The researchers set out to answer some basic questions about exercise prescription for back and neck pain: who is prescribing it, who is getting it and what type of exercise is being prescribed. The most striking finding was that less than half of the people in their study had been prescribed exercise. All had seen a physician, physical therapist and/or chiropractor within the last year, yet fewer than half of these people had been given an exercise program to follow.
Patients were most likely to receive an exercise prescription from a physical therapist. This isn't that surprising, since doctors will usually refer a patient to a physical therapist rather than prescribe exercise on their own. And physical therapists were the most likely to provide supervision and prescribe stretching and strengthening exercises, practices which follow current treatment guidelines and seem to lead to better outcomes.It can be very difficult for those with back and neck pain to gain permission for covered access to physical therapy and an exercise program.
Previous studies have suggested that individually tailored, supervised exercise programs such as those developed by physical therapists tend to work best.
So, why aren't more neck and back pain sufferers being treated with exercise? The researchers can only speculate about the reasons. They suggest that practitioner knowledge, organizational barriers and insurance and payment regulations all play a part. It can be very difficult for those with back and neck pain to gain permission for covered access to physical therapy and an exercise program. Sufferers may need to raise the topic with their physician or find out what is required for them to be able to see a physical therapist. While this is likely to be a pain in yet a third body location, taking the initiative may be the only way to get the ball rolling.
The study was performed by researchers at the University of North Carolina at Chapel Hill. Telephone interviews were conducted with nearly 700 individuals with chronic neck or back pain. An article describing the study appears in the February 2009 issue of Arthritis and Rheumatism.
One type of exercise that has become more prominent in the last decade is motor control exercise, also known as spinal stabilization or core stability exercise. This focuses on getting patients with lower back pain to regain control of specific trunk muscles which support the spine and have fallen into disuse.
In an article published the January 2009 issue of Physical Therapy, a team headed by Luciana G. Macedo a physical therapist and doctoral student at the George Institute for International Health in Sydney, Australia, undertook a statistical analysis of 14 previous studies of the use of motor control exercise as therapy. They found that motor control exercise is effective in reducing pain, but no more effective than manual therapy or other exercises-- basically just another weapon in the arsenal. It also requires a skilled clinician to teach them. Still, for those with lower back pain that hasn't improved with other treatment or exercise, it's an option worth looking into.
