SPINAL REHABILITATION
The purpose of Parry Pilates and spinal rehabilitation is to prescribe effective therapeutic manual therapy and exercise. This is indicated for individuals who have developed physical deconditioning of their muscular and other soft tissue systems. This may have arisen from a specific injury; from functional loss associated with degenerative processes; from disuse; fear avoidance behavior; or pain inhibition.
Several key concepts are fundamental to this therapeutic approach. Muscle weakness or, more specifically, decreased endurance or motor control around a specific joint axis, is an essential feature of chronic musculoskeletal pain (MP). Chronic MP is basically a motor control problem and cannot be clearly identified by diagnostic studies. In some cases, pathoanatomy is well correlated with a clinical symptom complex and orthopedic or neurologic testing. While surgery is sometimes appropriate in such cases, the majority of the time soft tissue or MP does not require surgery. Nonetheless, the locomotor system is not functioning appropriately and perpetuation of MP and repetitive strain naturally ensue. Thus, a rehabilitation program aimed at improving motor control-muscular endurance/coordination of joint stabilizers is justified.
A trained spinal rehabilitation specialist should know how to improve muscular endurance, coordination, balance, strength and flexibility through therapeutic exercise with simple techniques requiring minimal expense in equipment or space. They can coach patients and know when to refer to other rehabilitation specialists for more intensive training, multidisciplinary rehabilitation, or work hardening programs. As muscle and joint function improves pain is expected to diminish. If this does not occur, the patient requires re-evaluation to rule out "red flags" of serious disease, relevant pathoanatomy or "yellow flags" of abnormal illness behavior.
Certain spinal adjustments can achieve short-term relief of pain, but they cannot sufficiently influence the muscle system to improve motor control in chronic cases. For instance, atrophy of the multifidus has been found to occur in acute low back pain patients exactly where joint mobility restrictions and pain are found.
Relief of pain does not restore muscle mass to the multifidus: only a carefully executed spinal stabilization routine can achieve that. Patients can be motivated to participate in spinal rehabilitation programs by their desire to both improve function and relieve pain. This motivation will enable them to learn to tolerate some pain during the rehab process and learn to distinguish between hurt and harm. The rehabilitation program is successful because it follows modern physiological principles of tissue repair, endurance training, muscular hypertrophy and neural control.
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