|
ARTICLES:
*There are
three articles are available in Adobe PDF format.
If you do not have Adobe Reader,
click
here to download the free software.
LOW-BACK PAIN
An Old Problem-A New Solution
Richard Berkman, M.D., Ph.D., Director
MedX™ Diagnostic and Treatment Center
Low back pain is a common and costly problem;
one of
the most expensive non life-threatening problem in the
field of medicine. Four out of five people will suffer from low back pain
at one time or another. Costs of medical care and loss
of job time are difficult to determine, but may exceed
forty billion dollars annually in this country alone.
(1,2)
Every year over 300,000 back surgeries are performed
here. While many of these are necessary, some are not,
and many are ineffective.(3,4,5)
Although very few low back problems require surgery,
most do require treatment. When a back injury occurs it
is usually the result of a force that exceeds the
strength of a muscle, ligament, disc, or other body
part. Most low back pain results from injury to the soft
tissues, primarily those in the area of the muscles that
support and extend the spine. When the back muscles are
weak, even simple movements and relatively small forces
can cause damage. The chronic pain that invariably
results is the direct effect of de-conditioning, the
functional deterioration of the lumbar muscles.(6)
The importance of the lumbar muscles in the treatment
and prevention of lower-back problems is very clear, but
it does not follow that all doctors or therapists
understand just how to apply this information in
practical ways. Confusion on this subject is
understandable because until recently it was not
possible to test the strength of the lumbar muscles, not
possible to develop meaningful exercises, and also not
possible to measure the results of exercise.(7)
Meaningful strength measurements of the relatively weak
lumbar muscles requires stabilization of the pelvis so
that the very powerful hip and leg muscles are
immobilized. Likewise, exercises to strengthen the back
muscles effectively require pelvic stablilization.(8)
Thus, so-called "low back" exercise machines seen in
many athletic clubs do not provide adequate pelvic
stabilization, and thus they exercise only the muscles
of the buttocks and the thighs.(9) Occasionally, such
machines can even cause back injuries.
The Solution-In 1977 Arthur Jones, founder and retired
Chairman of Nautilus Sports/Medical Industries, donated
$8.5 million to the University of Florida College of
Medicine to develop a machine to strengthen the low back
effectively. Solving all the problems encountered in the
development of equipment capable of performing
meaningful tests of strength, range of motion and
muscular endurance required fourteen years of continuous
research. The result: The MedX™ Lumbar Extension
Machine.
Over the nine year MedX™ development
period, 45 different studies were conducted at
the medical school by a team of researchers
headed by Michael Pollock, M.D. involving 3,339
subjects, 18,540 functional tests and more that
100,000 exercise procedures. Some astounding
results came out of these studies, results which
were well beyond expectation.(10) In the words
of Dr. Michael Fulton, an independent
researcher, "...Carefully conducted large scale
research has clearly proven that less than two
minutes of weekly exercise is all that is
required to strengthen the lumbar muscles to a
degree that I would not have believed
possible!...To say that we were surprised by the
results is to put it mildly indeed, we were
stunned!
Figure 2. Pelvic restraint allows total isolation
of the
muscles of the lumbar spine.
How the MedX™ is able to measure the weak lumbar
extensor muscles and provide meaningful exercise is
shown in Figure 2. The restraining components prevent
motions of the pelvis and remove forces produced by the
powerful muscles of the hips and thighs. It is a system
that specifically exercises the lumbar muscles in total
isolation.
The MedX™ machine can determine the maximal strength of
the lumbar muscles in any position from flexion to
extension (Fig 3). Strength is measured isometrically to
eliminate frictional forces.
Finally, an adjustable counterweight equalizes the
forces produced by gravity acting upon the upper torso,
eliminating undesirable extraneous forces on the weak
lumbar spine.
Figure 3. Isometric strength
testing of the muscles of the
spine through a full lumbar range of motion.
How MEDX™ Can Work For You - A carefully conducted MedX™
test can readily detect weakness of the lumbar extensor
muscles. Muscle weakness is the primary cause of low
back pain and results in decreased stability of the
spine, reduced blood circulation(11), osteoporosis(12),
joint inflammation and other painful conditions.
Most patients with weak lumbar muscles can make enormous
strength gains on the MedX™. Usually, these gains are
accompanied by substantial pain reduction. Women with
osteoporosis of the spine show a marked improvement in
bone density(12).
A complete medical history and physical examination
usually are sufficient to rule out important alternative
causes of back pain such as kidney infections,
fractures, or cancer. Of course, when pain is
progressively worsening or new symptoms appear, a
further medical workup is in order.
Historically, exercise performed to increase strength
requires three workouts each week. But carefully
conducted large scale research has clearly proven that
fewer than one or two brief weekly exercises on the MedX™
is all that is required to strengthen the muscles of the
lumbar spine to an astounding degree.(13) Almost anybody
can increase the strength of these muscles by as much as
one or two hundred percent in less than one month!
Once a program is completed, most subjects maintain
lumbar strength and are symptom free without further
MedX™ treatments. In one major study of 627 mine workers
who completed a MedX™ program, most reported good to
excellent results, and over 90 per cent maintained their
improvement after a one year follow up.(14)
References
1. Mooney, V. et all: The effect of workplace based
strengthening on low back injury rates...J Occupational
Rehab V.5, No. 3, 1995.
2. Shwartzman, L. et al: Cost-effectiveness analysis of
extended conservative therapy vs. surgical intervention
in the management of herniated discs. Spine 17: 176-182,
1992.
3. Swezey, R.L. et al: Outpatient treatment of lumbar
disc sciatica. West J Med 145: 43-46, 1986.
4. Garfin, S.R. In: Symposium, Current concepts in the
management of herniated discs. Contemporary Orthopaedics
22:348, 350, 1991.
5. Waddell, G. et al: Failed lumbar disc surgery and
repeat surgery...Joint Bone and Joint Surgery 61A:
201-207, 1979.
6. Flicker, P.L. et al: Lumbar muscle usage in chronic
low back pain. Spine 18: 582-586, 1993.
7. Mooney, V. et al: Treating low back pain with
exercise. J. Musculoskelo Med 12(12): 24-36, 1995.
8. Graves, J. et al: Pelvic stabilization during
Resistance Training: Its effect on the development of
Lumbar Extension Strength. Arch Phys Med Rehab 75:
210-215, 1994.
9. Jones, A: Testing & Rehabilitation for the lumbar
spine, the cervical spine and the knee p. 18. Available
through MedX™ Corp. 1401 NE 77th Street, Ocala, Florida
34479.
10. Copies of these studies can be obtained by writing
to: Department of Medicine, University of Florida,
Department 277, JHMHC, Gainesville, Florida, 32610.
11. Risch, S. et al: Lumbar strengthening in chronic low
back pain patients. Spine 18: 232-238, 1993.
12. Sinaki, M. et al: Can strong back extensors prevent
vertebral fractures in women with osteoporosis? Mayo
Clinic Proc 71: 951-956, 1996.
13. Graves, J.E.:Effect of frequency & specificity on
isometric lumbar extension strength. Spine 15: 604-509,
1990.
14. Nelson, B.W. et al: The clinical effects of
intensive specific exercise on chronic low back pain. A
controlled study of 895 consecutive patients with one
year folow up. Orthopedics 18: No. 10, 1995.
|
