Spinal Rehabilitation

The combination of increasing life expectancy, lack of physical exercise, obesity and growing popularity of sporting activities with a high risk of injury leads to increasing importance of exercise therapy, rehabilitation and medical prevention of spinal disorders.

The human body is designed for physical activity. Since the beginning of the Industrial Revolution more than 200 years ago, however, manual labor has steadily decreased. The consequence: Our musculoskeletal and cardiovascular systems are often insufficiently challenged. The lack of exercise and physical work leads to diseases. Unbalanced burdens of daily working life (e.g. sitting at a desk from dawn to dusk), obesity and stress represent the most common causes of illness today. Especially chronic and acute pain in the spinal area are steadily increasing. This affects almost all age groups, starting with incorrect postures of schoolchildren and adolescents through the issues of adults often caused by lack of physical exercise and negligence of proper posture to severe degenerative problems of old age.

Preventive medicine

New therapies for corresponding indications allow specific therapies and help counteract harmful influences on the spine. In this case, preventive medicine is of significant importance. It is classified into:

• Primary prevention: begins before the onset of a disease. The detection of those disruptive factors which are initially still without pathogenic effect and cause disease only later is essential here.
• Secondary prevention: takes place in the early stages of a condition, with the objectives of early detection and prevention of deterioration and chronification of the condition.
• Tertiary prevention: strives to avoid sequelae and recurrences after manifestation and possibly acute treatment of a condition.
• Quaternary prevention: this refers to the prevention of unnecessary medical measures or “overmedicalization”.

How the therapy works

The mainstays of therapy and prevention are screening, a healthy diet, physical exercise for strengthening, stabilization and possibly correction of the musculoskeletal system (e.g. of leg length differences resulting in malposition of the spine) and for improvement of the organic function of the cardiovascular system, workplace ergonomics, stress management and prevention of addictions.

Starting with an individual analysis of posture, static conditions (pelvic and shoulder obliquities, scolioses, etc.), organ functions, acute and chronic pain and biopsychosocial conditions is mandatory. Differentiation is necessary as to whether muscles, bones or nerves are the reason underlying the incorrect posture.

The treatment objectives comprise pain management, normalization of muscle tone, treatment of joint dysfunction and malpositions, stabilization of the musculoskeletal system, as well as prevention by identification and elimination of underlying factors.

Tailored therapy

According to the current guidelines, a multimodal treatment plan individually fitted to the respective indication and patient is recommended. Therapeutic options include pharmacological pain management, physiotherapy, strength and stamina training, manual therapy, electrotherapy, cold and heat therapy, massage, acupuncture, psychological counseling, dietetic counseling, medical prevention and tele-rehabilitation. New therapeutic methods such as cold red light, shockwave therapy, therapeutic climbing, weight training for spinal disburdening (e.g. sling training), extension and vibration therapy, balance training and kinesio taping can also contribute significantly to success of the therapy.

A wide variety of well-tried and modern therapeutic options are available. The most important are going to be described in more detail here. All types of therapy mentioned are used at the Orthopaedic Rehabilitation Clinic Wien Baumgarten:

• Pharmacological pain therapy

Particularly noteworthy here is the infiltration therapy as an intramuscular injection in combination with stretching exercises in case of local pain and tension symptoms.

• Physiotherapy

Physiotherapy in the form of individual or group therapy and independent continuation of the exercises learned are the basis of any exercise therapy. For posture correction, corrective and stabilizing physiotherapy and subsequently workplace optimization are essential.

• Deep stabilization

Deep stabilization for the treatment of muscularly caused spinal complaints can be performed with general strengthening exercises for the affected muscles.

• Therapeutic climbing

Therapeutic climbing shows positive effects on motor function, cognition and emotion. This form of therapy is particularly suitable for posture weaknesses and instability.

• Strength, stamina and coordination training

Strength, stamina and coordination training serve for improvement of mobility and stabilization and functional enhancement. At least 30 minutes of aerobic exercise and 15 minutes of strength training for the core muscles should be done daily.

• Posturography

Posturography as a method for determining the functionality of balance regulation and posturographic training on unstable ground provide essential training for behavior in extreme movement situations and thus serve as an important means to prevent falls.

• Gait and posture analysis

Gait and posture analysis are among the standards in case of pathologies of the spine and lower extremities. Modern devices with treadmill furthermore allow computer-controlled gait training.

• Disburdening training

Disburdening training of the upper or lower extremities and the spine muscles is important after injury or surgery, or in case of chronic irritation.

• Full-body shockwave therapy couch

The full-body shock wave therapy couch acts according to the principle of mechanotransduction (transmission of a mechanical stimulus to tissues) using low-energy shock waves, and by influencing the muscular tone it achieves frequency-dependent relaxing or activating effects and pain reduction.

• Aquatherapy

Aquatherapy allows joint-friendly resistance training, which can be adapted by using appropriate appliances, such as water dumbbells, buoyancy belts or resistance gloves. It should be considered in every treatment plan.

• Manual therapy

Manual therapy is indicated in cases of blockages and hypermobility or instability, where manipulations and/or mobilization are particularly effective in combination with physiotherapy.

• Electrotherapy

Electrotherapy with direct or alternating currents is an essential part of therapy. Electrotherapy is used for muscle and nerve stimulation, improvement of circulation and alleviation of pain.

• Ultrasound therapy

Ultrasound therapy is characterized by effects in the deep tissue and stimulates the cellular metabolism by locally increasing the blood flow; hence it is excellently suited for postoperative and posttraumatic use.

• Thermotherapy

Thermotherapy in the form of local heat or cold therapy is another treatment option for localized pain.

• Massage therapy

Massage therapy can be included as a supplement into the treatment regimen.

• Psychological support

Psychological support comprising at least a motivational talk and, as required, psychopathological history, biofeedback, EMG, discrimination training (relaxation vs. tension), heart rate variability (adaptation of pulse and respiration), relaxation training, sickness, pain and stress management therapy (burn-out prevention) are indispensable in the context of inpatient therapy and often helpful for outpatient therapy.

Dietetic care

Dietetic care in terms of nutritional therapy, fat measurement and bio-impedance analysis (measurement of the electrical resistance of the tissue) are expedient for virtually every patient.

Conclusion

An individual, multimodal treatment regimen developed by the medical specialist, therapist and patient and consisting of a combination of pain management and active and passive physical therapies, taking into account the biopsychosocial components (weight and stress reduction, workplace ergonomics) is the primary objective of exercise therapy and rehabilitation. Where indicated, additional therapies can be applied. Subsequently, regular follow-ups at specialists in orthopedics and orthopedic surgery and physical therapists, and continuation of the physiotherapy exercises learned, possibly by tele-rehabilitation, are recommendable. This is possible using a tablet PC with the appropriate software.

The goal is to spend the years gained in the best health possible.

The author, Prim. Dr. Maximilian Schmidt, Specialist in Orthopedics and Orthopedic Surgery, is the medical director of the Rehabilitation Clinic Wien Baumgarten.

These articles might also interest you:

+ "ICF: Individual rehabilitation Systems" - from Univ. Doz. Dr. Thomas Bochdansky
+ "The Orpheus Program" - from Prim. Univ. Prof. Dr. Michael Musalek 
+ "Muscle relaxation in persistent vegetative state patients in the hammock" - from Mag. Barbara Seidel, BSc
+ "Personalized Rehabilitation" - from Prim. PD. Dr. Michael Fischer