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Five facts and five concepts for rehabilitation of mechanical low back pain
  1. Mark E Batt,
  2. Cheralynne Todd
  1. Centre for Sports Medicine,
  2. Queens Medical Centre,
  3. Nottingham NG7 2UH

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    Five facts

    1. The prevalence of chronic or recurrent back problems is high and may be present in up to 39% of adults.

    2. In the vast majority of cases it is not possible to identify a single source of pain, and findings—such as, reduced spinal movements, radiological changes, and protrusion, seen on magnetic resonance imaging have a weak correlation with the presence of back pain.1

    3. Reduced straight leg raise and neurological findings are typically associated with chronic low back pain (LBP), although psychosocial factors have been identified as more significant predictors of long term disability.

    4. Reduced trunk strength and physical fitness are predictors of LBP.

    5. Terminology for low back pain is imprecise. Standardisation of terminology would be of great help to health care providers and patients.2

    Five concepts

    1. Patients with acute and chronic low back pain should be encouraged to return to normal activities as soon as possible. Exercise programmes have been shown to be effective in reducing disability although they may not affect the intensity of pain.

    2. It is important to address both the somatic and psychological aspects of LBP—that is, patient beliefs, anxieties and expectations.

    3. Pacing: the aims of pacing are to increase the level or amount of activity that a patient can do without increasing pain levels. This is achieved by systematically increasing activity levels (by an agreed set amount) on a daily basis from an established baseline.

    4. Rehabilitation should be progressive, based on correcting truncal stabiliser dysfunction. This forms the basis of functional stabilisation programmes which begin with maintenance of the spine in a painless neutral position with use of local stabilisers. The next step is to maintain spine neutrality with added limb load. Gradually dynamic control of the spine can be addressed with retraining of global mobilisers. Functional movement retraining is essential starting with slow limb and spinal movements progressing to complex high speed ballistic actions.

    5. Proprioceptive retraining is integral to the programme using wobble boards and gymnastic balls.

    References

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