top of page

Science Behind RehabZone

By Craig Morton, MD

Low back pain is an epidemic of staggering proportions. The lifetime prevalence of low back pain has been estimated at 84%. 2.  According to a recent Johns Hopkins health alert, after the common cold, back pain is the problem that most frequently brings people to a doctor’s office. 1. It’s one of the most common reasons people miss work, and the most common cause of job related disability. 7-8. Low Back pain is also the most common indication for physical therapy and the most frequent reason for seeking care from a chiropractor. 3, 4-6. While there are genetic and environmental factors that can predispose one to low back pain, the epidemic of obesity, inactivity, and lack of awareness on the benefits of exercise appear to have huge implications on the odds of developing back pain and other disease processes. Studies dating back to the l 970’s have eloquently documented the degenerative process of the spinal structures, and it is now clear this process is directly impacted by the integrity of the spinal stabilizing muscles. Spinal movement is both a static and dynamic process requiring optimal function of the primary and secondary stabilizing muscles. Evidence has shown that in patients with low back pain, the stabilizing system is often very dysfunctional. 10

There is a large body of literature and studies looking at fitness and it’s impact on disease pro­cesses, and more specifically low back pain. In a recent review of the top 10 clinical practice guidelines for low back pain, which included the American College of Physicians and American Pain Society, the use of judicious back exercises was indicated for chronic low back pain.9, 11 A Cochrane review of 61 ran­domized controlled trials, showed that exercise therapy was found to be effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in popula­tions visiting a healthcare provider. 12 Another Cochrane review of 13 articles covering over 1520 patients found moderate quality evidence that post-treatment exercises were more effec­tive than no intervention for reducing the rate and number of recurrences of low back pain at one year. 14 A more recent review of 3 7 RC T’s that investigated the effectiveness of exercise therapy on adult nonspecific chronic low back pain drew similar conclusions, with a benefit also incurred by individuals with chronic low back pain. 13

“Evidence has shown that in patients with low back pain, the stabilizing system is often very dysfunctional.”

Proper education and resources have often been lacking in the healthcare and wellness setting making it difficult to guide and motivate patients on the benefits of exercise. In 2007 the Exercise is Medicine initiative was launched by the American College of Sports Medicine and American Medical Association with a vision to make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States. This initiative is committed to the belief that exercise and physical activity are inte­gral in the prevention and treatment of diseases, and should be assessed as part of medical care and integrated into every primary care office visit. They encourage physicians to include exercise when designing treatment plans for patients. The benefits of exercise have been shown to directly impact muscle mass, strength, posture, and endurance. 15, 16,17 , 18 Exercise programs recom­mended to improve health, function, and perfor­mance should include components of strength, flexibility, and stability in an integrated fashion.19

“Lack of awareness on the benefits of exercise appear to have huge implications on the odds of developing back pain and other disease processes.”

“RehabZone was built around the principles and exercises prescribed by healthcare and wellness professionals”

Unfortunately there are many barriers to initi­ating an exercise program for patients. Often lack of finances and time limit a patient’s abil­ity to attend multiple therapy visits or start a gym membership. Patients who are able to complete a therapy program are often given a sheet of paper with exercises to follow, but usu­ally don’t follow through due to lack of motiva­tion or guidance. All too often we are seeing patients once a problem or disease process has started. We treat the symptom, pain, or conse­quence of these conditions; yet don’t provide direction and resources for a long-term mainte­nance and prevention program. The Exercise is Medicine initiative challenges us to take action in providing our patients and clients with guidance on a proper exercise pro­grams to help improve flexibility, stability, and strength, thereby building the foundation for long term fitness and overall wellness. A recent Johns Hopkins health alert suggests that after the acute and recovery phase for low back pain rehabilitation, a third phase or “maintenance phase” should be initiated with two goals: edu­cating the individual on ways to prevent further injury and strain to the back, and helping the individual maintain an appropriate level of physical fitness to help further increase strength and endurance. 20 The time we invest in this part of patient care will provide the best chanc­es to reduce musculoskeletal pain and reverse or prevent chronic disease processes.

Most exercise programs seen on infomercials are not physician endorsed and can quickly lead to pain, which causes the client to quit the program. Walking, jogging, and riding a bike are good for cardiovascular fitness, but are not adequate enough to increase lean muscle mass, which ultimately makes the human body more resilient, less suscep­tible to injury, and more effective at burning calo­ries. RehabZone was built around the principles and exercises prescribed by healthcare and wellness professionals to strengthen the core and address the three major components of a health related physi­cal fitness program: flexibility, stability, and strength. The workouts are designed to break down barriers and introduce a progressive home exercise program that is fun, easy to follow, and can be done from the comfort of one’s home. The workouts are very basic and build slowly over time so they can be completed with ease, which provides a sense of accomplishment and builds motivation. This ultimately leads to consistency and dedication to a lifelong core exercise program.

1. Johns Hopkins Health Alert. Signs and Symptoms of Low Back Pain. January 11, 2013
2. Balague F., Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 20 l 2:379(9814):482-9 l
3. ChevanJ, Riddle DL. Factors associated with care seeking from physicians, physical therapists, or chiropractors by persons with spinal pain: a population-based study.] Orthop Sports Phys Ther. 2011:41(7):467-76
4. Bekkering GE, Emgers AJ, et al. Development of an implementation strategy for physiotherapy guidelines on low back pain. AusJ Physiother. 2003;49(3):208-14
5. Hurwitz E, Coulter I, Adams A, Genovese B, Shekelle P. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am] Public Health. l 998;88(5):771-776
6. NyiendoJ, Haldeman S. A prospective study of 2,000 patients attending a chiropractic college teaching clinic. Med Care. 1987 :25(6):516-527.
7. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2005). Handout on health: Back pain
[on-line]. Retrieved April 22, 2009. From http:/ / Info/Back_Pain/default.asp.
8. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2006). What is back pain? Fast facts: An easy-to-read series of publications for the public [on-line]. Retrieved April 22, 2009. From http:/ /
9. Chou R, Qaseem A, et al. Diagnosis and Treatment of Low Back Pain: A joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491
10. Barr KP, Griggs M, Cadby T: Lumbar stabilization: Core concepts and current literature, part 1. AmJ Phys Med Rehabil 2005;84:4 73-480.
11. Dagenais S, Tricco A, et al. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. The Spine Journal 10 (2010) 514-529.
12. Hayden], van Tulder MW, Malmivaara A, Koes BW Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005;(3):CDC000335
13. Van Middelkoop, Rubinstein SM, Verhagen AP, Ostwleo RW, Loes BW, van Tulder MW Exercise therapy for chronic non­specific low back pain. Best Pract Res Clin Rheumatol 20 l 0;24: 193-204.
14. Choi BKL, VerbeekJH, Tam WWS,JiangJY Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 1.
15. HidesJA, Richardson CA,Jull GA: Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 1996;2 l :2763-9
16. HidesJA,Jull GA, Richardson CA: Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 200 l ;26:E243-8
17. Scannell JP, McGill SM: Lumbar posture: Should it, and can it, be modified? A study of passive tissue stiffness and lumbar position during activites of daily living. Phys Ther 2003;83:907-17
18. Vincent HK, Vincent KR, Seay AN, Conrad BP, Hurley RW, George SZ. Back Strength Predicts Walking Improvement in Obese Older Adults With Chronic Low Back Pain. PM&R 2014; Vol 6: 418-426.
19. Micheo W, Baerga L, Miranda G. Basic Principles Regarding Strength, Flexibility, and Stability Exercises. PM R 20 l 2;4:805-811.

bottom of page