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How do the getback devices work? #1 The Lumbar / Thoracic Extension Device

Musculoskeletal disorders are the biggest cause of disability. Despite the billions spent, the problem is just getting worse. Latest medical guidelines strongly recommend exercise therapy as the first-line-treatment for musculoskeletal disorders instead of much more expensive surgeries.

getback™ devices were developed by Biomechanists and Exercise Scientists to enable targeted and safe exercise for the deep spinal muscles associated with back or neck pain.

The deep spinal muscles play a critical role in stabilising the spine, supporting the individual vertebra as they move during everyday activities such as bending forwards, sideways, backwards and rotating our body.

The getback devices control your individual treatment programme and record your strength and movement data for review with our Physiotherapists and Exercise Physiologists. 

The devices are included in the Australian Register of Therapeutic Goods [ARTG] as Class 1 Medical Measuring devices.

In a series of articles, we will look at the specific function of each of the getback devices.

The Lumbar / Thoracic Extension Device

#1 The Lumbar / Thoracic Extension Device 

The most common presentation to getback is patients with low back pain, made worse or aggravated by sitting for sustained periods during desk-based work or by activities with repetitive bending, such as gardening. 

As these presentations are aggravated by sitting and bending, the Extension Device is arguably the most important device in the getback programme.

The Extension Device isolates and assesses the strength of the extensor muscles (including the important multifidus muscles between each vertebra) and gradually strengthens them through a forwards and backwards movement. 

When a person begins to bend forward, the deep extensor muscles (multifidus) contract to stabilise the spine. As we begin to bend further forward, intermediate muscles counter the effect of gravity on our torso and control our forward movement. 

As we continue bending, the larger superficial muscles play an increasing role in controlling the trunk and ultimately, contract to bring us back to an upright position. 

A lack of strength in forwards and backwards motion is commonly associated with increased pain, spasm and stiffness in the back. Ensuring that the strength and movement range of your deep extensors (multifidus) are equal to, or greater than a comparable group of people for your age, height, weight and gender is critical for ongoing spinal health and pain reduction. 

How does the Extension Device strengthen the multifidus?

Figure 1: demonstrates how the angle of the thigh in the seat and hip lock at the front of the shin removes the glutes and hamstrings from contributing to the exercise

Weakness in the deep extensors (multifidus) has been shown to cause overactivity (spasm) in the larger superficial muscles. This weakness also causes us to engage the glutes (buttocks) and hamstrings to assist with controlling the bending motions described above. 

To strengthen the multifidus, the surrounding large muscle (glutes and hamstrings) must be disengaged from helping with the exercise. 

The unique seat design of the Extension Device is angled slightly upwards and a hip lock mechanism disengages the large gluteal and hamstring muscles, allowing the multifidus to be isolated, assessed and strengthened. 

Setting your individual programme on the device

In your Initial Consultation, your therapist will identify the pattern of your pain by asking questions such as: Where is your pain worse? Is your pain constant or intermittent? Is your pain worse when you bend forward? The responses to these questions allow your therapist to set the device to your individual needs.

Figure 2: training screen of the Extension Device, demonstrating the parameters that can be adjusted on a training programme: repetitions, repetition duration, resistance and range or motion.

Once on the device the therapist can complete an assessment of your deep spinal extensors, gaining valuable data about your strength levels, endurance, control and coordination, and mobility.

The therapist will then set the range of movement (how far forwards and backwards you move), resistance and speed of movement to ensure that you will feel comfortable and safe on the device while gently strengthening the multifidus.

When exercising on the Extension Device you will be encouraged to bend through the spine in a segmental (curl forward) manner. This allows one vertebrae at a time to move, as opposed to remaining rigid and moving in a block-like manner hingeing from the hip. 

Remember, the multifidus muscles run between the vertebra in your spine, so the bending motion is critical. 

The devices have a specially designed screen to guide your exercise. At the conclusion of the exercise you will be asked to rate the intensity of the exercise, while the device software provides you with feedback on how well you performed within the set parameters.

Training progression
Figure 3: example of the training progression of a patient on the Extension Device. Each dot point represents a training session, the increasing orange lines show the change in resistance used during the exercise over the course of treatment programme.