REHABILITATION PROGRAM SUMMARY
A thoughtful rehabilitation program for mobilizing people with severe back pain entails a number of components: reducing painful activity by activity modification; corset use; temporary use of anti-inflammatory medication; core exercises; and a good walking program. All of these actions are complementary, taking this severely debilitating injury and rehabilitating it in as short a time as possible. Frequently, a severe disk injury with sciatica will take a full three months to get better - one month just to eliminate the sciatica and two months to restore people to full function without their brace and without medication. The rehab program must be painless once people are mobilized. That is why we tend to keep people off any pain medication, including NSAID, during the day as this will mask pain and prevent total healing. Because of work requirements, sports and travel, it is frequently necessary to advance past walking and core home exercises to restore one’s strength to normal. Advanced procedures including the use of MedX equipment are regularly used for advanced strength training.
Because walking is an activity which has the lowest intradiskal pressure next to lying down, it is frequently the activity which can be started before prolonged standing, even when short-term sitting and standing are painful. With the corset on, intradiscal pressure is significantly reduced in the upright position when we are walking so that not only do you get all the benefits of walking including cardiovascular muscular strength and emotional benefits but you also get the benefits of keeping intradiscal pressure low while the patient is in the early phases of healing. A walking program must only be pursued with a good pair of walking shoes and, frequently, arch supports to make both the standing and walking more comfortable. Walking every day early on in divided segments of 5 to 10 minutes but as soon as possible getting to a 30-minute walk without the benefit of NSAIDs is a first goal, hopefully obtained between the first two and four weeks. Progressive walking, up to 60 minutes, one to two times a week and 30 minutes on other days followed by core exercises, is the ideal way to build one’s strength so they may return to daily life and work.
More Corsets-Less Opioids Pain Management
Treatment of Low Back Pain:
10 Options excluding gabapentin and hydrocodone
Principles 1. Pain leads to muscle weakness and stiffness
2. A patient cannot rehabilitate while in pain
3. Always protect the nerves
1) Modified Rest:
Avoid prolonged standing & sitting
Avoid carrying heavy boxes, bags & children
If sitting is required, then elevate chair and use cushion or stool
2) Ice pack for pain relief
Heat OK in shower or spa
NO HEATING PADS at night
3) Corset with stays worn 95% of up time:
Fit tight with firm back
Early in treatment put corset on while lying down to maximally reduce intradiscal pressure
4) Good shoes & arch supports for walking & standing
5) Begin Daily Walking program 10-30 min, 1-3x per day when comfortable
6) Stretching: 3-4x per day.
7) Core strengthening: 2x per day.
8) Ibuprofen 600-800 or naproxen 440-660 qhs.
9) Prednisone burst: 4-5 days
50mg, 40mg, 40mg, 30mg, 30mg average male dose.
40mg, 40mg, 30mg, 30mg average female dose.
10) Physical Therapy- Modalities: elec stim/ultrasound, Manual Therapy
ADVANCED REHABILITATION TECHNIQUES
Frequently in order to return one’s strength to normal even after a vigorous walking program building up to 60 minutes and daily core exercises, more strength training is needed. This strength training could be begun by a number of choices including:
1) Slow resistive exercises 2-3x week, emphasizing lat pull-down, seated row and leg press;
2) Pilates training on a Reformer 2-3x per week
3) Light free weights two to three times per week
4) For specific gym rehabilitation, seek a gym that has MedX lumbar rehabilitation equipment which has helped countless low back sufferers. This equipment, designed by the owner of Nautilus and rehab specialists, is made specifically for rehabilitating degenerative low back injuries.