Exercise compliance – Insights from using Yoga DVDs at home to instill discipline and motivation in patients.

I leave the clinicians to work out what the best exercises are, my interest is improving compliance.  

Knowing exercises is one thing, doing them is another! 

For a few years I have had a growing feeling that I need to preserve joint mobility, particularly in my lower back!   So I have toyed with the idea of doing yoga (also for a few years!).

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At the end of the summer I bought a box set of yoga DVDs and over the last couple of months I have started to use the Yoga videos in the morning, at least twice a week.

They really help and now, I would probably be happy to join a class because I understand that “Cobra” is not a beer brand we have with a curry!

The point is, I did know what a sun salutation was but I never bothered doing them on my own.

With the DVD there is a framework and time structure.  From 30 minutes to 45 minutes.  ie it’s doable and someone is there with you.

Many patients leave a clinic with a set of written or verbal exercises to do. That is not going to work for most.  It DOESN’T work for most people!

I have written about exercise diaries, wall planners etc, my strong recommendation is to find a DVD that you like and sell it to patients for them to do at home (and record when they do it in their exercise diary!)

Then tell them to do the exercises at least 3 times a week or daily or whatever is appropriate.

The APPI do a video for back pain which I believe you can buy at trade prices
http://www.ausphysio.com/product.aspx?productid=344

but there are many others.

IDEA – Why not put on a “back class” at your clinic or elsewhere, get a local videographer to record it and then give that to patients as your own-branded DVD, give complimentary copies to GPs etc etc, then who’s the local daddy?!

If you do hear yourself saying to patients “do try to do your exercices” you know that most won’t bother. Try the DVD route, it can can only help and you will stand out from the masses.

Now time for some Cobras … I’ll do my yoga in the morning 😉

Author: Stephen Small, Director Steadfast Clinics

Steadfast Clinics is the international distributor of IDD Therapy spinal decompresion, SDS SPINA, Accu SPINA and Thermedic Infrared Therapy Systems. We’re on a pain relief mission !

Leominster Osteopaths, Four Years of IDD Therapy Spinal Decompression for Back Pain, Neck Pain and Sciatica

Leominster Osteopaths was the second clinic in the UK to provide IDD Therapy for their patients.

With some great results and an expanding practice, the clinic is attracting patients from far and wide to get relief from chronic disc-related problems.

[youtube=http://www.youtube.com/watch?v=MlnlgEI0jfQ]

Stephen Small and Mark Roughley

Stephen Small of Steadfast Clinics is pictured here with Leominster Osteopaths Clinic  Director Mark Roughley.

For more information about IDD Therapy treatment at Leominster Osteopaths, visit www.leominsterosteopaths.co.uk

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

Sarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

Physiotherapy Clinic Solihull – IDD Therapy back pain treatment at Broad Oaks Health Clinic

Broad Oaks health Clinic is the longest established physiotherapy clinic in Solihull, West Midlands, UK.

Having been aware of IDD Therapy and the SDS SPINA, clinic director Mark Webb upgraded his old traction unit to offer the advanced IDD Therapy spinal decompression programme. What a difference!

Before …

Traction Bed

After …

SDS SPINA IDD Therapy at Broad Oaks Health Clinic

Broad Oaks Health Clinic IDD Therapy

 

 

 

 

 

 

 

 

 

 

 

For more information about IDD Therapy, back pain treatment and physiotherapy in Solihull, contact Broad Oaks Health Clinic on 0121 705 3509 or visit www.broadoakshealthclinic.co.uk.

Spinal injections for back pain relief – Is there a disconnection from rehabilitation?

I recently gave a talk to a group of about 40 physiotherapists, osteopaths and chiropractors where I posed this question and asked for a show of hands.

There was universal agreement that there was a significant disconnect.

Looking at how to improve back pain treatment outcomes for both patients and over stretched healthcare budgets, there appears to be a significant opportunity to improve outcomes from spinal injections by making spinal rehabilitation an integral part of the post-injection treatment plan.

Patient pathways

There is a lot of debate about the merits of spinal injections.  The Cochrane Review (1) concludes “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain”.

Yet many clinicians report that patients do benefit which is backed up by the same Cochrane Review “it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.”

As with many back pain treatments, it is difficult to get a black and white answer since there are so many variables in play.

The typical pathway for a patient who develops chronic low back pain (or neck pain) looks something like this:

Self-prescribed pain medication
GP visit, pain medication and advice to remain active
GP visit
Manual therapy and exercise (physiotherapy)
GP visit
Consultant referral
Spinal injection
Consultant referral
Injection, possible surgery,
self-management (aka get on with it because we have no more options for you)

Self-pay patients typically bypass their GP and go straight to a physiotherapist, osteopath or chiropractor.  Private patients who are referred to a consultant often receive a spinal injection without first having a course of rehabilitation.

As a former member of the Society of Back Pain Research Committee said on stage at their annual meeting a few years ago, “I have a clinical intuition that they (spinal injections) are effective … and patients ask for them”.

Working with so many different clinicians, the problem appears to be that once a patient sees a consultant and is given an injection, many are simply sent home with little more than a recommendation to remain active, to do exercises and to possibly see a physiotherapist.

Given the costs of injections and clinical time, is this an efficient use of resources?

Manual therapists often dismiss injections because they do nothing to address the underlying condition believing them to be a band aid at best”.  Yet the purpose of the injection is not to cure the problem: it is to relieve pain to help the patient get on with their life.

If a patient can then be more active then the body has a chance to heal itself.

However, in the many cases where patients remain in pain it is perhaps in part because there is no proper rehabilitation.  Then the issue we have is what kind of rehabilitation will they get? 

If it is in the NHS, then the sort of rehabilitation a patient might access is exactly the same physiotherapy treatment which failed to address the problem in the first place.

Einstein’s definition of insanity is over quoted but to keep doing the same rehabilitation and expect a different outcome is surely insane … and an inefficient use of valuable resources.

Many spinal injections are given in the private sector.  One neurosurgeon I know sees approximately 1,500 patients a year.  He operates on 3% and gives an injection to around 20%, i.e. around 300 patients.

If a patient has an injection they leave hospital and then if they need follow up, they return to their consultant.  In some circumstances patients will receive a further injection.  If the injection hasn’t worked then the patient is more likely to become a candidate for surgery.

After all, conservative methods failed to resolve the problem.  Yet, I can’t help but feel that many of the spinal rehab programmes for patients who reach a stage of requiring (wanting) injections are simply not intensive enough.

Working with and talking to many clinicians, I often hear that if a patient is not better within four to six visits, then it’s time to look at other options.  It has become accepted dogma.

When IDD Therapy spinal decompression was originally developed, the clinicians who looked at back pain suggested in part that if they could work one on one with patients for eight hours a day, they would get much better results.

When people seriously embark on a diet to lose weight or train for a sporting event, they approach their goal with a level of commitment and intensity that is quite different to an approach to back pain rehabilitation.

Perhaps those involved in spinal rehabilitation should examine intensive programmes of spinal rehabilitation which are an agreed condition if a patient wishes to have an injection.

IDD Therapy spinal decompression programme offers such a programme for patients with disc related issues.  It is one method and undoubtedly not the only method.  A case study recently received from one provider detailed a 33 year old male office worker with a six month history of neck pain and headaches.

The patient received two injections during this time and felt no change.

He then embarked on a twice weekly course of cervical IDD Therapy.  After three weeks and six treatments, the headaches were gone and VAS pain was down to 1/10.  A further two weeks saw VAS pain at zero and no headaches.

That is a total of 10 treatments over a six week period.

All clinicians will have an opinion on the efficacy of injections.  The author believes that some people benefit from injections whilst for others there is no benefit, particularly without rehab.  However as with all back pain treatments, the difficulty is being able to predetermine who will benefit and who won’t!

There are significant costs to providing injections for back pain.  However as the British Pain Society point out, the unintended consequence of discontinuing pain interventions may be that more patients then access more costly interventions such as spinal surgery.

In the meantime, it would seem to make sense to reconnect spinal injections to a more intensive programme of spinal rehabilitation to help some patients return to a more active lifestyle.  If you have a comment, do share for others.

Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review.Spine (Phila Pa 1976). 2009 Jan 1;34(1):49-59.
http://www.ncbi.nlm.nih.gov/pubmed/19127161

Author: Stephen Small
Director Steadfast Clinics Ltd
http://www.SteadfastClinics.co.uk

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.

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