DECREASING DISABILITY IN CHRONIC BACK PAIN THROUGH AGGRESSIVE SPINE REHABILITATION

This paper discusses specific techniques for rehabilitation of chronic low back pain through aggressive physical therapy with behavioral sup port. The rationale for approaching the outcome dimensions of impairme nts in back function and pain-related disability as opposed to chronic pain symptoms is explained. This approach requires that impairments i n back function are systematically identified through the quantificati on of trunk flexibility, straight leg raising, back extensor strength, lifting ability, and endurance. The described treatment approach focu ses on eliminating those impairments through aggressive, quota-based e xercise and is usually completed within 8 weeks. It requires only a mo dest amount of space and equipment. Useful behavioral techniques for e xtinguishing pain behaviors, lessening pain beliefs, and for promoting wellness are described. Results from a treatment program using these techniques demonstrate normal back function and reduced disability for a majority of treated persons. Applying such a program to the VA popu lation is an important challenge.