When your back goes out, do you head for the couch? Maybe you’d be better off heading for the gym. Although doctors once advised people with back pain to take it easy, guidelines now make it clear that most people recover from back pain sooner if they stay active. A day or two of rest may be okay in the early stages of acute back pain, but longer periods of inactivity just lead to physical de-conditioning of the muscles, tendons, and ligaments and more prolonged pain. A pioneering approach called aggressive spinal rehabilitation makes the case that the solution to this problem is not a little exercise—but a lot. Proponents of these “back boot camps” say that a month or two of really intense physical activity can actually restore normal function even to individuals who have suffered from chronic and debilitating back pain for years.
The Spine Center at New England Baptist Hospital in Boston was among the first hospital-based aggressive rehab clinics for back pain now scattered across the country. Its director, James Rainville, MD, a doctor of physical medicine and rehabilitation (physiatrist) and assistant clinical professor at Harvard Medical School, is a firm believer that the old medical advice to “let pain be your guide” with regard to exercise is dead wrong. In fact, the mantra at Dr. Rainville’s clinic is, “Hurt doesn’t necessarily cause harm.” The focus at his clinic is on improving physical ability, not on preventing pain. New patients are told that exercise will hurt at first as weakened muscles and connective tissue struggle with the new physical demands on them. But they are also told to work through any pain, much as an injured athlete would. “We really don’t back down on that,” insists Dr. Rainville. In the 15 years since the clinic opened, thousands of people with back pain have learned that if they push through their initial pain instead of quitting, they will eventually raise their pain thresholds and become strong and flexible enough to lead normal lives once again.
How it works.
The Spine Center’s six-week program of twice-a-week, hour-and-a-half workouts is supervised by specially trained physical therapists. It incorporates all three major forms of exercise—aerobic, stretching, and strength training on Nautilus-style machines—as well as simulations of real-world activities such as lifting heavy grocery bags or kids. Patients’ physical abilities are assessed at entry, then their exercise programs are based on meeting slowly rising, clearly achievable “quotas” of exercise duration or intensity. Participants spend the first week or two focusing on exercise form and technique, and the following weeks pushing to become as strong as they can. They are then given a maintenance program to follow at home.
As patients meet their goals and see evidence they’re becoming stronger and more flexible, their attitudes change from “I won’t be able to do this with my fragile back” to “I can do this—and more.” Although some aggressive rehab programs have a specific cognitive-behavioral therapy component, the psychological element to the program at The Spine Center is not as obvious. “Exercise to some extent is just the tool that helps patients overcome their fears and allows them to see that they can safely live a normal life again,” suggests Dr. Rainville.
No matter what their initial diagnosis—spinal stenosis, spondylolisthesis, herniated disc, or even failed-back-surgery syndrome—all patients go through the same basic program, and most of them become stronger, more flexible, and more active with less pain. In fact, Dr. Rainville reports that normal function is restored in 70 percent of the approximately 2,000 people who go through this rehabilitation each year, and studies at other clinics that offer a similiar aggressive rehab approach have shown similar success rates.
I am impressed that clinics such as The Spine Center help people with back pain concentrate on becoming stronger, fitter, and more self-reliant rather than depending on medical procedures and drugs that just address their pain. I think the most important lessons to be learned from aggressive rehabilitation are not to let pain or the fear of it stop you from living a normal life and to be prepared to work very hard to achieve your goal. Studies have found that over time an intense exercise program can actually normalize an oversensitive pain response. To get these results, however, you have to work to the outer limit of your abilities. If there isn’t an aggressive rehab program near you, it might be a good idea to find a professional such as a physical therapist at a sports medicine clinic or a certified fitness trainer who can help you set and meet your exercise goals safely and keep you from quitting too soon.
Restoring your back will require motivation, time, and hard work—and okay, maybe a little pain. And this approach involves being actively committed to regaining normal function and taking responsibility for your recovery. But aren’t a few hours of discomfort worth it to be able to run, or work, or pick up your grand kids again?