GEORGIOS Η. GOUDEVENOS
OSTEOTHERAPIST - PHYSIOTHERAPIST
Osteo-Physiotherapy Lab.
71 Vasilissis Sofias Av., Hilton, 115 21 Athens
Tel. +30 210 7224536
Physical Rehabilitation of Lower Back Pain by Measuring the True Functional Ability and Strengthening of the Lumbar Stabilizator Muscles.
The rehabilitation of patients with lower back pain is a comprehensive process that requires both accurete diagnosis and early intervantion. The rehabilitation program should be terminated only at the point where the patient can succesfully return to a maximal realistic level of activew function.
The rehabilitation process can be devided into eight phases, each of which is part of the overall plan to restore function:
1. Control of the inflammatory process
2. Control of pain
3. Restoration of join Range of Motion (ROM) and soft tissue extensibility
4. Improvement of muscular strength
5. Improvement of specific biomechanical skill patterns (coordination retraining)
6. Improvement of general cardiovascular endurance
7. Maintenance exrcise programs
During the last century, dozens of treatment protocols have been used in attempts to rehabilitate spinal pathology: passive attempts to rehabilitate spinal pathology: passive movements manipulation, immobilization, massage, heat, cold, electrical stim- ulation, ultra sound, laser, and a long list of other treatments, and although some of these provide at least a temporary relief of pain in acute cases, they have not been of much value of treating chronic pain.
For most exercises of the abdominal or the dorsal muscles it has been established that their use for spinal rehabilitation is worthless for their intended purpose. To be effective during spinal rehabilitation, the exercese must be specific.
The first excersise machine designed for developing the strength of the muscles that extend the lumbar spine was the Nautilus- Lower-Back Machine. However, research conducted at the school of Medicine of the University of Florida, Gainsville, has clearly established that such machines will increase the strength of the hip and thigh muscles, while producing no change in the strength of lower back muscles.
The problem of isolation of the lower back muscles was solved when the MedX machine was designed, providing accurate measurement of the stabilizator lumbar muscles (Longisimus Dorsi - Iliocostalis - Spinalis Dorsi) by isolating those muscles by restraining pelvis muscles, and the thigh muscles by neutralization of Gravity by the means of counterweight. By the means of standardized methods by the various protocols, and the safety and specification of the evaluation through the measurment of strength, an objective way to measur and exercise the stabilizator muscles is provided. So MedX is a medical machine, which, through the application of pelvic-to-thigh and foot restraint, is providing the ability to isolate the stabilizator muscles of the lumbar. By its function, the machine gives the ability to have an isometric fatigue test of the muscles involved, which gives the safe number of weight and repetitions for the dynamic exercises that will follow. With the assistance of computers, muscle strength will be measured in different levels (from 72o flexion to 0o extension). These levels, by following the protocols 2-3 times weekly for 15 to 24 times, will be compared each time, and will show the improvement of the muscular strength of the lower back muscles. This way, we are going to have a reliable test by the means of repeatability and constant results. The curve of the strengthening test should be descending.
The criteria for the patient to enter a MedX functional restora- tion Diagram is to be post-acute or post-surgical more than 45 days, to have the appropriate diagnosis, to have failed from conservative care and to have a documented subnormal musculosceletal strength in the isometric test.
The patient should be released from MedX functional restoration program when the treatment goals are met, for example being pain free, having improved the range of motion, having increased dynamic and static strength, and finally, having im- proved physosocial factors.
MedX seems to give an answer to the rehabilitation question. Having repaired the disfunction, the next question to be asked is how shall we maintain function.
Specific exercise will restore normal function in about eighty percent of all cases of chronic pain, will increase functional and structural strength, and will remove or greatly reduce pain. Structural weakness can be corrected, but an improvement of functional ability produced by specific exercises (MedX) will not be maintained if the exercise is stopped. Functional ability is constantly changing, becoming better or worse; the body responds to recent demands, and if you don't use it you lose it. Vert Mooney, Professor of Orthopaedics in the School of Medicine at the University of Californa, San Diego, is aware of the need of continued specific exercises for a successful re- hailitation and suggestion of a possible sol;ution. According to Dr. Mooney's team, and Dr. Bryan Nelson of Minneapolis, his research gave outstanding results in evaluation and rehabilitation in more than 80/% of chronic patients. Additional research with hundreds of chrinic spinal patients has been conducted in se- veral cities and locations in the USA, Canada, Japan, Australia, and Europe, with great results.
I happened to be one of the first Greek physiotherapists specialized in Manual Medicine who were sent by the Professor of Orthopaedics in Crete and Texas, Dr. Alex Hadjipavlou, to the Universities of Florida and San Diego to be on a certification course and practice on the MedX machine under Dr. Fulton and Dr. Mooney. I am absolutely persuaded that MedX philosophy will present the answer of maintenance of the stabilizator muscles, which play the most important role in pre- vention of lower back pain, in restoration of the Range of Motion, and in rehabilitation after injury of operation of the lumbar spine, getting the patient to the realistic level of maximal active function.
