Exercises for spinal pain Flashcards
What are 4 main exercise options for patients to help ease or manage spinal pain?
1 - Specific exercises (McKenzie exercises, stabilising/core, flexibility or resistance training targeting specific impairments)
2 - General exercise (Not targeting specific impairments)
3 - Yoga/ Tai Chi
4 - Physical activity
How and with what do the NICE 2016 guidelines suggest spinal pain patients should be treated?
- Guided self-management
- Continue normal activities.
- Exercise (Supervised, either 1-1 or in a group).
- Psychological therapies, but only in conjunction with exercise.
- Manual therapy (manipulations, mobilisations, massage) but only in conjunction with exercise.
- Combined physical & psychological programmes. particularly if they’re at risk of developing persistent spinal pain.
What does research evidence suggest about the effectiveness of exercise interventions for spinal pain?
Evidence has found:
- Exercise is effective in subacute and chronic pain.
- ‘Best’ exercise unclear, some but little suggestion that strength is more effective than cardiorespiratory.
- No evidence that specific exercise is better than general exercise.
What specific exercises are there?
- McKenzie / ‘self-mobilising’ exercise
- Spinal ‘stabilisation’ / ‘core’ / motor control retraining.
- Other targeted resistance training.
What is the thinking behind general exercises.
- Everyone gets similar exercises; the dose may vary.
- Biomedical, psychological and social mechanisms for their back pain suggested.
What are the 3 different diagnoses in McKenzie (‘Self-mobilising’) exercise theory.
And what is the thinking behind each of them.
Postural: theory is no pathology in spinal tissues, pain due to end-range stress of normal structures caused by poor posture.
Dysfunction: theory is spinal tissues have shortened and reduced range, pain occurs at end-range stress of shortened structures.
Derangement: theory is disc internal derangement, resulting in spinal pain during movement, pain reduces or centralises with repeated movements in one direction (also called Directional preference).
Under the McKenzie principals there are 2 directional preferences, either pain upon flexion of the spine or extension of the spine.
If a patient has pain upon flexion what is the advice in terms of exercise?
Do extension exercises.
For treatment selection and dosage for McKenzie exercises, what are the deciding factors?
Dose according to severity & irritability (like manual therapy).
Acute: symptom relief, according to directional preference. Resolving: introduce other directions, regain full ROM.
Can combine with accessory movements – sustained glides.
What is the typical progression for the McKenzie exercises?
Typical progression:
- Static position →
- Physiological movement →
- Physiological movement + manual overpressure
(Starting with if the patient has server pain and irritability, then as it eases you advance to the next stage)
Also if a patient no-longer feels any pain you may then want to do the other movement that originally caused them pain, to regain full ROM.
When are McKenzie exercises been effective?
Only in acute Lower back pain.
Ineffective for Chronic/ persistent LBP.
What are the indications that McKenzie exercises might be useful?
- Acute/sub-acute ‘mechanical’ pain.
- Low risk of developing persistent problem.
- Directional preference (symptoms reduce or centralise with position or repeated movement).
Advantages:
- Simple exercises, can assess and teach quickly and easily.
- Emphasis on self-management, promotes self-efficacy.
What are the cautions for using McKenzie exercises?
Cautions:
- Focus on pain.
- Implies pathoanatomical explanation for pain.
- Inappropriate for high-risk of developing persistent problem, distressed, unhelpful health beliefs.
What is the theory behind ‘spinal stabilisation’ for easing lower back pain?
To improve/normalise function of trunk muscles to reduce mechanical load on spine and subsequent pain.
What is the evidence strength for the ‘spinal stabilisation’ theory on LBP?
Weak, as the OG experiments results were debunked by Lederman in 2010, as well as others.
Do motor control exercises change trunk muscle size or timing?
“Trunk muscle onsets … do not seem to be a valid mechanism of action for specific trunk exercise rehabilitation programs.”
Essentially even though exercise programmes did increase the strength and mass of the muscles, it didn’t ease the spinal pain.
