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Update

December 1, 2002

Subject: "New back pain therapy gets aggressive"
Wall Street Journal by Tara Parker-Pope

For people with back pain, the advice has long been simple: Take it easy. Now, some doctors have a radically different suggestion: Make it hurt even more.

The new treatment, called aggressive rehabilitation, goes well beyond traditional physical therapy, taking the "no pain, no gain" approach to an excruciating level.

Those who can soldier through the treatment call it a miracle cure. A number of recent studies show back-pain sufferers who use aggressive exercise are far more likely to return to work, have less pain and are less likely to seek additional back treatment than those who use more traditional treatments.

"We say, 'Let's not guard it and protect it anymore,'" says Carol Hartigan, a physical medicine and rehabilitation physician at the Spine Center at New England Baptist Hospital in Boston. "It’s the opposite of what they’ve been told. If you have a bad back, it should be strong and flexible and fit"

The treatment runs counter to what most back-pain suffers have been told. Often, physical therapists tell patients to ease up if they start to hurt. But proponents( such as myself) of intensive exercise say it only does more damage when people stop using their backs. The patient becomes "deconditioned," and the back becomes weaker, making it more likely to be injured again. Whether the problem stems from an injured disk or degenerative disease, proponents say strengthening the muscles will help.

Still, says Charles Kelly, a founder of the Physicians Neck and Back Clinic, getting better often is "dependent on whether they have the chutzpah to go through an initial increase in symptoms." Patients face a huge psychological hurdle in believing that they can start using their backs. As many as a third of patients drop out of the intensive exercise programs.

The key to all of the programs is that they don’t focus on pain relief but on restoring back function. "Rarely do they say they have no pain," says Tom Mayer, an orthopedic surgeon and medical director of Pride Rehab. "But these are people who were previously thought to never be able to work again...who do go back to the same kinds of jobs they did before."

Of course, patients shouldn’t just run off to the gym on their own. Proponents say that, at least initially, such treatment should always be monitored by their physician through a physical therapist trained in a high intensity, low force exercise protocol. Meanwhile, finding a spine specialist who recommends aggressive rehabilitation rather than just traditional physical therapy can be tough.

COMMENTS: As my referring physicians know, I’ve been using this protocol for the past three years, long before it became headlines in the paper. Thank goodness these physicians trusted me, as the results have been just as profound as those quoted in the article. (Not included in this update) The SuperSlow® protocol is by far and away the safest form of high intensity strength training, as the trainer always has the student under control while under load.

If you want more information, either as an inquiring patient, or as a physical therapist interested in this protocol, or call at 510-793-2480.

Thanks to Gail Dressler, M.D. for making me aware of this article.