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The getback Reconditioning Phase, Step 1: Co-ordination

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.

By Geoffrey Mackay, getback Co-Founder and Clinical Director

In a previous blog, getback Co-Founder Professor Emeritus John Carlson focused on the Deconditioning Cycle and how its inevitable downward spiral can result in ongoing functional disability and chronic low back disorder. 

getback™ recognises four major steps patients must complete to reverse the De-conditioning Cycle, collectively known as the Reconditioning Phase. 

It is important that patients complete each step before moving to the next one, and that each step is completed sequentially. The rate and progression through each step will be determined by factors such as age, fitness level, injury type and severity, but there are defined goals to be achieved before moving to the next step. 

Most of the evidence suggests that Lower Back Pain (LBP) is associated with the progressive De-conditioning of the Multifidus muscle.

Importantly, as one of the unique qualities of the Multifidus is to ‘turn off’ following injury or a sustained period of inactivity, it must be ‘turned on’ again and the coordination of its activity restored. 

Re-conditioning the coordination of the Multifidus is a very important first step and patients who skip this step, or move to the second step without completion, often respond slowly.

Functionally, the Multifidus contracts in three different ways. Its ability to switch from one type of contraction to another is referred to as muscle coordination. 

The initial type of contraction, when the Multifidus muscle fibres shorten, is called concentric contraction. As the Multifidus reaches a shortened state there is a pause where the Multifidus maintains tension but does not shorten or lengthen. This is the isometric phase. 

After the isometric phase, the Multifidus starts to lengthen but maintains tension to control the motion. This is called the eccentric phase and it requires more effort than the first two stages. 

getback™ devices are uniquely designed to assist patients in understanding how they can achieve this very important first step of rehabilitation. 

The Multifidus muscle is largely activated subconsciously. getback devices have been designed specifically to eliminate the activity and mechanical advantage of all the superficial muscles which may assist in a movement, leaving Multifidus as the only muscle that can achieve the particular action. 

getback™ programmes are designed in a way that movement is exclusively within a range that the Multifidus functions in, and the prescribed amount of work is sufficiently light not to overload the muscle and inadvertently encourage unwanted involvement from other muscles. 

Getback Screen Monitor

To complement this approach, getback devices provide real time biofeedback so a patient can understand what is happening at this micro level. The feedback enables a patient to take control of their own programme and not rely on feedback from a third party who may not have all the necessary cues to provide accurate and relevant feedback. 

The graphs below are examples of this biofeedback and how a patient can progress themselves session by session and understand how their progression looks. 

The graphs appear on a screen in front of the patient and are designed to guide them through each specific exercise in their programme. 

  • The green bands define the limit of movement
  • The trace starts at the bottom right and progresses right to left (concentric phase), left to right (eccentric phase)
  • When the trace hits the left and right bands is the eccentric phase 
  • Each time the trace hits the right band it describes one repetition of the exercise
  • In the first case the patient has done 15 repetitions
  • When the trace is Red it indicates that there is hesitancy consistent with the movement being uncomfortable
  • Yellow indicates that the patient is struggling to keep up with the prescribed speed and you will notice that the lines are further apart
  • White indicates that the exercise is being performed at the prescribed speed and range.
Graph 1: This graph was from the patient’s 2nd treatment session and indicates the patient is quite hesitant at the start, but after about 12 repetitions the patient starts gaining some control.
Graph 2: This graph is from the 4th treatment session and shows that the patient is improving. Initially the movement is smooth, but after the 3rd repetition the trace from left to right (eccentric part of contraction) is starting to fatigue. This fatiguing is consistent throughout the rest of the prescribed program.
Graph 3: This is from the 6th session and the trace indicates that the patient has gained control and coordination of the movement. There is a little hesitancy at the beginning and end of the set but throughout the exercise the patient has been able to comply with speed and range and importantly, is coordinating the concentric, isometric and eccentric phases of the exercise. This in an indication for the Therapist to start progressing the patient’s program.