP.

In this episode you will find information about the treatment options often recommended in these guidelines.

 

Setting evidence into your personal situation

After having examined all the best available evidence from systematic research it is important to know how to apply this information to your individual situation.

Evidenced based treatment is more than simply the best available evidence from systematic research alone.

It should also take into account the expertise of your clinician(s) as well as your personal expectations, beliefs and preferences!1,2,3

 

Treatment Recommendations with strong supporting evidence

  • Information, education and self-care

"All the guidelines explicitly underline the importance of educating and providing patients with information on LBP with regard to their expected course and the possibility of effective prevention and selfcare options."4

  • Physical activity and therapeutic exercise

"There is strong evidence that physical activity and therapeutic exercise are effective for the management of CLBP, even if it is not clear what kind of exercise is best. An individual, graded and active exercise program supervised by an expert (physical therapist) is almost always recommended."4

  • Multidisciplinary treatment programs

"Combined physical and psychological interventions with cognitive-behavioral therapy and exercise are particularly recommended for people who have received at least one course of less intensive treatment and have high disability and/or significant psychological distress."4

 

All other forms of treatment are currently categorized using the following descriptions:

Might do - recommendations with moderate supporting evidence

Don’t know - recommendations with limited or inconclusive evidence

Don’t do - recommendations with strong evidence against intervention

 

For more information of other treatment options please refer to the original article which can be found via the Internet: "An updated overview of clinical guidelines for chronic low back pain management in primary care."4

 

Find out more: www.mybackrecovery.com

 

Literature:

 

  1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17340682. Accessed December 16, 2012.
  2. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461–73. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3474298&tool=pmcentrez&rendertype=abstract. Accessed December 16, 2012.
  3. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786–805. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12940766. Accessed October 5, 2012.
  4. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176–185. doi:10.1016/j.jbspin.2011.03.019.

 

 

Oct 17, 2016

Movement control not only helps you control your posture and position whilst exercising but can also help you adjust exercises to your own personal needs by controlling stress and strain on the spine.

This episodes guides you through impaired movement control, lists exercises to improve your ability to control movement and talks about the resulting benefits in your experience of pain and everyday activity.

 

Movement-Control – a Basis for Healthy Training

 

Therapists and trainers have always highlighted the value of good posture and position, and now science also backs up the importance of movement control for people recovering from chronic low back pain.

 

Traditionally movement control is taught by therapists and trainers in order to gain control over the position of your spine as a basis to:

  • exercise in a healthy way
  • adjust exercises to your own needs
  • control stress and strain on your spine in your everyday activities

 

Your brain adapts according to your needs

There is scientific evidence to promote movement control as a therapy approach. Today it is widely accepted that chronic LBP is often not caused by a single structure at fault in the back. At least this is the case with 80-95 %, which is why this group is called non specific low back pain.1,2,3,4,5,6,

Recent research points out that there is growing evidence of changes in the brain with people with chronic pain.7

 

Chronic pain patients sometimes have a decreased cortical representation of the affected body parts8,9 - which in the case of LBP is also shown by diminished movement control.10

This means that when you want to make a movement without moving your back you are unable to do so, and instead you still move your back because you can’t control it. This movement sometimes happens without you even noticing it.

 

Practicing movement control can lead to a better representation of your different body parts in your sensual cortex , which is a section in your brain that makes you feel your body surface.

Imagine a musician, they will have much better cortical representation of their hands than someone who has not acquired this coordinative skill. Your brain adapts to how you are using your body.

What some research suggests is: The better your body is represented in this part of your brain (and you can train this through movement control) the less pain you will experience if you are suffering from chronic pain.11,10,12,

 

Basic Anatomy for practicing movement control:

Your pelvis is connected to your thigh-bones as well as your spine. Therefore when you tilt your pelvis up or down, the position of your spine changes too.

It’s also necessary to understand that the neutral position of your lower spine is a curved line (looking at it from the side). Keeping your lower back slightly curved during different exercises without moving it is often a goal in movement control.

A good way to start practicing movement control is to learn how to tilt your pelvis in different positions and become conscious of the resulting movement in your lower back.

Listen to the podcast, episode 05, “Movement Control" at www.mybackrecovery.com to learn more about movement control for people recovering from low back pain.

 

Videos:

find all the resources at: http://mybackrecovery.com/resources.page

watch the clip

  • quadruped - position
  • supine
  • side lying position
  • seated
  • standing position
  • lean forward from a seated position without moving your back as a movement control exercise. If you do it correctly your back will not change its curvature while leaning forward, therefore the movement is coming from your hips.

Literature:

  1. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-68. doi:10.1007/s00586-006-1070-3.
  2. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012.
  3. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012.
  4. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5.
  5. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250.
  6. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-91. doi:10.1007/s00586-006-1071-2.
  7. Wand BM, O’Connell NE, Di Pietro F, Bulsara M. Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants. Phys Ther. 2011;91(4):535-546. doi:10.2522/ptj.20100150.
  8. Catley MJ, O’Connell NE, Berryman C, et al. Is tactile acuity altered in people with chronic pain? A systematic review and meta-analysis. J Pain. 2014;15(10):985-1000. doi:10.1016/j.jpain.2014.06.009.
  9. Moseley GL. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain. 2008;140(1):239-243. doi:10.1016/j.pain.2008.08.001.
  10. Gutknecht M, Mannig A, Waldvogel A, et al. The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. J Bodyw Mov Ther. 2015;19(4):722-731. doi:10.1016/j.jbmt.2014.12.003.
  11. Daffada PJ, Walsh N, McCabe CS, Palmer S. The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review. Physiotherapy. 2015;101(1):25-33. doi:10.1016/j.physio.2014.07.002.
  12. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Improvement in low back movement control, decreased pain and disability, resulting from specific exercise intervention. Sports Med Arthrosc Rehabil Ther Technol. 2010;2(Mc):11. doi:10.1186/1758-2555-2-11.

 

Oct 3, 2016

This episode presents the different groups within low back pain and looks at where statistics come from. This information helps you battle fear associated with the condition and validate your experience of pain.

Facts about Low Back Pain (LBP)

LBP is defined as pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain.1

LBP is categorized into acute LBP and chronic LBP, which is LBP lasting for longer than 12 weeks.2,3,4,5,6

LBP is the most common form of chronic pain,7 a leading cause of disability in people younger than 45 years old8 and has a lifetime prevalence of 70 % in industrialised countries9.

LBP is among the top ten causes of long-term disability in every country and number one cause in 86 countries.10 LBP is the fifth most common reason for all doctor’s visits in the United States11 and the third most common diagnosis in German prevention and rehabilitation facilities.12

One year after a first episode of back pain 62% of people will still experience pain while 16% of those initially unable to work are still not working.13

What Back Pain do You Have?

  • 80-95 % non-specific LBP
  • 5% radicular syndrome
  • 1 % serious spinal pathology

What is Non-Specific LBP?

Today it is widely accepted that the biggest group of LBP is non-specific-LBP. Non-specific LBP means that no anatomic structure can be identified that is at fault. You might be surprised to learn that this is the case with 80-95% of all people with

LBP. 9,12,4,5,14,15

How Should it be Diagnosed?

Almost all guidelines16,17,6 recommend that people presenting with an acute episode of LBP should be screened for:

  1. potential serious pathology (e.g. cancer, fractures, infections of the spine, cauda equina syndrome, systemic disease) that could cause pain in the back
  2. radicular syndrome (that means pain arises from the nerve roots in your spine)

Potential serious pathologies for LBP are very rare (0,01% spinal infections, 0,7% cancer) and together with neurological impairment make up for approximately 1-5% of all LPB-Incidents.18

Nerve root pain (pain caused by the nerves in your spine) is considered to be present if there is pain radiating down the leg, together with a positive neurological examination (muscle strength, sensibility and deep tendon reflexes should be assessed). The neurological examination is positive when there is a palsy/weakness of a muscle in your leg that wasn´t there before, or if you experience incontinence or urinary retention that wasn´t there previous to your back pain, or if parts of your skin are numb. 

If you have no confirmed serious disease and no radicular symptoms you have non-specific LBP.

For LBP with substantial neurologic involvement (1-5 %), guidelines generally do not recommend conducting any further assessment until appropriate conservative management (which is rarely defined) has failed, after which MRI or CT (imaging of your spine) is generally recommended.6

Find out more: www.mybackrecovery.com

Sources:

  1. Duthey BB, Ph D. Priority Medicines for Europe and the World “ A Public Health Approach to Innovation ” Update on 2004 Background Paper Background Paper 6 . 24 Low back pain. (March 2013).
  2. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2(November 2004):192-300. doi:10.1007/s00586-006-1072-1.
  3. Savigny P Watson P, Underwood M, Ritchie G , Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough,C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. KS. Low Back Pain: early management of persistent non-specific low back pain. London Natl Collab Cent Prim Care R Coll Gen Pract. 2009;(May):1-235.
  4. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012.
  5. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5.
  6. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. doi:10.1016/j.spinee.2010.03.032.
  7. Froud R, Patterson S, Eldridge S, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15:50. doi:10.1186/1471-2474-15-50.
  8. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283-298. doi:10.1007/s00586-006-0143-7.
  9. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-S168. doi:10.1007/s00586-006-1070-3.
  10. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;6736(15):1990-2013. doi:10.1016/S0140-6736(15)60692-4.
  11. Cowan P. Consumer Guidelines for Low Back Pain. (Kelly N, Chou R, eds.).; 2008. http://theacpa.org/condition/back-pain.
  12. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012.
  13. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-165. doi:10.1007/s00586-002-0508-5.
  14. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250.
  15. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-S191. doi:10.1007/s00586-006-1071-2.
  16. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176-185. doi:10.1016/j.jbspin.2011.03.019.
  17. Koes BW, van Tulder M, Lin C-WC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-2094. doi:10.1007/s00586-010-1502-y.
  18. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586-597. doi:10.7326/0003-4819-137-7-200210010-00010.

 

 

Sep 13, 2016

Episode nr. 3 is about respecting and understanding your pain as well as a guide to a selection of safe exercises designed to enhance metabolism and blood flow in your back muscles and how to adapt them to your individual needs.

 

Golden Training Principles

  • Training should feel good 
  • Adjust exercise if it feels painful/bad:

change the range of motion

change the position

change the intensity

change the duration

change the training frequency (trainings per week)

change the resting time or interval time between training

 

Good vs Bad Pain Patterns

Pain in the leg that vanishes or pulls back upwards (i.e. first pain was being felt from buttock to shin, than pain is being felt only from buttock to tigh) even when pain in the lower back gets worse has a good prognosis.

Whatever you do, when you feel that pain radiating down the leg is getting worse or pain in the leg that wasn´t there before now is being felt, this is a good indicator that things have to be done differently. Even when pain in the back vanishes but pain in the leg starts or is getting worse or is getting now further down than it was before stop with whatever activity, movement or posture you are doing and try differently.

 

Exercise-Videos

find all the resources at: http://mybackrecovery.com/resources.page

(Always check with your medical professional if there are any health related problems that do not allow you to exercise and that these exercises are safe for you to perform!)

Videos

Warm Up 8-10 times carried out gently.

Bird-Dog (also called superman)

Side lying-leg lift

Bridging

 

Sets and Repetitions

20 repetitions of each exercise (leg raise 20 each side). Three rounds. Always ‘pain free’.

Pain should never get worse during the exercise. If this is the case, try to adjust the exercise or proceed to the next exercise. During the course of this podcast series you will get to know many different exercises, therefore you will always be able to find exercises that work for you. Just take your time, experiment and adjust the training to your personal needs.

 

Other Content including Quotes

  • Static work, decrease of blood flow, build up of local by-products of metabolism.2,3
  • Prolonged dynamic exercise produces a long lasting (60–120 minutes) increase of blood flow in the muscle even after cessation of muscular activity.3 Some studies even suggest that this effect can last up to 13 hours.4
  • Decrease of strength and LBP.5
  • Changes in the brain could contribute to the persistence of the problem and might represent a legitimate target for therapy.6
  • Safe exercises/loading profiles of the spine.7

 

More infos at

http://mybackrecovery.com/

 

 Literature

  1. May S, Aina A. Centralization and directional preference: a systematic review. Man Ther. 2012;17(6):497-506. doi:10.1016/j.math.2012.05.003.
  2. Plowman SA, Smith DL. Exercise Physiology for Health Fitness and Performance -. 4th revise. Philadelphia: Lippincott Williams & Wilkins; 2013.
  3. Korthuis RJ. Exercise Hyperemia and Regulation of Tissue Oxygenation During Muscular Activity. Skelet Muscle Circ. 2011;(Figure 10):1-11. http://www.ncbi.nlm.nih.gov/books/NBK57139/.
  4. Kenney MJ, Seals DR. Postexercise hypotension. Key features, mechanisms, and clinical significance. Hypertension. 1993;22(5):653-664. doi:10.1017/CBO9781107415324.004.
  5. Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin. 2014;30(January):1-47. doi:10.1185/03007995.2013.875465.
  6. Wand BM, O’Connell NE, Di Pietro F, Bulsara M. Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple-baseline study of 3 participants. Phys Ther. 2011;91(4):535-546. doi:10.2522/ptj.20100150.
  7. Liebenson C. A modern approach to abdominal training-Part III: putting it together. J Bodyw Mov Ther. 2008;12(1):31-36. doi:10.1016/j.jbmt.2007.10.005.
Sep 13, 2016

Episode nr. 2 is about how to detect changes in your chronic low back pain, including setting a personalized base line and learning how to work towards achievable goals using validated tools to capture your progress.


Download Material Episode 2:

find all the resources at: http://mybackrecovery.com/resources.page

 

 

Literature: 

Calmels P, Bethoux F, Condemine A, Fayolle-Minon I. [Low back pain disability assessment tools]. AnnReadaptMed Phys. 2005;48(6):288-297.

Ostelo RWJG, de Vet HCW. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):593-607. doi:10.1016/j.berh.2005.03.003.

Roland M FJ. The Roland – Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976). 2000;25(24):1994. doi:10.1097/00007632-200012150-00006.

Guideline. Assessment and Management of Chronic Pain Health Care Guideline : Assessment and Management of Chronic Pain. Icsi. 2013;(November).

Ostelo RWJG, Deyo RA, Stratford P, et al. Interpreting Change Scores for Pain and Functional Status in Low Back Pain. Spine (Phila Pa 1976). 2008;33(1):90-94. doi:10.1097/BRS.0b013e31815e3a10.

 

More infos at

http://mybackrecovery.com/

Sep 12, 2016

An introduction to how to start your recovery process, including education, support and practical recovery advice.

More infos at

http://mybackrecovery.com/

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