‘Personalised Systemisation’: getback and the Brave New World of Functional Exercise

By Geoffrey Mackay, getback Co-Founder and Clinical Director

In a previous blog I compared two schools of thought in Physiotherapy regarding the management of Chronic Back Pain (CBP). 

Namely – Physiotherapists who feel back pain is best treated by pain management strategies (massage, analgesia etc), and those who believe that exercise is the best medicine to treat back pain.

Just to make life more complicated, Rehabilitation Therapists are divided about the best way to ‘exercise’ for the treatment of Chronic Back Pain (CBP). One group of Therapists believes functional exercise is the only way to rehabilitate back pain, and the second group believes in targeted, isolated and specific exercise. 

Sometimes these discussions are like stepping through a minefield of opinions, but my colleague Emeritus Professor John Carlson and I focus on presenting evidence-based research to address concerns and misconceptions. 

Professor Emeritus Kyle Kiesel of the University of Evansville (Indiana) is credited with developing the term functional exercise through his research into motor control of the core and functional movement testing and training. 

Functional exercise has been a grey area for me, so I was fortunate to be able to socially engage with Professor Kiesel on his recent visit to Australia. To my amazement, Professor Kiesel emphasised that he could not actually define what functional exercise was, and that it was a term he had used in a general sense.

The Professor described a conundrum: the problem with functional exercise is that there is no way to quantify what a patient is doing and the benefits or harms they are experiencing; and hence the difficulty of definition. 

Exponents of functional exercise are wary of machine or device-based exercise programs because they consider them one-dimensional for patients, and not applicable to normal daily activity. Their bug bear is that machine-based exercise programs are considered a ‘cookie cutter’ approach, where one program suits everyone. 

Functionalists cite examples where exercise sets are defined as Time Under Load (TUL), specific time limits are reached and load is increased by a set amount (usually 2kg). In this scenario, there is no satisfactory way to asses a patient’s needs before starting a program, so every patient is introduced into the program in a similar way. 

Progression through the programs are generally based on the load lifted and the total time a patient is able to lift that load (TUL). Put in practical terms, a patient may do 10 repetitions of an exercise at a pace of 9 seconds, which equates to a 90 second TUL. 

As this set becomes achievable the number of repetitions is steadily increased until the patient does 120 seconds TUL. At this stage, resistance is increased (usually by 2kg) and the cycle starts again at 90 seconds TUL. 

This is just an example of what Functionalists commonly define as cookie cutter, and it’s hard to disagree with!

At getback, one of the differences from this ‘cookie cutter’ approach is that our device-based exercise programs can target and isolate specific muscles, especially the deep stabilising muscles of the spine. 

multifidus muscle
getback device-based exercise programs target and isolate the deep stabilising muscles of the spine.

Exercise science is guided by Cochrane, a British international charitable organisation formed to organise medical research findings. This group facilitates evidence-based Reviews of health interventions including the most appropriate interventions for Chronic Back Pain (CBP). 

Cochrane Reviews clearly encourage more research in Isolated, Specific and Targeted Strengthening exercises which is closely aligned with the program developed by getback.  Cochrane Reviews also provide pointers to researchers on how to specifically exercise the Multifidus muscle, which is the primary focus of getback exercise rehabilitation.

Professor Kiesel was impressed at how getback has individualised our exercise rehabilitation to provide programs that are specific to the patient and their condition. He coined the phrase ‘Personalised Systemisation’, which after discussing internally for a week, we have accepted.

The primary benefit of creating any System is that you can examine the process and make improvements, and this is exactly how getback personalises its program for each patient. 

This provides the core of our treatment motto: Every patient goes through the same rehabilitation steps; the order of these steps is identical; however the rate and timing of this progression is very personalised to each patient’s adaptations.

By Geoffrey Mackay, getback Co-Founder and Clinical Director

In a previous blog I compared two schools of thought in Physiotherapy regarding the management of Chronic Back Pain (CBP). 

Namely – Physiotherapists who feel back pain is best treated by pain management strategies (massage, analgesia etc), and those who believe that exercise is the best medicine to treat back pain.

Just to make life more complicated, Rehabilitation Therapists are divided about the best way to ‘exercise’ for the treatment of Chronic Back Pain (CBP). One group of Therapists believes functional exercise is the only way to rehabilitate back pain, and the second group believes in targeted, isolated and specific exercise. 

Sometimes these discussions are like stepping through a minefield of opinions, but my colleague Emeritus Professor John Carlson and I focus on presenting evidence-based research to address concerns and misconceptions. 

Professor Emeritus Kyle Kiesel of the University of Evansville (Indiana) is credited with developing the term functional exercise through his research into motor control of the core and functional movement testing and training. 

Functional exercise has been a grey area for me, so I was fortunate to be able to socially engage with Professor Kiesel on his recent visit to Australia. To my amazement, Professor Kiesel emphasised that he could not actually define what functional exercise was, and that it was a term he had used in a general sense.

The Professor described a conundrum: the problem with functional exercise is that there is no way to quantify what a patient is doing and the benefits or harms they are experiencing; and hence the difficulty of definition. 

Exponents of functional exercise are wary of machine or device-based exercise programs because they consider them one-dimensional for patients, and not applicable to normal daily activity. Their bug bear is that machine-based exercise programs are considered a ‘cookie cutter’ approach, where one program suits everyone. 

Functionalists cite examples where exercise sets are defined as Time Under Load (TUL), specific time limits are reached and load is increased by a set amount (usually 2kg). In this scenario, there is no satisfactory way to asses a patient’s needs before starting a program, so every patient is introduced into the program in a similar way. 

Progression through the programs are generally based on the load lifted and the total time a patient is able to lift that load (TUL). Put in practical terms, a patient may do 10 repetitions of an exercise at a pace of 9 seconds, which equates to a 90 second TUL. 

As this set becomes achievable the number of repetitions is steadily increased until the patient does 120 seconds TUL. At this stage, resistance is increased (usually by 2kg) and the cycle starts again at 90 seconds TUL. 

This is just an example of what Functionalists commonly define as cookie cutter, and it’s hard to disagree with!

At getback, one of the differences from this ‘cookie cutter’ approach is that our device-based exercise programs can target and isolate specific muscles, especially the deep stabilising muscles of the spine. 

multifidus muscle
getback device-based exercise programs target and isolate the deep stabilising muscles of the spine.

Exercise science is guided by Cochrane, a British international charitable organisation formed to organise medical research findings. This group facilitates evidence-based Reviews of health interventions including the most appropriate interventions for Chronic Back Pain (CBP). 

Cochrane Reviews clearly encourage more research in Isolated, Specific and Targeted Strengthening exercises which is closely aligned with the program developed by getback.  Cochrane Reviews also provide pointers to researchers on how to specifically exercise the Multifidus muscle, which is the primary focus of getback exercise rehabilitation.

Professor Kiesel was impressed at how getback has individualised our exercise rehabilitation to provide programs that are specific to the patient and their condition. He coined the phrase ‘Personalised Systemisation’, which after discussing internally for a week, we have accepted.

The primary benefit of creating any System is that you can examine the process and make improvements, and this is exactly how getback personalises its program for each patient. 

This provides the core of our treatment motto: Every patient goes through the same rehabilitation steps; the order of these steps is identical; however the rate and timing of this progression is very personalised to each patient’s adaptations.

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