I seem to have spent a large part of my career to date banging on about the importance of physical rehabilitation in the treatment of low back pain. The NICE Guidelines advise clinicians what they should and shouldn’t be doing when treating low back pain and physical rehabilitation seems to be the only mainstay over the last 20 years. Other treatments come and go, like acupuncture and hands-on treatment, but exercise is the only treatment that has stood the test of time.
I’ve written before on my online blog about the importance of using both general exercise (i.e making sure that you’re doing enough general exercise), but today I want to address the other part of physical rehabilitation; specific rehab. This means we’re going to take a dive into the home exercises that you are given when you go to see a chiropractor, physiotherapist or osteopath.
Rehab to match your goals
The number one mistake I see is with patient’s rehab is that the previous clinician did not clearly define the patient’s goals for treatment. Does the patient want to get back to gardening, lifting their child up from the floor or simply walking regularly? Whatever the patient wants to do for their goal should guide the rehab that the clinician prescribes.
For example, if a patient wants to bend down to lift their child up from the floor, I would start them with some body weight exercises that gently induce bending of the low back. Then I would progress this up to be more multidirectional, before adding a weight when the patient is ready. Finally, I would progress the mass of the weight and turn the rehab into strength-based training. The reason that I take this approach is because these exercises mimic the movement that the patient does when bending the lift the child
This approach meets the patient where they are at and then helps them to transition back to normal life, with a lower chance of experiencing repetitive flare ups.
Far too often I have patients come in who have been to see a number of other manual therapists, who have got the patient doing every possible kind of fancy exercise they possibly can, without actually making any of that rehab specific to the patient’s goal.
If you are a bricklayer and you cannot work because of back pain, and your main goal is to get back to work, then doing rehab that is similar to the movements you do every day is the only thing a clinician should be thinking about when writing your rehab programme.
Rebuild your strength
I distinctly recall a patient coming to me in my first year at Diss Chiropractic Clinic with long term
low back pain. The patient’s goal was to return to cycling long distances on weekends. The previous clinician that the patient saw had recommended for them not to cycle and instead to do seated glute exercises, despite the fact that the patient was able to cycle short distances without pain.
With all due respect to my fellow clinician, the only way to get this patient cycling long distances
again was to start off with them with short cycles and rehab that mimicked the movements/positions you would find yourself in whilst riding a bike.
This isn’t an isolated incident – I find myself dealing with it at least once a month. Whether through
a bad recommendation from another clinician or because the patient has read something unhelpful online.
I always endeavour to keep my advice simple when treating low back pain and this time is no different. Your rehab needs to look like the thing you’re trying to achieve. If you’re wanting to walk for 2 hours again, then try walking shorter distances. If you’re wanting to lift your child off the floor, try lifting up lighter objects first.
Too often I see patients struggling to get back to cherished activities because their rehab has been over-complicated; keep your rehab specific to the activity you want to do. That’s it.
To read Rob Bailey’s latest column in the Diss Express please click here.
