PostureBall Rehab Exercises and Chiropractic
StevenP. Weiniger, DC / Founder, BodyZone.com
The current mantra of neck and back care is active care, with good reason. Randomized clinical trials (RCT), the gold standard of research, has shown better outcomes and less disability for people with neck and back problems who receive exercise therapy than for those who don’t. (1) (2) In addition,traditional, common sense wisdom has always said that exercise is good for a weak back, or a weak neck. So, if it were that easy, why are back problems such a large and growing problem? As with many things in life, the answer is that the spinal problems have many facets. There is no one cause for back pain. (3)
We live in a capitalistic society, and so it is enlightening to look at the world of spine and joint health from a macro-economic point of view. There are many different treatment modalities playing on the field of spine and joint therapies. Pharmaceutical companies sell drugs. Physical therapists sell one on one passive care initially, followed up with exercise and lifestyle advice. Orthopedic surgeons sell increasingly hi tech surgery, with faster recovery times. Retailers and manufacturers sell products such as beds, chairs, shoes and sports gear, all ergonomically engineered for comfort and wellness. And chiropractors sell visits consisting of spinal adjustment/manipulation, with ancillary support procedures.
One of the first rules of business is to sell people what they want. The trends show baby boomers want to keep functional, even if care is dramatic or“non-essential” for which they have to pay out-of-pocket. According to the Wall Street Journal, baby boomers don’t want to slow down, resulting in the 16% sales growth of the orthopedics industry. Knee replacement surgeries have doubled in the 38-56 year old set from 1996-2001, according to Oxford Health Plans. New procedures such as cartilage cell transplants, arthroscopic procedures and artificial knees, hips and discs all contribute to create a growing 14 billion dollar industry. (4) This is coupled with a growing interest in fitness and wellness ranging from yoga and Pilates to meditation and massage.
The decisions for the purchase of these different products are a blend of the patients’ desire, and insurance companies’ reimbursement. Both demand results, and both expect active care, aka exercise, as treatment for back, neck and other biomechanical conditions. Although many believe that the insurance companies’ incentive is aimed more towards reducing costs than improving lifestyle, research shows patients strongly expect to learn about exercises and posture when they visit a chiropractor (5)
The best-case scenario for back and neck pain, according to clinical research, is active care combined with passive care.(6)(7) Studies show the combination gives better subjective improvement on VAS and other pain and lifestyle instruments, as well as better objective improvement when measured by ability to accurately know when the head is accurately straight and level. Also,all passive care is not equal. Studies show manipulative therapy where the ligaments of the joint are stressed (as in an adjustment) demonstrate better outcomes than passive therapies stressing primarily muscles, without sufficient force and/or velocity to affect the joint function.
There are 3 subsystems of tissues affecting the neuromusculoskeletal system. The muscles (Contracting system), the Connecting tissues (ligaments, tendons, bones,and fascia) and the Control system (the brain and spinal cord, with all the myriad levels of proprioceptive and reflex interactions) all functionally choreograph every motion a person makes. On the passive therapy side, chiropractic adjustments affect the contracting, connecting and control subsystems of the neuromusculoskeletal system on a more fundamental level than any other therapy. The ideal active care therapy to affect all three systems, and complement a chiropractic practice, is a PostureBall.
Chiropractors by and large practice in small office settings. The PostureBall is a tool that forces the body to balance as you exercise on a labile surface. There is a much higher demand on the motor control system when exercising on a PostureBall, which changes both level of muscle activity and the way that the muscles co-activate to stabilize the body.(7)(8)(9) A protocol composed of a series of short interval encounters fits well into most chiropractic practices. This kind of exercise and posture awareness program is designed to promote symmetrical, coupled motion and improved balance, thereby reducing injury and improving an athlete’s form and performance. PostureBall rehab protocols allow chiropractors to work synergistically with other fitness professionals, who have learned that creating motion and posture consciousness helps improve a person’s form, and hence the effectiveness of any exercise program.
In my opinion, the combination of active and passive care, where passive care consists of therapies designed to maintain muscle function as well as joint motion, will ultimately prove to be the most clinically and cost effective way of initially treating, and then keeping people moving as they age. Just as cholesterol, blood pressure, and LDL/HDL ratios have become part of the national health conscious, many aging baby boomers will embrace the wisdom of keeping a body moving as it ages in order for the person to stay active as they age. Manipulation to restore and maintain balanced joint motion, coupled with muscle therapies and exercise to keep it all working can become the magic bullet for aging well. The irony of chiropractic may be that the most popular therapy of a late 19th century mono-causal philosophy of health may well become the vital link in 21st century wellness biomechanics for aging baby boomers.
This article is the next in a series on integrating Managed Care, insurance, and personal pay in a practice treating patients for AcuteCare, RehabCare and WellnessCare. If you agree with the Patient Choice philosophy of care, and believe this is the intelligent path for our profession, I’d like to hear from you. Direct your email to DrWeiniger@BodyZone.com
References:
- Linton, PhD, van Tulder, PhD. Preventive interventions for back and neck pain problems: what is the evidence? Spine 2001;26:778-87.
- Moffett JK, Torgerson D, Bell-Syer S, et al. Randomized controlled trial of exercise for low back pain: clinical outcomes, cost and preferences. British Medical Journal, July 31, 1999: Vol. 319, No. 7205, pp279-283.
- Deyo, MD, MPH. Diagnosis of LBP. Arch Intern Med 2002; 162(July 8):1444-1447.
- Wall Street Journal, Friday, August 22, 2003, page w1,4
- Håkan Sigrell, DC Expectations of Chiropractic Treatment, JMPT, 2002; 24:300-5
- Rogers R. The Effects Of Spinal Manipulation On Cervical Kinesthesia In Patients With Chronic Neck Pain: A Pilot Study. JMPT; 1997;20:80-85.
- Evans R, Bronfort G, et al. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 2002:27(21), pp. 2383-2389.
- Heiklilä H, Àström P-G. Cervicogenic Kinesthetic Sensibility In Patients With Whiplash Injury. Scan J Rehab Med; 1996;28:133-138
- Vera-Garcia, Performing curl-up exercises on labile surfaces increased abdominal muscle activity. Phys Ther 2000; 80(6): 564-9.