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Medical Strengthening Therapy for Treatment of Back Pain

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Manual of Spine Surgery

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Abstract

Recent studies have suggested that chronic back and neck pain are associated with a deconditioning process of the deep paraspinal muscles including local changes such as atrophy and local fat infiltration. Studies on exercise therapies that specifically strengthen these muscles have provided promising results for avoiding and decreasing back and neck pain. One particularly promising tool is an exercise machine (e.g. Powerspine Back/Neck, MedX LE/CE) that allows isolated lumbar/cervical extension resistance exercise (ILEX/ICEX) with restraint systems that minimizes the activity of other superficial muscle groups causing maximal fatigue in the local paraspinal extensor muscles. The training protocol is characterized by dynamic extension movements with low frequencies (one set, once/twice per week), high intensities causing momentary muscular failure, and a pathology-specific range of motion that is adjusted to symptoms and pain sentiment. Before and after the therapy program, an isometric extension strength test is commonly performed to measure strength levels and to monitor the results of the treatment. Experience from multiple orthopaedic facilities shows that the majority of chronic patients can recover from their pain symptoms by this noninvasive method. The clinical outcome, is influenced by the severity of spine degeneration and psychosocial factors. In a clinical setting with patients suffering from severe spinal disorders, it is essential that the protocol (including range of motion during exercise) is customized to the patients’ pathology in order to enable high intensities but also to ensure safety for the patient. In conclusion, ILEX and ICEX exercise training is an excellent conservative treatment approach for different pain conditions in the back and neck and can clinically be used for rehabilitation but also as preventive and postoperative method.

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Acknowledgment

The authors would like to thank radiologist Dr. Heiko Braun for providing MRI images.

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Authors and Affiliations

  1. Orthopaedic Spine Center Dr. Alfen, Würzburg, Germany

    Christoph Spang, Bruno Domokos & Florian Maria Alfen

  2. Institute of Sports Sciene, University of Würzburg, Würzburg, Germany

    Bruno Domokos

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  1. Christoph Spang
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  2. Bruno Domokos
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  3. Florian Maria Alfen
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Correspondence to Christoph Spang .

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Editors and Affiliations

  1. Surgical and Conservative Spine Therapy, Hospital Rummelsberg, Schwarzenbruck, Germany

    Uwe Vieweg

  2. Metropol Medical Center, Center for Orthopaedics, Neurosurgery and Traumatology, Nuremberg, Germany

    Frank Grochulla

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Spang, C., Domokos, B., Alfen, F.M. (2023). Medical Strengthening Therapy for Treatment of Back Pain. In: Vieweg, U., Grochulla, F. (eds) Manual of Spine Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-64062-3_16

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  • DOI: https://doi.org/10.1007/978-3-662-64062-3_16

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