26. Composite exercise programmes
• Combine the benefits of all above
• Grade them sequentially
– Start with strength, endurance, stabilisation
and ROM
– Upgrade to proprioception
– Relaxation last
• Ensure that exercise programme is
continued
27. Which is ideal?
– Structured therapeutic exercise
– Playing basket ball
28. Rational of exercise therapy
GASS
• Generalized well being and weight reduction
removes illness behaviour
• Aerobic activity increases circulation and
psychological well being
• Stretching of muscle and ligaments so that they can
stretch with less pain
• Strengthening the guy ropes and cantilevers so that
they can bear more load
Am. Academy Neuro Surgeons
29. Examples
• ACL reconstruction-Goals
– Improve range of movement
– Strengthen the dynamic stabilisers of the
knee
– Improve proprioception of the reconstructed
and natural ligaments
Priority=Stabilization
30. ACL reconstruction
• ROM: active and passive/ assisted
stretching
• Strengthening: increasing weights-Quads,
Hams, Gastroc
• Proprioceptive: wobble board, Swedish
ball, inclined plane, beech games
31. Total shoulder replacement
• ROM: active and passive/ assisted
stretching
• Strengthening: increasing weights-Deltoid,
Spinatii, Subscap, Lats, Pecs, Trapezius
• Endurance: increasing cycles for above
• Proprioceptive: classical dancing
• Priority=Stabilization: limiting TROM
32. Designing an exercise regime
Time
Intensity
aerobic
strength
endurance
proprioception
33. • What is the rationale for doing exercises
for IVDP?
34. • Do you recommend Flexion or extension
exercises for IVDP?
41. Prescribing exercises for low back
pain
• Depends on pain pattern
– Fatigue endurance
– Mechanical pain stabilisation
– TROM pain and stiffness stretching
• Depends on Pathology
– Spondylolisthesis no extension
– IVDP sciatic stretch
42. Goals of exercise therapy in LBP
• Increase stable zone
• Improve mobility
• Improve strength
• Improve endurance (effort tolerance)
• Increase proprioception (prevent injury)
• Empower the patient to help himself
• Prevent deconditioning
43. Exercise therapy do’s and don’t’s
• Avoid bending
• Avoid lifting
• Sleep on hard bed
• Avoid pillow
• Avoid 2 wheelers
44. Can back pain patients bend?
References
• Mercer
• Turek
• Campbell
• Apley
• Bridwell et al
• White et al
• Frymoyer
• Aebi et al
• S Rengachary
• Youman
• Benzel E
• McCullough
• Harrison
• Price
• Davidson
51. Exercise in low back pain
• Should be tailored to the type of pain
pattern
• And the pathology
• Eg:
– Effort intolerance type of pain
– Spondylolisthesis
53. Extensor strengthening without
extension
• Example: extension of the spine causes
impingement of the facets- spondylolysis
• Yet extensor strengthening is important for
spondylolisthesis
• How to achieve this?
• Diagonal lifts; Dying bug exercises
55. Postural back pain
Bad posture causing back pain is best
treated by postural corrective devices (car
seat back rest)
Yes
No
56. Postural LBP
• Of the chronic 80% are P.LBP
• Does not mean bad posture
• Means bad postural muscles
• Reflects urban life style and stressful
living
60. Postural LBP
the person
• Young adult (male> female)
• Obese/ asthenic
• Sedentary employment
• Stressful life style
• Lack of physical activity
• 2 wheeler travel
61. Postural LBP
Pain pattern
• Dull aching
• Increased by sitting/ standingIncreased by sitting/ standing
• Decreased by walking
• Not aggravated by bending/ squatting
• Bilateral para-spinal pain
• No Radiculopathy
• Normal or non-contributary
investigations
