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‘Our strength grows out of our weaknesses’ – Emerson

Worldwide, chronic back pain is one of the leading causes of disability and early withdrawal from the workforce.

Chronic back pain is also a precursor to deteriorating health and other forms of illness, so it’s no surprise there is an ever growing body of research into its management and treatment. 

The recent Random Control trial study RESTORE, released by Professor Peter O’Sullivan et al, focused on the application of bio-psychosocial treatment through Cognitive Functional Training (CFT). 

What does all that mean? Let’s start with a couple of brief definitions. 

Bio-psychosocial (BPS): a treatment approach that considers all factors including biological, psychological and social, and how they interact to impact our health or illness (URMC, n.d.). 

In simple terms, BPS treatment looks at a person in full to understand their needs, including:

  • their injury history
  • what happened, if known
  • their thoughts and beliefs about their ability to improve
  • the strength of affected areas, and;
  • how worried they are about their health/pain

Cognitive Functional Training (CFT) is an integrated approach focused on listening to a patient’s story and needs as it relates to their pain. 

CFT elements
The overlapping relationship between CFT factors: making sense of your pain, exposure with control and lifestyle change. 

CFT uses this listening to integrate three components: 

  • making sense of your pain
  • controlled movement exposure, and; 
  • lifestyle change (Sullivan, P et al., 2018)

CFT looks at how pain is impacting the patient as an individual, considering their emotions and feelings. Controlled movement within the patient’s capabilities is introduced to ultimately encourage lifestyle change (ie regular exercise, stress management and better dietary choices) and long term health improvements. 

How does getback integrate Cognitive Functional Training?

getback™ is an evidence based rehabilitation program that safely isolates and strengthens the muscles most often associated with chronic back pain. 

Evidence based practice is a key pillar of the getback program. There is an abundance of research showing the changes that occur in underused or injured Multifidus (the small muscles between each vertebra in the spine). The Multifidus atrophies quickly, the composition of the muscle changes and it does not spontaneously recover when pain reduces (see The Mighty Multifidus for more detail).

Similarly, there is mounting evidence about the importance of making sense of pain and how pain impacts a person’s physical and mental wellbeing. 

getback™ considers both ends of the research landscape and meets in the middle, taking into account all the research when designing and implementing treatment plans for chronic back pain. 

This is achieved in the following ways:

Pain mapping – questions asked by the therapist to establish how long pain has lasted, its severity, and the activities that aggravate or relieve pain. 

Pain response – questionnaires validated by research used to understand lifestyle and emotional concerns about pain. 

Education process – initial appointments are 1:1 so therapists can provide important pain education and support. 

Graded exercise – the initial getback program uses graded exposure exercise, ie if a patient doesn’t like bending forward and sitting, we will start with backwards movement and gradually expose/introduce forward motion. 

Progressive strength building – as patients progress, movement gradually moves into areas that were uncomfortable to slowly build their strength.

Listening – the patient’s voice is the most important voice in the getback treatment process. We can’t feel what you feel – listening to you and hearing your story will help us make the right treatment decisions.

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