Exercise Underutilized for Chronic Back and Neck Pain
A recent study, funded by the National Institutes of Health, looked at exercise prescription—who is prescribing it, who is getting it, and what type of exercise is being prescribed—and found that exercise may be underutilized for chronic back and neck pain.
This study was published in the February 2009 issue of Arthritis Care & Research. Led by Timothy S. Carey and Janet K. Freburger of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, researchers conducted a phone survey of almost 700 individuals who saw a physician, chiropractor and/or physical therapist (PT) and were treated for chronic back or neck pain during the previous 12 months. They asked participants the following questions: if they were prescribed exercise, the amount of supervision they received, and the type, duration and frequency of the prescribed exercise.
Exercise can commonly be used to improve physical function, decrease symptoms and minimize disability that can be caused by chronic low back or neck pain. Numerous randomized trials and clinical practice guidelines support exercise as a beneficial modality, and studies suggest that personally designed, supervised exercise programs are associated with the best results.
"Less than 50 percent of the subjects in our research study were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain," the authors state. Also, health-care provider seen played a major role in whether participants received a prescription for exercise. Of those who received exercise prescription, 46% received the prescription from a PT, 27% from a physician, and 21% from a chiropractor. The authors note that these findings correlate with previous studies that have shown that "who you see is what you get."
The authors conclude: “Considering current evidence on the efficacy of exercise, these findings demonstrate that exercise is being underutilized as a treatment for chronic back and neck pain.”
As Pilates practitioners, it is beyond our scope of practice to “prescribe” anything. (Exercises included!) However, you can grow your business with an excellent source of client referrals if you work closely with the doctors, physical therapists, and chiropractors who have prescribed exercise and work to develop personalized Pilates training programs that meet the guidelines and “prescription” recommended by your client’s health-care providers.
The following things I always request from clients who are starting a Pilates program and have special considerations / health issues:
1. A written release \ authorization to begin an exercise program from their physician.
2. Contact details for both the doctor and physical therapist, and permission from the client to contact these professionals and discuss how we can work together to solve the problems, alleviate symptoms and pain and restore a healthy, active quality of life.
3. Information about any medications they may be taking for pain management.
4. A copy of the exercises they have been “prescribed” by their health-care provider (physician, physical therapist, chiropractor)
5. Any other information they think might be beneficial and relevant.
It’s actually been my experience, that when a physician says, “you need to exercise.” That’s as specific as it gets. They rely on my expertise to develop a safe and effective Pilates exercise program. I actually had one new Mat class participant show up with stitches from recent back surgery because her doctor told her she was ready to go, didn’t need physical therapy and needed to get started with an exercise program right away!
I believe that as Pilates professionals it’s our job to help educate the medical community as to the benefits of Pilates, and appropriate place to start for their post-rehab patients. Doctors who have never done Pilates themselves need to be educated about the differences between a personalized Pilates equipment program and group Matwork class so when they refer their patients, they’ll be confident that they are in the safest, most appropriate program to start.
While some physical therapists are in a situation to provide supervised care, unfortunately, our health-care and insurance system is not set up for them to provide patients with the length of care they might require for a full recovery. This is where communicating with a client’s PT can be an excellent networking opportunity to establish a lifetime Pilates wellness program for ongoing post-rehab care.
If a client is currently in therapy and has been given the ok to begin Pilates, it’s important to know what the safe movement guidelines are for them at this point in their recovery. As they progress, it is only with physician or P.T. approval that increased resistance, and additional ranges of movement should be incorporated into their program. Always defer to the recommendations of their medical health-care providers.
If a client has been released from therapy, it’s still important to check before beginning a program or adding anything new—until their physician, and physical therapist are confident that they can do whatever they want with no restrictions.
Many people with chronic pain may be managing it with medication. This is an important piece of information, as their medications may mask their ability to assess how their body feels before, during, and after exercise. Encourage clients to work closely with their physician to monitor how much medication they may actually need, as this may change as they get stronger and more flexible with their exercise program. And be aware that you might easily push too, far too fast, because with their medication they can’t feel the pain that would normally indicate the need to stop or modify an exercise.
Ask lots of questions.
Here are some I usually start with when interviewing a new client with chronic pain:
• Is your condition related to an injury? What happened and when?
• How long has this bothered you?
• Do you ever experience numbness or tingling?
• What do you do for a living? Sit more, Stand, Active?
• What activities, exercises, movements aggravate your condition the most?
• What activities, exercises, movements give you the most relief?
• Is your pain a dull, ache? Sharp? Stabbing?
• Are there times of the day when you feel better or worse?
• What things are you doing now to improve your health?
• What things have you tried in the past? How long? What were the results?
• What has your doctor told you to do and/or avoid?
• What exercises have been prescribed by your doctor or physical therapist?
• How often are you supposed to do these exercises? How often are you doing these exercises? How do you feel while you’re doing them? How do you feel after?
• How can I help you the most?
• What are your goals for participating in Pilates?
• Are there any other injuries or accidents that you’ve had during your lifetime? (Related or unrelated to the current issue?)
• Is there anything else you feel it’s important that I know?
The answers to these questions, the information provided by their health-care providers, and an initial assessment of standing and walking posture provides the starting point for developing a safe and effective Pilates exercise program to assist in the care and management of chronic back and neck pain with the goal of using exercise to improve function, decrease symptoms, and minimize disability for an improved quality of life.
As a Pilates practitioner, take the time to network with the health-care providers in your community to build a referral source for quality care. As a client searching for ways to improve your health, be pro-active! There are many traditional and non-traditional methods for reducing pain and improving your quality of life—Pilates and exercise can be a great choice! Consult with your doctor, P.T., and chiropractor to determine the options available in your community. It is never too late to improve your health!
Article: "Exercise Prescription for Chronic Back or Neck Pain: Who Prescribes It? Who Gets It? What Is Prescribed?" Janet K. Freburger, Timothy S. Carey, George M. Holmes, Andrea S. Wallace, Liana D. Castel, Jane D. Darter, Anne M. Jackman, Arthritis & Rheumatism (Arthritis Care & Research), February 2009.
Aliesa George is a wellness consultant and author with 25+ years of professional experience. She is founder and president of Centerworks® Pilates Institute. Certifications include: PMA Pilates Teacher, ACE Personal Trainer & Group Exercise Instructor, and Bigu Qigong Weight-Loss/Weight Management Instructor. Ms. George is available for private/group training and offers workshops in Pilates, movement re-education, and mind-body health enhancement. For additional resources and to contact Aliesa, please visit www.CenterworksPilates.com.