L28 - Exercise Theray, Spine Focus Flashcards
Effectiveness of physical exercise intervention
- Exercise therapy widely recommended for individuals with chronic non-specific neck pain
- Most effective type of exercise for neck pain has not yet been determined
- Exercise like strengthening, motor control & Yoga/Pilates/Tai Chi/Qigong show comparable
positive effects, with consistent outcomes supported by studies & larger participant numbers - Until stronger evidence becomes available, exercise selection should consider all mentioned above tailored by clinician according to patient preference to ensure personalized care
Effects of exercise dosage
- Exact influence of exercise dosage still unclear due to variability in exercise across studies
- Regardless of dosage, exercise therapy consistently improving pain & disability in individuals with neck pain
- Clinicians encouraged to incorporate exercise therapy into management of mechanical neck pain
- Treatment plans should be tailored to each patient’s individual presentation & treatment
response
Manual therapy vs therapeutic exercise
- Both manual therapy & therapeutic exercise produce statistically significant & clinically
meaningful improvements compared to control group - Manual therapy reduces pain perception, faster, whereas therapeutic exercise leads to earlier reductions in cervical disability
- In short & medium terms, there are no significant differences between 2 treatments
- Combined approach ideal: manual therapy provides quicker pain relief due to its
neurophysiological effects. Therapeutic exercises ensure sustained improvement by reducing disability
Personalization of treatment
Treatment plans must adapt to each patient’s presentation, focusing on pain relief, stiffness reduction, & resumption of ADLs.
Rehabilitation goals
Rehabilitation Goals
- Reduce pain & stiffness.
- Enable patient to return to sports & functional activities
Patient profiling for exercise selection
Acute or chronic patient without evident alterations (cognitive, affective, social-env., sensorimotor)
- Focus: reconditioning
- Exercises: mobility, stretching, neuromuscular activation & resistance training
Patient (acute or more problematic chronic) with moderate impairments (motor or affective-socialenvironmental alterations)
- Focus: motor control & functional representation
- Exercises: motor control, progressive resistance, reconditioning, cognitive-behavioral aspects
Patient (probably chronic) with dominant psychosocial factors or significant motor control issues
- Focus: psychosocial aspects
- Exercises: cognitive-functional therapy, graded exposure, mobility training
Functional exercises activity based on non-functional
Functional exercises (f) activity based non-functional (nf) – impairment based
- Mobility: relates to ROM available to spine or body segments
- Motor control: ability to control spina segments & movement
- Work capacity: refers to ability to sustain spinal support under load over time (local endurance)
- Strength: rate of force development (stiffness or power) required for spinal stability
Mobility:
- key points
Self-mobilization, mobility exercises, stretching, and lengthening
Key Points:
- Intensity: Low/Moderate (low RPE)
- High number of sets (3 → 5/6)
- High number of repetitions (8 → 15/20)
- Frequency: High (up to daily)
- Recovery time: Minimal/Moderate
- Speed: Slow and controlled
- Complexity and difficulty depend on:
o Reactivity
o Provocative movement
o Anatomical region
Load tolerance, endurance & work capacity
Load tolerance, endurance, work capacity
Endurance exercises with progressive load, functional exercises with trunk stability in functional context & on functional, resistance exercises
Key points:
- Intensity: Low/Moderate (low/moderate RPE); generally, <50% 1RM for subacute phases or
deconditioned/elderly subjects – but up to 60-80%.
- Moderate → High number of sets (variable).
- Moderate → High number of repetitions (15-20 if not isometric).
- Frequency: High (up to daily).
- Recovery time: 1 to 2 minutes
→ Increase load tolerance through ROM
→ Desensitization (combined with mobility, aerobic & isometric exercises)
→ Restores force absorption & transmission capacity
Strengthening exercises:
- description
- specific movements
Choice: depends on reactivity, acute, sub-acute or persistent phase, psychosocial profile, reconditioning
& patient preferences
- Patients with LBP with mild to moderate reactivity
- Patient with persistent LBP & deconditioned youth, adults or elderly
- Patients with LBP & fear of movement
- Patients with functional demands requiring hip involvement (tasks involving lifting weights from ground, sports…)
- Warm-up or integration to workout
Specific movements
- Pillar strength (non-functional)
- Stiffness (functional)
- Power (functional
Motor control:
- description
- repetitions & practice
= exercise with progressive load challenging patient to maintain neutral lumbar spine position in increasingly functional & demanding positions, focus on flexors & extensors
Repetitions & practice
- External attentional focus
- Analytical exercises (supine pelvic tilt & progression to functional exercises)
- Build exercises based on results of motor control tests.
- Dose, frequency, & volume still unclear, with no consensus among authors. Focus on flexors & extensors
Structuring exercise session
Warm Up:
- Low intensity mobility & aerobic exercises
- Functional warm-up with moderate load
Workout:
- Exercises chosen based on reactivity, goals & patient profile
- Include endurance, motor control & resistance training
Cool Down (if necessary):
- Light mobility & stretching exercises
- Aerobic activities for recovery
Enhance adherence to treatment
ENHANCING ADHERENCE TO TREATMENT
Adherence critical, as non-compliance can hinder long-term recovery. Strategies to improve adherence include:
- Co-designing program with patient
- Starting with simple, functional exercises aligned with ADLs or sports
- Providing regular reviews & updates to exercise plan
- Leveraging tools like apps or video recordings to support adherence
- Lack of adherence → potential long-term detrimental effects
- Greater adherence → double likelihood of long-term recovery
