Say “Yes” to Exercise for Back Pain

An interesting article where I both wholeheartedly agree and don’t agree: the researchers report that “the best form of exercise is the one that you are going to stick with”. Exercise in the form of general movement is generally fantastic, but often there are specific directions/ movements that could actually help repair the problem– read more 

If this interests you, you will find the blog from July to be a great read.

View original article:  www.scientificamerican.com

 

A Very Cool Study: Directional Preference in Action

In a previous blog, I was mentioning the McKenzie System of Mechanical Diagnosis and Therapy (MDT) and outlined what a “directional preference” is: the assessor is trying to determine if the person with back pain has one direction of movement that they can do repeatedly that will consistently decrease their pain or increase their movement.

There is a huge and growing area of research dedicated to the McKenzie system, and I want to outline perhaps my favourite study of back pain of all time! Audrey Long is the lead researcher for this study, and she is a Physiotherapist and McKenzie Faculty in Alberta, Canada. She and her team examined over 300 people with lower back pain, and was able to categorize 230 people who demonstrated a directional preference into flexion (bending forward), extension (bending backward) or lateral (sideways)—performing repeated movements into their direction of preference would lessen their pain consistently. These people were then randomized to continue, as homework for 2 weeks, repeated movements several times per day into their 1) direction of preference, or 2) the movement opposite to their direction of preference, or 3) the control group, which was assigned general stretches and strengthening of the back and hips.

People worked on this consistently, and after 2 weeks, the >90% of the group that worked into their direction of preference reported being improved or resolved. That is HUGE! It’s not often in research that you get such dramatic results. This group also reported having to take much less medication than initially, and their level of function had significantly improved.

Interestingly, 23% of the group that worked into the direction of movement opposite to their direction of preference showed improvement, and 15% of that group and the control group reported being worse. You don’t start doing exercises that make you worse as the days go on!

This study really demonstrates how important it is to determine if you have a direction of movement preference that consistently lessens pain or increases movement, as that can really allow back pain to move along quickly!

The study is called:  Does It Matter What Exercise? A randomized contol trial of exercises for low back pain. (2004) Spine. 29(23): 2593-2602 by Long, A., Donelson, R., Fung, T

What is the McKenzie Method & Why Should You Care?

Physiotherapists often use a method of assessing and treatment called the McKenzie Method for people who have back pain and physical limitations– I highly recommend you check out information from their website here. In a nutshell, The McKenzie Institute International began several decades ago with Robin McKenzie, a Physiotherapist in New Zealand who developed a new way of assessment and treatment in the 1950s and advanced this thinking over the next several decades. It focuses on a thorough examination of each person individually by looking at various repeated movements and sustained positions to see how they move or their pain changes, and educating the person on exactly what to do and how often, so that progression moves along efficiently. I have found it to be an elegant system, and very helpful for many people who are suffering not just from back pain, but really any musculoskeletal issue. The McKenzie Institute International describes the system like this.

Within this McKenzie system, there is a term called “directional preference”, which is really determining if the person with back pain has one direction of movement that they can do repeatedly that will consistently decrease their pain or increase their movement. This sounds quite basic, but often the person in pain doesn’t know the direction of movement that could be helpful. Think about it—if you have a lot of back pain, you sure don’t want to do anything that might make it worse, or make the location spread out, so you tend to not move much. If your physiotherapist can help you determine if you have a directional preference that helps your pain or movement, then research shows that is a really great sign that your situation should move right along.

There is tons of research that supports the validity and reliability of the McKenzie System of MDT, and regardless of if you are suffering from a new issue or you’ve had pain for awhile, you should consider seeing a trained practitioner in this system. You can find a clinician who is either Credentialed or has a Diploma (even further education) in this system through this link.