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This update is intended as a means for us to keep busy clinicians in the medical community up to date with recent research as it relates to physical therapy. Hopefully, this will increase the options you have when prescribing physical therapy for your patients.
Low Back Strengthening for the Prevention and Treatment of Low Back Pain Chronic low back pain (CLBP) is the greatest cause of functional limitation among people under 45 years old. CLBP is one of the costliest medical problems in the industrialized world. The focus of the this article was to review and summarize the findings of several studies examining different treatment approaches to low back pain. Prior to the last 30 years, spine rehab was commonly approached with aggressive, specific exercise. In the last 30 years, treatment focus has become more passive, focused on symptom relief. A common factor present among CLBP patients is the “Deconditioning Syndrome.” The low back hurts so the person becomes less active. The less active one is the greater the deconditioning becomes, and the more decondtioned one becomes, the more painful activity becomes. Hence, a downward spiral! Pollock et al. determined that the key to accurately measuring lumbar extension strength was to isolate paraspinal function via pelvic stabilization, to eliminate the contribution of hip extensors to strength readings. Graves et al. compared the effectiveness of various machines that performed low back strength testing and training. They too found that pelvic stabilization was pivotal, and that the Med-X lumbar extension machine was unique in its ability isolate lumbar muscles for testing and training. Pollock et al. also have shown the lumbar extensors have great potential for strengthening. Fifteen asymptomatic people trained, on a lumbar extension machine, 1x/week for 10 weeks while a control group did no training. The training group had average lumbar extensor strength gains of 42% in the flexed position, and 102% in the extended position. The control group had no changes in strength. Pollock et al. went on to show that LB extension training also increases bone mineral density (BMD). 17 elderly subjects trained 1x/week for 6 months on a lumbar extension machine. A control group (N = 6) did no training. Study results (L2, L3 lateral perspective) showed significant BMD and lumbar extensor strength gains in the training group while the control group had no BMD change. Foster et al. studied 9 males over a 6-month period as they trained 1x/week on a lumbar extension machine. Pre and post-training MRIs showed significant increases in cross sectional area of the erector spinae. Significant low back strength gains were demonstrated also. Nelson et al. tested the long-term benefit of isolated lumbar strengthening for 895 subjects that had CLBP an average of 26 months. The 627 that completed the program showed significant increases in lumbar ROM and extensor strength, improved tolerance for ADL’s, and decreased low back and lower extremity symptoms. A one-year follow up showed patients in the treatment group maintained their decreased symptoms and utilized the health care system less often. The results of the research involving Med-X are compelling evidence for the efficacy of Med-X in the treatment of spinal disorders and spinal pain. Renaissance PT’s three clinics are equipped with both the lumbar and cervical extension Med-X machines. Having these tools affords us the ability to offer a unique approach to the treatment of chronic neck and back pain, quite often a function of paraspinal deconditioning.
Giving Way Event During a Combined Stepping and Crossover Cutting Task in an Individual With Anterior Cruciate Ligament Deficiency This was a case study comparing knee kinematics and moments of nongiving way trials to a giving way trial during a combined stepping and crossover cutting activity in a 27-year-old female subject with left ACL deficiency. The collected data from the giving way episode suggests which motor control strategies may lead to instability as well as which strategies assist in recovering stability during movement. A force plate and infrared emitting diodes (IREDs) placed on the pelvis, thigh, leg, and foot were utilized to track joint displacement and moments in 3 dimensions. The recorded activity was stepping down onto the involved extremity and cutting at a 45-degree angle in a crossover pattern. Data from 5 trials was captured. During the first 4 trials, there were no reports of giving way; however, during the 5th trial, the subject stated she had felt her knee give way. Results indicate that the combined loading pattern of increased knee internal rotator moment and decreased knee abductor moment may contribute to a giving way event. Due to the rapid increase in internal rotation angle immediately following this, it is suspected that a reflex response is necessary to control giving way. It was discovered that this ACL deficient subject displays a knee flexor moment during nongiving way trials, but uses a flexed knee posture and knee extensor moment to regain control of her knee in the giving way episode. In addition, there is a suggested external rotation moment that acts to control knee motion. In clinical practice, it is important for physical therapists to incorporate control of 3-dimensional loading patterns in rehabilitating an individual with ACL deficiency. Based on this case study, it is suggested that training in this fashion will likely result in greater success than programs that focus primarily on sagittal plane control. Perturbation training, figure-of-eight maneuvers, and sidestep shuffle activities will challenge the patient to control frontal and transverse plane loads. Increasing knee flexion during these exercises may also help to control knee motion more effectively.
The Effects of a Comprehensive Ergonomic Injury-Prevention Program with an Emphasis on Employee Ownership This study demonstrated the benefits of implementing a comprehensive ergonomics and injury prevention program within a large oil company’s support facility. Petroleum Technology Center (PTC) is a Marathon Oil Company’s technology and field-operations support facility. PTC has 227 engineers and scientists. Most employees worked at computer work-stations or in a laboratory setting. The employees used computer work-stations from .5-8 hours per day with an average of 4 hours per day. The majority of tasks became computerized during the early part of 1993 and the workforce was downsized, requiring more work to be accomplished by fewer workers. These factors were thought to be contributing to an increasing number of Cumulative Trauma Disorders (CTD’s). Workers compensation records (OSHA logs) verified the increasing number of CTD related injuries, and this was the method used to identify the hazard within the oil company’s support facility. The ergonomic risk factors of concern included awkward postures and repetitive motions while performing various tasks. In order to assess and decrease work-related injuries, PTC hired an ergonomic consulting firm to perform an ergonomic and injury prevention program within the support facility. The consulting firm initially educated all support employees in proper workplace ergonomics, and implemented 5-minute exercise breaks after every half hour of work. Educational pamphlets and wall posters were displayed throughout the buildings for continued reinforcement of workplace ergonomics. The consulting firm also performed advanced ergonomic training to supervisors and management. Workstation changes included lowering work surfaces, adjusting current chairs and purchasing new chairs, changing the location of terminals, purchasing articulating keyboard trays, wrist rests, mouse rests, foot rests, glare screens, document holders, task lights, and lumbar back supports. Upon full implementation of the ergonomics program, PTC realized many benefits. Employees performed tasks with reduced exposure to CTD’s, employee morale increased, positive feedback was received, and worker productivity increased. The company benefits included CTD claims decreasing to zero, and no new CTD claims were reported after implementing the program. Workers Compensation costs were also reduced by 80%, leading to increased company profits. The total cost of the project was $44,000; $39,000 was spent for new chairs and equipment and $5,000 for an ergonomic consultant to train employees and assist with implementing the program. Overall, the PTC study revealed that a sound ergonomics program could reduce work-related injuries such as CTD’s. The success of the program depended on manager support and employee involvement to keep the program going. This led to a ‘win-win’ result for both management and employees involved. This study also illustrates the importance of good ergonomics in the workplace for individuals recovering from an injury. Renaissance Physical Therapy NW utilizes the services of InjuryFree when seeking ergonomic consultation or product solutions, such as ergonomic task chairs, for their patients. InjuryFree specializes in quality ergonomic products that have been tested and evaluated in the workplace to ensure they are successful solutions. For more information on InjuryFree’s services or to request a clinician’s ergonomic product prescription pad, call 206-363-7676, or email info@renaissancept.com.
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