Back pain is the No. 1 medical problem in Australia (1) and up to 70% of sufferers continue to have pain 12-months after injury (2). Advance Healthcare has over 20 years clinical and research experience in developing innovative and effective treatment for back pain. We pioneered the recently published Specific Treatment of Problems of the Spine (STOPS Back Pain) approach that accurately diagnoses the cause of back pain and provides tailored treatment (3-7).
However understanding your back pain problem requires a multi-factorial approach. Your Advance Healthcare physiotherapist will use a range of assessment methods to get to the bottom of your pain.
1. REAL TIME ULTRASOUND
Everyone has heard about “the core” muscles of the back (transversus abdominis and lumbar multifidus). We know that identifying and retraining poor control of these muscles protects injured structures and prevents re-injury (8).
Real time ultrasound is the most effective method (when combined with an expert physiotherapist’s instruction) of getting the core activated. For many people this is the first step on the path to recovery
ViMove is a revolutionary device with wearable sensors to identify movement patterns in the lower back. This technology removes the guesswork from clinical assessment allowing us to better understand the factors contributing to your pain.
We use ViMove to assess movement patterns in the clinic and also posture/movement patterns at home. The device is also invaluable for retraining movement with the powerful visual feedback provided to patients as they exercise.
Some example ViMove reports are provided below.
This example ViMove report shows the percentage of time spent sitting and standing. Patients can take the ViMove home for 24 hours to get a full analysis of their movement and postural patterns. Additional reports reveal the amount of time in non-optimal posture (eg slouched sitting) and the amount of side bending/rotation done. These data greatly assist your expert physiotherapist in identifying movement and postural issues that may be preventing recovery.
The figure above is what a patient sees when trying to retrain normal movement (in this case pelvic tilt - an important movement that is often restricted in back pain). Using the ViMove the patient can see their target range for movement and get real time feedback as they try to hit this goal. The ViMove keeps track of all your exercise sessions so you can see visually and with data how far you have improved!
3. SURFACE ELECTROMYOGRAPHY (EMG)
Exciting new research from our STOPS Back Pain group has shown that some patients with back pain have overactive muscles the alter movement patterns, cause pain and prevent recovery.
Through surface EMG recordings we can identify and retrain these muscles. In combination with real time ultrasound and ViMove we’ve got the ultimate treatment program to restore normal movement and control resulting in reduced pain and increased performance!
4. EXPERT CLINICAL ASSESSMENT
The results of high-tech based assessment are only of value when interpreted through the eyes of an expert physiotherapist (9, 10). At Advance Healthcare the practitioners providing our Expert Back Care service are all PhD graduates or candidates and as part of the STOPS Back Pain research team are well equipped to provide outstanding service.
An expert assessment will:
- Diagnose the injury be it discogenic, facet joint, sacroiliac joint or related to nerve compression (3-6)
- Liaise and/or triage your case within our team if further input is required (eg organise an assessment with our medical specialists to discuss medication and/or surgical options)
- Use clinical and high-tech based assessment tp devise a prioritised list of barriers to recovery
- Explain and implement a comprehensive plan providing a long term solution to your back pain problem
WHAT TO EXPECT AT ASSESSMENT (1-2 sessions)
Simply ring or email the clinic requesting an Expert Back Care assessment; no referral is required.
Before the assessment you will receive detailed instructions regarding completion of a series of questionnaires. It is essential that you bring the completed questionnaires as well as all scans/medical reports to your assessment.
Your expert physiotherapist will spend a minimum of 1 hour completing a clinical and technology based assessment. For complex cases up to 2 hours will be required.
Following assessment you will receive a full explanation of the diagnosis, barriers to recovery and treatment plan. You and your GP will also receive a comprehensive written report.
WHAT TO EXPECT WITH TREATMENT
No two treatment programs are alike, however for people with chronic (or persistent) back pain there are typically 3 phases.
1. Education and treating specific barriers to recovery (2-4 sessions)
Knowledge is power and our expert physiotherapists will engage you in understanding your problem and the appropriate treatment program.
Common barriers to recovery and specific treatments (different for every patient) include:
- Manual (hands-on) treatment to improve joint mobility and reduce pain
- Medication and self management strategies to reduce pain and inflammation
- Direction specific exercise to help “reduce” discogenic pain from a bulge
- A variety of different exercises to address the issues identified in our high-tech assessment
- Learning how to “pace” and keep active without aggravation of symptoms
This phase is also used to identify patient goals that focus your expert physiotherapist on getting you to where you want to be.
2. Rehabilitation (3-6 sessions)
Most people with persistent back pain need a program to slowly build up core control, strength, flexibility and confidence to return to the activities in life they love. Your Advance Healthcare expert physiotherapist will develop a rehabilitation plan based on your current activity and where you want to be (your goals).
Over a 2-3 month period you will work in partnership with our expert physiotherapist to problem solve issues, progress an exercise program, have ongoing hands-on treatment (if required) and increase overall activity.
3. Independence (1-3 sessions)
Phase 3 commences when you are well on your way to recovery and consists of a few sessions to ensure you stay on track to achieving your goals without any flare ups. Patients in this stage are loving life with reduced pain and increased confidence to move but sometimes need guidance to not overdo things and continue the path of rehabilitation.
WHAT DOES IT COST?
The cost of expert physiotherapy services varies between $150-250 per hour depending on the level of experience of your practitioner. All practitioners are PhD graduates or candidates who have worked within our group and the STOPS Back Pain research team for at least 10 years.
1. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–223.
2. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 2013; 17(1): 5-15.
3. Ford JJ, Hahne AJ, Chan AYP, Surkitt LD. A classification and treatment protocol for low back disorders. Part 3: functional restoration for intervertebral disc related disorders. Phys Ther Rev 2012; 17(1): 55-75.
4. Ford JJ, Richards MJ, Hahne AJ. A classification and treatment protocol for low back disorders. Part 4: functional restoration for low back disorders associated with multifactorial persistent pain. Phys Ther Rev 2012; 17(5): 322-34.
5. Ford JJ, Surkitt LD, Hahne AJ. A classification and treatment protocol for low back disorders. Part 2: directional preference management for reducible discogenic pain. Phys Ther Rev 2011; 16(6): 423-37.
6. Ford JJ, Thompson SL, Hahne AJ. A classification and treatment protocol for low back disorders. Part 1: specific manual therapy. Phys Ther Rev 2011; 16(3): 168-77.
7. Hahne AJ, Ford JJ, Surkitt LD, et al. Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders. BMC Musculoskelet Disord 2011; 12: 104.
8. Bystrom MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976) 2013; 38(6): E350-8.
9. Ford JJ, Hahne AJ. Pathoanatomy and classification of low back disorders. Manual Therapy 2013; 18(2): 165-8.
10. Ford JJ, Hahne AJ. Complexity in the physiotherapy management of low back disorders: clinical and research implications. Manual Therapy 2013; 18: 438–42.