Exercise for Spine Health
We at Palm Beach Pain Institute, serving the entire Boca Raton area, strongly endorse physical therapy style movements and stretches as part of your daily exercise routine. It is widely known that benefits of exercise include improvement of cardiovascular conditioning, flexibility, and muscle strength. What is not widely known is that exercise is not necessarily working up a sweat and lifting heavy weights. Exercise may be used to help improve core strength, control of movement, and range of movement; so, it is an important component in spine rehabilitation, pain management and management of various spine conditions. Benefits may be maximized by identifying key problem areas at the foundation and addressing these areas with appropriate exercises – exercise prescription.
Exercise prescription in a spine rehab setting is tailored to an individual’s spine condition; addressing muscle imbalances as well as stability and flexibility problems, while avoiding aggravating or exacerbating symptoms. The Physiatrist's role is important in understanding various spine conditions, prescribing appropriate exercises, instructing proper techniques in performance of exercises, and guiding progression of a home exercise program to meet an individual’s goal to return to sport or functional activity. In that end, it is important to look at the foundation first.
How and why we test local muscles
“Getting to the Foundation”
Local muscles are the smaller muscles that attach directly to the spine. Research has shown the importance of these local muscles with contributing to the stability and function of the spine. Their primary roles include: controlling segmental translation, maintaining activation that is continuous and independent of the direction of movement, and to protect the spine by anticipating movement. Local muscles stop working like they should in the presence of pain or a history of pain. Non-mechanical or pathological pain can have the same effect. Therefore, retraining of a local stabilizer is necessary to reduce reoccurrence of the pain symptoms.
So why retrain these small seemingly insignificant muscle groups vs a traditional strengthening program? Research has shown that problems with local stability muscles are related to motor control deficits, not weakness. These deficits can be retrained with specific low load exercises. Strengthening programs do have some placebo effect by releasing endorphins but in the presence of dysfunction of local musculature, strengthening programs may contribute to that dysfunction and pain.
Retraining these muscles can be challenging as it often requires learning how to get control of a muscle you never thought about using before. Motor control is the priority initially in a good spine rehabilitation program, not strength and flexibility.
Global stabilization muscles
“Learning to Move Without Pain”
Another major component of rehabilitating the spine is global stability retraining. The purpose of global stability retraining is to learn how to move above and/or below an area of pain without moving that segment. This often involves instructing someone to move one part of their spine without moving another. This becomes especially important when teaching a patient to protect an injured disc or to avoid putting pressure on an injured nerve or joint. Seeing a spine specialized therapist to accomplish this is key because they have to tools to give the feedback necessary to achieve global control. Gaining control of the global stabilizers often result in patient learning what motions/activities cause them pain and how to avoid them.
When doing a rehab program for the spine it is important to remember that “no pain, no gain” does not apply. If any exercise reproduces your symptoms or makes your pain worse, stop.