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Low back pain and the Reconditioning Phase, Step 4: Normalising

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, Clinical Director and Co-Founder of getback

Before we introduce Step 4 of the Reconditioning Phase (Normalising), it might be worthwhile reviewing what we have learned so far.

Remember there are four distinct steps of the Reconditioning Phase and patients must complete each step. Steps must be completed in the same sequence, but the completion time for each step will be individual to the patient and determined by factors that are specific to each patient.

In Step 1 (Co-ordination) the patient relearns how to contract the multifidus (deep spinal muscles), then to co-ordinate the muscle contraction. Once a patient has restored all the normal neuromuscular control over contraction the Therapist can test this by subtly adding more load, and then gradually increasing the range of movement during Step 2 (Adaptation).

Step 3 – Strengthening –  aims to continually increase the pain-free range of movement and build strength. Importantly, the ratio of strength between each group of muscles is different and the Therapist will start to balance a patient’s program by bringing these strength ratios into line.

Patients who have weakened deep spinal muscles are often over-reactive in the superficial muscles. These superficial muscles will try to work harder to compensate for weakened deeper muscles. The common reaction we see is muscle spasm.

As normal strength is restored and balanced, the spasm and tension in the more superficial muscles eases. Patients are then ready to commence Step 4 of the Reconditioning Phase (Normalising), where the deep and superficial muscles coordinate their activity and a patient’s program focuses on restoration of everyday functional activities.

Back treatment results graph

Range of motion and resistance continue to increase during Step 4, until the patient is able to lift close to the weight of their torso for low back pain patients, or the weight of their head for neck pain patients.

As much as Step 4 of the getback treatment program is about completing the restoration of function and achieving the milestones mentioned above, it is also about the future. 

Your therapist will discuss how you are going to maintain your improvement in strength, mobility and reduction in pain. 

The key to maintaining spinal health is to regularly engage in physical activity that appeals to you.

In an earlier blog we reported data showing how, 12 months after the completion of their getback treatment program, 94% of patients had maintained or further improved their spinal health. 

The key to this is physical activity. We are not talking about qualifying for the Olympics or completing the Tour de France, but being able to engage in regular physical activity that appeals to you. 

Your getback therapist will work with you in the fourth Step to put in place a plan that is right for you and achievable. At the conclusion of Step 4 – discharge – you will have a plan for the future and an invitation to come back in six months for a follow-up assessment. 

Your follow-up assessment is critical. It allows the therapist to review your plan to ensure it is maintaining your improved strength, mobility and reduced pain, or allows us to work with you to adjust the plan appropriately.