Exercise Rehabilitation for Musculoskeletal Conditions and Injuries

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Lower Back Pain

If you suffer from back pain, you are not alone!

 

Lower back pain is one of the most common and costly medical problems in modern societies.

  • The prevalence of chronic lower back pain in New Zealand adults is 9.1% (approximately 305,600 people) and places a large financial burden on our health care system- New Zealand spends $321 million per year on the care of patients with acute and chronic lower back pain. 1

 

Chronic lower back pain leads to a loss of strength and range of movement and ultimately compromises an individual's functional ability and quality of life.

 

People generally become less active when they are suffering from lower back pain and therefore implementing an exercise programme which incorporates lower back strengthening, as well as cardiovascular and general strength training exercises is particularly important. 2

MedX Lumbar Extension Machine

Many lower back problems are muscular in origin and insufficient strength of the lumbar muscles appears to be a common factor related to the development of back pain. 3,4 Like any other group of muscles, weakness in the lower back should be treated with active movement and overload. The MedX Lumbar Extension Machine is designed to isolate the lumbar muscles. 3

 

Research has found testing and exercising on the MedX Lumbar Extension Machine to be safe and effective.

  • Using MedX with individuals who suffer from chronic lower back pain can yield good-excellent results in up to 76% of those who use it 5
  • Treatment programmes using MedX also improve perceptions of physical and psychological functioning in individuals with chronic lower back pain 2
  • Studies have shown there is a 92% chance of individuals avoiding or delaying spinal surgery by strengthening the spine with the MedX Machine. 6

 

The ExerScience Clinic offers numerous services with the MedX Lumbar Extension Machine which include:

  • One-off testing to assess lower back strength and compare against age-matched normative data
  • Packages which include dynamic strengthening sessions, as well as periodic testing

Lulu on medx

Arthritis

The two most common forms of arthritis are Osteoarthritis and Rheumatoid Arthritis. In New Zealand arthritis is the single greatest cause of disability with more than half a million people affected by arthritis in their lifetime. 7

Whilst there is no cure for arthritis, there is a large body of evidence demonstrating that exercise rehabilitation can help. 7,8


 

Benefits of Exercise for Osteoarthritis

  • Reduces pain & symptoms
    • An 8 week strength training programme found a 53-69% improvement in total pain scores 9
  • Reduces joint stiffness and improves range of movement
  • Improves muscle strength around affected joints
    • high intensity strength training resulted in a 20-50% improvement in strength around the knee joint 10
  • Prevents functional decline 9
  • Improves mental health and quality of life
  • Provides better outcomes than usual care
    • Overall 50-75% of the studies reviewed found knee osteoarthritic symptoms, physical function and strength significantly improved when compared to usual care 10

Benefits of Exercise for Rheumatoid Arthritis

Both aerobic and strength training is recommended for the management of people with Rheumatoid Arthritis (RA). 11

  • Less pain & greater physical function 11
  • Improves psychological health
    • 12 weeks of exercise resulted in a reduction in fatigue by 17% and depression by 7%
  • The first study on the effects of exercise on heart disease risk factors in people with RA demonstrated significant beneficial effects of both aerobic and strength training 13
    • Reduced blood pressure and cholesterol
    • Reduced body fat by 2.5%
    • Increased aerobic fitness by 17% after 6 months

Pre- and Post-operative Rehabilitation

In New Zealand, the cost of osteoarthritis knee and hip surgeries account for 42% of the total public cost for arthritis and with the aging population the number of these surgeries is increasing. 14

Rehabilitation after total joint replacement is used to help avoid the persistence of impairment and optimise functional recovery. There is also emerging evidence that pre-operative exercise is beneficial for post-operative functional recovery. 15

 

 

Benefits of Pre-operative Rehabilitation

Grindem et al. (2014) looked at how a combined pre-operative and post-operative rehabilitation programme influenced the outcome of an anterior cruciate ligament reconstruction 2 years after the surgery.

Those who completed pre-operative and post-operative rehabilitation had:

  • Significantly better pre-operative Knee Injury and Osteoarthritis Outcome Scores (KOOS) in all subscales of the form.
  • At a 2-year follow-up, approximately 86-94% of the prehab/rehab patients scored within the normative range of the different KOOS subscales, compared to 51-75% of the patients in the usual care. 16

Benefits of Post-operative Rehabilitation

Resistance training 3 times per week for 12 weeks after total hip joint replacement resulted in:

  • reduce time in hospital
  • increase muscle mass
  • increase muscle strength
    • 25% increase in quadriceps muscle strength of the operated leg
  • improve functional performance
    • 30% increase in functional skills 17
       

Unfortunately, large functional deficits can persist after total knee joint replacement. Moffet et al. (2004) investigated the effectiveness of an intensive functional rehabilitation programme after total knee joint replacement.

Two months after total knee joint replacement, patients attended 12 supervised exercise rehabilitation sessions and then continued with home based exercises for up to 4 months.

Exercise rehabilitation resulted in:

  • Significantly longer (9%) walking distances in 6 minutes compared to the control group.
  • Approx 10% less pain, stiffness and difficulty performing daily activities in the first 2 follow-up evaluations 18

Evidence

1. National Health Committee. 2015. Low Back Pain: A Pathway to Prioritisation. 

2. Risch, 1993. Lumbar Strengthening in Chronic Lower Back Pain Patients.

3. Pollock, 1989. Effect of resistance training on lumbar extension strength.

4. Mooney, 1995. The Effect of Workplace Based Strengthening on Low Back Injury Rates: A Case Study in the Strip Mining Industry.

5. Nelson, 1995. The Clinical Effects of Intensive, Specific Exercise on Chronic Low Back Pain.

6. Nelson, 1999. Can Spinal Surgery be Prevented by Aggressive Strengthening Exercise? A Prospective Study of Cervical and Lumbar Patients.

7. Arthritis New Zealand, 2016. http://www.arthritis.org.nz/information/

8. Fransen, 2015. Exercise for osteoarthritis of the knee: A Cochrane systematic review.

9. Gür, 2002. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee.

10. Lange, 2008. Strength training for treatment of osteoarthritis of the knee: a systematic review. 

11. Hurkmans, 2009. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.

12. Neuberger, 2007. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis.

13. Stavropoulos-Kalinoglou, 2013. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis.

14. Gill, 2013. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials.

15. Hoogeboom, 2014. Merits of exercise therapy before and after major surgery.

16. Grindem, 2015. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? 

17. Suetta, 2004. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients—a controlled, randomized study. 

18. Moffet, 2004. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial.