S-4-02-02
THE ROLE OF THERAPEUTIC EXERCISES IN PATIENTS WITH LOW-BACK PAIN
Osamu Shitado, M.D., Toshikazu Ito, R.P.T. (Hokkaido University, Sapporo, Japan)
Therapeutic exercise for patients with low-back pain includes trunk muscle strengthening, ROM, stretching, endurance, and work stimulation exercises. In order to strengthen trunk muscles, two of the most popular are "sit-up exercise" for abdominal muscles and "extension exercise" for back muscles. Although hyperextension of the lumbar spine should be avoided during both exercises, there are no recommended standards for cervical alignment while maintaining posterior pelvic tilt. Our electromyographic analysis showed that a maximum flexed neck with pelvic stabilization through muscle contraction seemed to be the most optimal posture for decreasing the lumbar lordosis and for activating trunk flexors and extensors most effectively. The patients with chronic low-back pain are involved in deconditioning syndrome. Stretching is also effective to treat low-back pain patients by decreasing fascial and muscular contracture which is produced in deconditioning syndrome. Our experiment revealed that the stretching preceded by heating such as hot-pack was useful to diminish chronic low-back pain. The data from our back school showed that good results were obtained in the patients who often performed exercises. It proved that therapeutic exercise is one of the most effective treatment modalities for the patients with chronic low-back pain.
5-4-02-03
Gary A. Okamoto, MD, MPH Rehabilitation Hospital of the Pacific, University of Hawaii, Honolulu, Hawaii, U.S.A.
RATING OF PERMANENT LUMBOSACRAL IMPAIRMENT IN THE CHRONIC PAIN PATIENT
Purpose: Provide rehabilitation physicians with a standardized way to rate the severity of physical impairment in patients disabled by chronic low back pain.
Method: The "Guides to the Evaluation of Permanent Impairment, Fourth Edition", organized and published by the American Medical Association, proposes two conceptual models of impairment that prescribe specific methdologies. Both models share a common measurable outcome quantified in percentages of whole person impairment. The Injury Model categorizes a patient's low back condition into one of eight unique Diagnosis-Related Estimates with fixed percent ratings. The Range of Motion Model integrates active range of motion, imaging data, and surgical results with variable rating percentages.
Results: Adopted by over 40 states in the U.S.A., the AMA "Guides" is applied to several illustrative low back cases at their maximum medical stability. Conclusion: Within their methodologic limits, the AMA "Guides" is useful in determining a patient's impairment as it reflects physical disability.
