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Old 27-05-2004, 09:11 AM   #1
bernard
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Default New back pain therapy gets aggressive

New back pain therapy gets aggressive
The treatment hurts, but it works because it strengthens the muscle and increases flexibility

By Tara Parker-Pope
WALL STREET JOURNAL

For people with back pain, the advice has long been simple: Take it easy. Now, some doctors have a radically different suggestion: Make it hurt even more.

The new treatment, called aggressive rehabilitation, goes well beyond traditional physical therapy, taking the "no pain, no gain" approach to an excruciating level. After years of tentatively guarding their backs for fear of injury, back-pain sufferers who can barely walk or stand are subjected to grueling exercise, using their back muscles to stretch and push weight.

Those who can soldier through the treatment call it a miracle cure. A number of recent studies show back-pain sufferers who use aggressive exercise are far more likely to return to work, have less pain and are less likely to seek additional back treatment than those who use more traditional treatments.

"We say, 'Let's not guard it and protect it anymore,'" says Carol Hartigan, a physical-medicine and rehabilitation physician at the Spine Center at New England Baptist Hospital in Boston. "It's the opposite of what they've been told. If you have a bad back, it should be strong and flexible and fit."

Intensive exercise has been slow to catch on. The therapy is far less lucrative than the pain pills, injections and surgical treatments that are the cornerstone of the back-pain industry. And patients, too, are reluctant to pursue the treatment, which takes more time and effort than passive therapies. But now, with growing evidence that spinal-fusion surgery doesn't work for most people, more patients are looking for nonsurgical options.

David Shorr of Chicago is a believer. A few years ago, he was ready to undergo spinal-fusion surgery for three degenerating disks. Shorr, a 38-year-old partner in Chicago trading firm, was barely able to work.

In a last-ditch effort to avoid surgery, he flew to the Physicians Neck and Back Clinic in Minneapolis, where doctors prescribed intensive exercise that focused on building up his muscles. Before treatment, he could use his back to push 42 pounds; after 31/2 months, he could push 178 pounds -- his body weight. He and his business partner invested $25,000 to buy the MedX exercise equipment used by his doctors.

"The first night I was crawling around, that's how much pain I was in from my first treatment," Shorr says. "Now, at 38, I'm as strong as I've ever been. When you're living with back pain, you are willing to experience worse pain to get past it."

The treatment runs counter to what most back-pain sufferers have been told. Often, physical therapists tell patients to ease up if they start to hurt. But proponents of intensive exercise say it only does more damage when people stop using their backs. The patient becomes "deconditioned," and the back becomes weaker, making it more likely to be injured again. Whether the problem stems from an injured disk or degenerative disease, proponents say strengthening the muscles will help.

"The more inactive they are, the lower their chances of recovering are," says Charles Kelly, a founder of the Physicians Neck and Back Clinic.

Still, he says, getting better often is "dependent on whether they have the chutzpah to go through an initial increase in symptoms." Patients face a huge psychological hurdle in believing that they can start using their backs. As many as a third of patients drop out of the intensive exercise programs.

"I was very afraid and very concerned," says Elizabeth Prouty, a 56-year-old Boston resident who has suffered years of back and disk problems. She underwent aggressive rehabilitation twice a week for 10 weeks and now regularly does the back stretches and weight-lifting that keep her pain in check.

Of course, patients shouldn't just run off to the gym on their own. Proponents say that, at least initially, such treatment should always be monitored by a physician. Meanwhile, finding a spine specialist who recommends aggressive rehabilitation rather than just traditional physical therapy can be tough. Some doctors use MedX exercise equipment, which uses computers to monitor a patient's progress. A list of clinics that use the equipment can be found on http://www.medxonline.com/Backpainclinics.htm.

Dr. Hartigan says her center uses the Cybex back-extension machine and other weight machines commonly found in health clubs. Most centers also recommend a maintenance program using an inclined "Roman chair" that a patient can lean on while lifting and stretching the back.

The treatment can cost $100 to $125 an hour, depending on the clinic. A 10-week program at the Minneapolis clinic costs about $2,000. A more intensive program at Pride Rehab in Dallas, however, can last 90 to 200 hours, costing thousands more. Some, but not all, insurance plans cover the cost.

The key to all of the programs is that they don't focus on pain relief but on restoring back function. "Rarely do they say they have no pain," says Tom Mayer, an orthopedic surgeon and medical director of Pride Rehab. "But these are people who were previously thought to never be able to work again ... who do go back to the same kinds of jobs they did before."

St. Paul, Minn., lawyer Tim Malchow, 60, could barely walk, drive or even sleep in a bed because of paralyzing back pain. After aggressive rehabilitation treatment, he continues to exercise on his own and is now able to drive, swim and go hunting. "I was not at all intimidated by the fact that they said, 'You're going to have to exercise, and you're going to hurt,'" says Malchow. "I know what pain is all about."
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Old 27-05-2004, 09:36 AM   #2
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Bernard -

I don't know what to make of this!

It flies in the face of everything we have been informed of from Butler et al; I cannot see it working for the catastrophising patients, not those who cannot accept that their pain must get worse, much worse before it gets better. And it calls for regular maintenance of a high order.

I stick with the principle that some pain must be experienced, back off, go back and experience the pain again. General exercise has been shown to be beneficial; so I would need a lot more convincing that these guys have researched thoroughly.


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Old 27-05-2004, 10:16 AM   #3
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Nari,

Mad men! I agree but try a search on pubmed with these words;
aggressive rehabilitation back pain

I found 30 replies that shows;

1/ the majority of studies are US. :shock: ($$$$$$$$)
2/ they promote function and don't care of pain! :twisted:

my conclusion is that I do not want a such thing, at any price!!
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Old 27-05-2004, 03:19 PM   #4
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Quote:
Intensive exercise has been slow to catch on.
Maybe because it hurts so much? (:roll

Quote:
The therapy is far less lucrative than the pain pills, injections and surgical treatments that are the cornerstone of the back-pain industry. And patients, too, are reluctant to pursue the treatment, which takes more time and effort than passive therapies. But now, with growing evidence that spinal-fusion surgery doesn't work for most people, more patients are looking for nonsurgical options.
Looks to me like this is a big opportunity for Servaas to come along with his tiny army of people he is training and say, "..Ahem, ..s'cuse me, we can do all that with no medX machine and no expensive doctors, and little to no pain. Aggressive removal of sm-nesia..

I agree with your analysis Bernard.
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Old 27-05-2004, 08:24 PM   #5
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Hi Bernard:

The issue means , a progressive way to get money in a ggressive method.

we need evidence , which seems not supporting the method significantly.

As we live more , we will see more :shock:

cheers
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Old 28-05-2004, 04:16 PM   #6
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Hello,
I have seen this machine. A physician that has a "pain doesn't matter, only function" attitude loves it. I tried it on myself.....can't imagine making someone in significant pain push through this thing! It is ALL lumbar motion, and it even puts you in a bit of overpressure into end range lumbar flexion.
It is another gadget, it has a computer for visual feedback, makes noises like a video game, and gives a print out on where their strength is compared to normal.
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Old 29-05-2004, 10:10 AM   #7
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....and I might cynically add, as well, what's strength got to do with it?

Perhaps I am missing something, but I see quite a few persistent pain patients with nearly full range ROM and flexibility, limited by pain, and looking mighty miserable....

These are the ones with whom I DO venture into Hands-On, as almost every segment of their spines hurt.

I think they could do well with Somatics; but my understanding of clinical practice in this field is limited...

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Old 02-06-2004, 06:38 AM   #8
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Nari,

I agree with you. I'm sure that Somatics could be a real key issue for those poor patients.

But I'm sure that in chronic patients there is some who are definetely "lost"?
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Old 02-06-2004, 08:24 AM   #9
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Bernard,

Do you mean that some chronic pain patients are lost to us, or to themselves? Or both?

I would think there are quite a few whom we can do nothing with, because they don't really want us to.
'Just fix the pain, luv'......


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Old 02-06-2004, 08:53 AM   #10
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Nari,

Both, we met few, fortunately, but in this case, I know that I will fail before doing anything!

They are engaged in health system in a different way?
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We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 03-06-2004, 04:47 AM   #11
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I see things a bit differently. I think there is a role for agressive exercise rehabilitation. It comes down to patient selection. It seems the people hey describe have been told for a long time not to use their body, to protect it, perhaps causing an iatrogenic disbility, and avoidance of activity due to fear of making things worse. Now they are being told that it's OK to move, it's OK to lift, and they are given a way to do it that is supervised and makes them feel better. I see nothing wrong with that. It's probably not for everyone, but what is?

I don't know that you need an expensive machine to do it, though. The results are what matter. Bernard, you mentioned there are some studies. Are there such published studies in Somatics? I will try a search later.

Strength may not ahve anything to do wiyth it as such. But maybe giving people more confidence in their own abilities does. I see the aggressive approach as doing just that for the right group of people. Some people may respond better to this than to other therapies, don't you think?

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Old 03-06-2004, 06:31 AM   #12
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Hi Pablo,

Caught! :wink:

I must recognize that actually Somatics, because it is a whole holistic approach, is not well considered and then not studied.

But about aggressive therapy, it may function effectively on some ones. The therapy does not clearly say that pain is relieved and it is not its goal! They say that patient return to work, only.

I have some doubts on this side of caring because it surely fails to distinguish the real physical induced pain and the emotional component?
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We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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