Professor of Orthopaedics UCSD, Medical Director Orthomed Center, San Diego
It is now recognized that chronicity of musculoskeletal pain is associated with inhibited motor function and a phenomenon called „deconditioning“. Under these conditions reoccurrence of pain inducing episodes with the usual life event of the „unguarded moment“ can be expected. Significant sudden changes in physical demands, either increased or decreased, are often associated with this phenomenon.
Physical therapy in the form of manual therapy and surface supplied modalities to decrease pain, often offer short-term relief. There is no documentation, however, that these forms of treatment to change the natural course of disease and recurrence. There is no consensus even as to the most effective pain diminishing physical therapy modality. One reason for the lack of consensus is our inability to measure the dose of the therapeutic modality, and objectively measure the results of treatment. On the other hand, resistance training is measurable and the results of training, aside from the subjective statement of diminished pain, are likewise measurable by strength and endurance testing. The use of equipment, however, is necessary to achieve measurement.
In our own studies, recurrence of pain complaint after completion of a strength training program on chronic back pain patients, all which had failed previous physical therapy, was 10 %. This is at 1-year follow-up. Other studies using more passive therapies quote recurrence rates of up to 50%.
The future of this form of treatment, Le. physical training, depends upon transfer of care responsibility to the patient away from the „healer“. This is not easy to accomplish and the duration of training necessary to have the desired insurance. The feasible solution for this dilemma is the medicalization of health clubs. In this environment, musculoskeletal disorders are treated as ailments not diseases, and physical therapy becomes physical training supervised by qualified staff who are comfortable with treatment of musculoskeletal disorders ideally such facilities would have the back up of appropriate medical professionals. Nonetheless, the treatment theme will have to be the pleasure of self-care in a supportive environment of training. A key component of training must be however, feedback of measured performance which requires appropriately designed equipment.