An update on the use of core muscle strengthening and lumbar spinal stabilization for patients with low back pain or other indications of spinal musculo-skeletal dysfunction.
Spinal rehabilitation is the discipline of medicine that guides the physical, psychological, and social recovery of individuals who have become partially or totally disabled because of spinal disease or injury. Because the muscles and joints of the spine are not easily observed, the need for rehabilitation from spinal disorders has been recognized slowly and rehabilitation gains have been more difficult to measure by objective standards. Manual or manipulative therapy may be effective for the treatment of pain and restoration of movement in the short term, but it has not been shown to be effective in the long term. On the other hand, core strengthening programs may improve function and decrease pain, but the effectiveness in the long term management of lower back pain has been hotly debated. Despite this, strengthening programs continue to be recommended.
Spinal-related pain is one of the most complex problems modern medicine faces today, and is considered one of the “last frontiers” in clinical medical practice. It is the primary complaint prompting medical consultation. Compartmentalization of pain problems into physiological, physical, and psychosocial categories may be useful diagnostically, but must be synergistically joined to achieve therapeutic success. The interventional pain specialist (often the PM&R musculoskeletal/spine specialist, anesthesiologist, orthopedist, or neurosurgeon) is a valuable and often crucial member of the pain management team. Injury and tissue-specific therapeutic exercise programs must form the basis of physical rehabilitation and functional restoration protocols. The program can combine a core of sedentary exercises coupled with the injury-specific exercises. Importantly, the protocol must expand to encompass psychotherapeutic intervention in chronic pain conditions. Neuromuscular reconditioning must be included to ensure a function-specific, task-oriented program. Essentially and most importantly, the program must be geared to enhance and foster functional recovery among the affected patients.