Abstract:

Eight hundred ninety-five consecutive chronic low back pain patients were evaluated. Six hundred twenty-seven completed the program.  One hundred sixty-one began but dropped out, and 107 were recommended for treatment but did not undergo treatment for various reasons. Average duration of symptoms prior to evaluation was 26 months. Forty-seven percent of patients were workers’ compensation patients. The primary treatments was intensive, specific exercise using firm pelvic stabilization to isolate and rehabilitate the lumbar musculature. Patients were encouraged to work hard to achieve specific goals. Seventy-six percent of patients completing the program had excellent or good results. At 1-year follow up 94% of patients with good or excellent results reported maintaining their improvement. Results in the control group were significantly poorer in all areas surveyed except employment.

 

Spine Strong Comments:

Since 1998, Dr. Dan Bruno, the owner and developer of Spine Strong, has been performing “Intensive Spine Strengthening” for patients with chronic and recurring lower back pain. Intensive spine strengthening, as used in the Spine Strong Program, was created by leading medical experts due to the great deficiency in effective treatment methods for low back pain.  Decades of scientific research and clinical study has shown that most back problems are the result of weak back muscles, specifically the lumbar spinal multifidus muscles.  While most treatments methods use a variety of methods to try and “mask the pain”, intensive spine strengthening addresses and corrects the underlying problem…spinal muscle weakness.

The 90′s were an important decade for research looking into both the technique and effectiveness of intensive spine strengthening.  In 1995, a research study came out entitled “The Clinical Effects Of Intensive, Specific Exercise On Chronic Back Pain: A Controlled Study of 895 Consecutive Patients With 1-year Follow Up”. In this study a large group of chronic low back pain patients were put through a rehabilitation program with a strong emphasis on progressive, intensive lumbar spine strengthening with firm pelvic stabilization.  Nearly all participants had tried and failed multiple treatment modalities including supervised exercise programs. A brief overview is below:

PATIENTS PARTICIPATING IN THE PROGRAM:

• Duration of symptoms ranged from 3 months to 30 years
• Symptoms included lower back pain as well as leg pain
• Patients had tried an average of 6 different treatments
• 14% had previous back surgery
• 89% failed a supervised exercise program
• 47% tried and failed chiropractic

OVERALL RESULTS:

• Overall 76% had an excellent or good response to treatment
• Of these, 94% maintained their improvement 13 months later
• Of those with back pain, 79% had a substantial decrease or a decrease in back pain
• Of those with leg pain, 79% had a substantial decrease or a decrease in leg pain
• 93% had an improvement in their ability to perform the activities of daily living

This study is one of many showing the advantages of an “active” approach for chronic/recurring lower back pain versus the traditional “passive” approach that provides little more than a Band Aid effect.

Spine Strong is also proud to offer standard chiropractic services in addition to our Spine Strong Program.  Along with being the owner and developer of Spine Strong, Dr. Daniel J. Bruno is a California licensed Chiropractic Physician with over a decade of clinical experience.  Our unique mobile, or “traveling”, business provides personalized chiropractic and rehabilitation services at your location, wherever that may be. We have the ability to go almost anywhere our services are requested (within reason).

Our mobile services have proven very beneficial for individuals with widely varying needs including stay at home parents, those with demanding schedules or difficulty getting away, individuals with a desire to stay out of the public eye, as well as those just preferring a more one-on-one experience in the comfort and convenience of their own personal environment.

No need to pack up the kids and battle traffic only to end up sitting in a busy office waiting. We make  the road to recovery from your neck and back issues a breeze.

• We Come To You!
• Appointments Available 7 Days Per Week
• Personalized One-On-One Service
• High Quality care
• Affordable Rates

How It Works

It’s easy!  Contact us by phone or with our contact form HERE and you will speak directly to Dr. Bruno.  From there you will have the option of a free in-home consultation or, if you are ready to get started, you can schedule a time for Dr. Bruno to personally come to you home, office or other convenient location for an initial evaluation and treatment (if deemed appropriate).  Please note that our mobile chiropractic services are for non-emergency issues only.

Intensive spine strengthening, as used in The Spine Strong Program, is shown in research to have about an 80% success rate. That leaves us with about 20% in need of a different form of treatment.  It is for this reason we also provide standard Chiropractic services and have a small team of health care providers in various fields that we are happy to refer to.

In order to best help all of our patients, please share your experiences by answering the questions below:

• What types of treatments for back pain have you tried? 

• Were they successful?

• If so, were the results temporary or lasting?

Please post your responses in the comment box below so that others seeing this can also benefit from your experiences.  Thank you!

Back Pain: Here Lies The Problem….

Most standard treatment methods for lower back pain, such as chiropractic, most physical therapy, pain relieving medications, epidural injections, massage and a myriad of electrical devices, have the ability to help relieve some of the pain, but the results are generally short-lived with little or no effect on preventing the pain from returning. Those suffering from recurring episodes of back pain often require repetitive, seemingly endless treatments in an attempt to just control the pain.

Along Comes Intensive Spine Strengthening….

Due to the stubborn, resilient nature of back pain and the huge economic burden it presents, medical research over the past several decades has focused on finding a solution to this problem that makes sense.  Intensive Spine Strengthening was born as a result of their exhaustive efforts and is nothing short of amazing with about an 80% success rate for relieving back pain AND preventing the pain from returning. Read More.

Bringing Intensive Spine Strengthening to the public….

Spine Strong was developed for the sole purpose of bringing the amazing benefits of Intensive Spine Strengthening to the people who need it most…lower back pain sufferers.  Our Spine Strong Program is fast, convenient (we come to you), affordable and extremely effective. If you live in San Diego give us a call for a free in-home consultation.

So the question is “Why Haven’t You Tried Intensive Spine Strengthening?“

Imaging studies (such as x-ray, MRI and CT scans) are generally unnecessary for lower back pain unless there are “red flags” pointing to the possibility of a more serious condition. Don’t worry, red flag symptoms are rare and are easily assessed with a thorough health history and physical evaluation by a trained spine specialist.

In an article HERE, Consumer Reports comments on a survey performed by the National Physicians Alliance and the Archives of Internal Medicine regarding imaging studies performed within the first 6 weeks of onset of lower back pain:

Imaging for low back pain within the first six weeks. The doctors said that’s generally necessary only if there are red flags, such as progressive neurological problems or serious underlying conditions, such as osteomyelitis, a bone infection. Otherwise, the tests—including X-rays, MRIs, and CT scans—just increase costs without improving results.

Consumer Reports take: Our report on back pain also concluded that the tests are overused. If your doctor orders one, ask why, and how it will affect your treatment and management. Staying active through exercise, or physical or chiropractic therapy should often be tried before tests or treatment. In fact, back pain usually clears up on its own within a month or so.

Spine Strong’s Comments:

Imaging studies for lower back pain, performed in the absence of red flag symptoms, should be questioned immediately by the patient. You should ask “why do I need an imaging study?” and “how will it change my treatment plan?”. Remember, you have the right to question EVERYTHING your doctor recommends and you should exercise that right EVERY TIME a health care provider recommends a test or treatment.  If you are dissatisfied with their reasoning, you also have the right to say no.

http://www.health.harvard.edu/healthbeat/the-real-world-benefits-of-strengthening-your-core

Here’s an excerpt from the Harvard newsletter article.

Weak, tight, or unbalanced core muscles can undermine you in any of these realms. And while it’s important to build a strong core, it’s unwise to aim all your efforts at developing rippling abs. Overtraining abdominal muscles while snubbing muscles of the back and hip can set you up for injuries and cut athletic prowess. If washboard abs are your holy grail, it’s essential to trim body fat through diet and aerobic exercise and build strong abdominal muscles through frequent core exercise sessions.

Spine Strong’s comments:

As I’ve spoken of on many occasions in the past, focusing all of your effort on strengthening your abdominal muscles and ignoring the spinal extensors can not only decrease the stability of your spine, but can also CAUSE lower back pain. If you are already experiencing lower back pain, then you are setting yourself up for injury. Take a look at some of the links below for more information:

http://www.spinestrong.com/the-importance-of-intensive-spine-strengthening/

http://www.spinestrong.com/back-pain-will-you-need-surgery-for-degenerative-disc-disease-djd-spine-strong/

Dr. Daniel J. Bruno D.C.

http://www.spineuniverse.com/blogs/knight/will-eventually-need-surgery-degenerative-disc-disease

Here’s an except:

Question: I’m 60, and I just found out that I have degenerative disc disease (DDD). Since it’s a degenerative condition, I assume it’ll just get worse as I get older. What’s the likelihood of me needing surgery for DDD?
—Ottawa, Ontario

Answer: This is a very common question I get from patients who have degenerative disc disease (DDD). And for the majority of my patients, the answer is: “No, you probably won’t need surgery.” In fact, there are several requirements you need to meet in order for your doctor to recommend spine surgery for DDD. READ MORE

Spine Strong’s comments:

This is a good article that stresses the importance of always taking a conservative approach first when dealing with benign musculoskeletal issues and back pain.  However, I would like to make a comment on his reference to abdominal and core strengthening for spine related issues since this is an extremely common mistake made when recommending exercises for spine related issues. 

The “core” has become a way overused term and in many people’s minds is associated only with the abdominal muscles.  The problem is that the “core” refers to the group of muscles that support, protect and stabilize you lumbo-pelvic or mid section area. 

Of these muscles, the most important group for spinal stabilization are your deep spinal erector muscles known as the multifidi muscles. These muscles are located on the rear portion of the spine and promote spinal extension and some aspects of rotation, but primarily they stabilize the spine during body movements to prevent excessive or aberrant motion of the spinal segments.

Exercises for the multifidi muscles are not the some as those done for the abdominal muscles.  And in my opinion, if you have spine related pain and degeneration, addressing only the abdominal muscles may do more harm than good.  I will address this more specifically in future posts.

Daniel J. Bruno D.C.

Read more on the importance of spine strengthening HERE

I’ve compiled a short list of activities that are generally back pain friendly, meaning they are low impact and can be performed without over exerting your painful muscles.   Remember to start out slow, listen to your body and learn to understand the difference between good pain and bad pain.

1.  Walking/Hiking

I’ve placed walking at the top of the list since it is the easiest, most convenient and can be performed every day. Start out slow and on an even, flat surface and give yourself a goal of a set time.  From there you can add time, distance, speed and inclines to increase the difficulty.

2.  Biking

Biking is another low impact, convenient and fun option.  Follow the same general rules as with walking.

3.  Paddling/Swimming

The motion produced by swimming allows your spinal muscles to constantly work without any harsh impact placed on your joints.  Of all the exercises listed, I would consider swimming the most beneficial for promoting strength, flexibility and endurance of the spinal and skeletal muscles.  A good alternative for those not comfortable with swimming is to either arm or leg paddle.  This can be performed with some type of flotation device such as a boogie board (leg kicking) or surfboard (arm paddling).

4.  Gentle Yoga/Pilates

We all know the benefits of yoga, and there are many.  For back pain sufferers, the slow controlled full body movements that combine lengthening with strengthening of the spinal and skeletal muscles can be an enormous boost to reducing your pain and increasing your strength and flexibility.  The key, at least initially, is to find a gentle form of yoga that will not put too much stress on your already weakened spinal muscles.

5.  Low Impact Aerobics/Water Aerobics

Most health clubs offer a low impact aerobic class and some even offer water aerobics.  If you are already a member of a health club, speak to the manager to help determine if they have a class that will work for you.

Comments and suggestions are always welcome.  And although this list is a “top 5″, I’m more than happy to add suggested activities to it.  Thank you and GET MOVING!!

http://www.health.harvard.edu/healthbeat/the-secret-to-joint-pain-relief-exercise

Dr. Bruno’s comments:

In actuality, this is no secret. We’ve known for decades that movement is the key to keeping the joints of your body (shoulders, knees, hips, ankles, spine, etc…) healthy and pain free.  Combine this with healthy eating and weight management and you can help prevent future joint related problems such as osteoarthritis and osteoporosis.

Here’s something more to think about.  The joints of your body, including the spine, are comprised of different soft tissue structures that serve different purposes.  In very basic terms, there are ligaments that hold the joint together, muscles that move the joint as well as muscles that stabilize the joint while it is being moved.  Of those three types of structures, it is the stabilizing muscles that play the most important role in preserving the health of the joint.  Ironically, it is also the stabilizing muscles that are the most overlooked when developing a workout program.

So, in addition to basic cardiovascular and strength training, a special emphasis should be placed on the stabilizing muscles of the body.  By “stabilizing muscles”, I am referring to the muscles that maintain balance and stiffness of the joint as well as work to hold your body upright and posturally sound against gravity.  I will get more into the roles of stabilizing muscles in future posts and will include some “how to” videos as well.  Subscribe to this blog if you are interested in receiving updates.