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Exercise therapy vs. manual therapy for chronic low back pain (LBP).

Exercise therapy vs. manual therapy for chronic low back pain (LBP).

About 70% of the population in the western world will experience low back pain (LBP) at some stage in life. There are three stages, acute, sub-acute and chronic low back pain.

The effect of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and spinal range of movement have been investigated in a number of studies. The results are, however, conflicting and we therefore have compared the outcomes of several randomized controlled trials1 to compare the effect of manual therapy to exercise therapy in patients with chronic low back pain.


Two treatments, exercise therapy and manual therapy.


Four common outcome measures for each treatment:

- Spinal range of motion
- Pain perception
- Function
- General Health


All studies showed significant improvement on all four outcome measures in both approaches. However:

- The exercise therapy approach resulted in significantly greater improvements than manual therapy on function and general health in chronic lower back pain.

- In chronic lower back pain the manual therapy approach shows significantly greater improvements than exercise therapy on spinal range of motion.

- Both groups showed equal significant improvement on pain levels but no significant difference between manual therapy and exercise therapy.

Due to a favourable prognosis in the acute stages, 80% to 90% of the patients will improve considerably within 6 to 8 weeks. The prognosis for chronic LBP is considerably less favourable causing potentially long-lasting suffering to the patient and significant socioeconomic costs.

Significant improvements in pain, general health, and functional disability were observed in both groups from before to after treatment.

A number of different conservative treatment methods have been studied, but controversy remains as to the preferred treatment. It has been proclaimed that various national guidelines for treatment in primary care are fairly consistent, but discrepancies were emphasized with regard to exercise and spinal manipulation. Several recent reviews claim also claim a strong evidence of effectiveness for exercise therapy in chronic LBP and moderate evidence of ineffectiveness in acute LBP. There is some evidence for a dose-response effect of exercises for chronic low back pain, although the effect was dependent on regular and continuous exercise activity.

Another recent study of LBP patients found no significant difference between graded medical exercise therapy and conventional physiotherapy with lesser intense exercise regime in acute or sub-acute lower back pain. In a recently published report by the International Paris Task Force on Back Pain, it was concluded that “there is sufficient scientific evidence to recommend that patients who have chronic low back pain perform physical, therapeutic, or recreational exercises”, however we have found that some specific active techniques or methods have proven superior to other.

Most studies of manipulation in LBP focus on patients in the acute or sub-acute stages. Review studies presented over the past 13 years of randomized controlled trials conclude that the effect of spinal manipulation is promising but the results still inconsistent.

1.               Van Tulder et al., Anderson et al., Abenhaim et, al. Coste et al.

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Athletics

HIT Pilates (Part II)

Healthy HIT Pilates, ‘Hits’ The Mediterranean Coast

By: Sam Mednick

Editor’s Note: This Is Part Two of a Two Part Interview. Part One can be found at http://www.active-8.es/ejercicio-fisico-y-perdida-de-peso/hit-pilates/

Australian native, Shay O’malley has brought a unique and revolutionary workout to Barcelona. The forty-one year old Physiotherapist, Pilates instructor, Acupuncturist (and a host of other qualifications) has now become Spain’s first and only certified Healthy HIT Pilates Trainer. We had the privilege of sitting down one-on-one with the Aussie to get her take on this innovative new exercise program and its incredible benefits.

Quick HIT Explanation: Healthy HIT Pilates was created by Glenn Withers, a Physiotherapist and one of the co-founders of the Australian Physiotherapy and Pilates Institute (APPI). This new workout regime is a combination of High Intensity Training (HIT) and traditional mat work Pilates movements. The class is approximately 45 minutes in length with 20 minutes of high intensity workout, which is a mix of 30-second cardiovascular bursts and a 30-second Pilates recovery moves.

 

Q: Is there a specific sport or reason where you’d recommend using HIT Pilates as the training method?

A: It’s great for sports with a lot of starting and stopping. For example: Football, Basketball, Skiing or anything that requires a level of endurance and power. The main thing though is to mix it up and try not to do the same thing every day. The body accommodates very quickly to the same sort of exercise, even with Healthy HIT Pilates you have to keep changing things up; like the spice of life, keep it fresh and different and keep introducing new things.

Q: What’s your favourite exercise within the work out and why?

A: I quite like the Burpee Reverse Lunge believe it or not and the Squat Cross Feet (squats, lunge, lunge squat). I like the plyometrics and I like the speed of those.

Q: What’s the most challenging exercise for you?

A: Squat Catch Kick. You have to jump forward, side, back, side and then side, forward, side, back and do this over and over.

Q: What do the majority of people find to be the most challenging part of the class?

A: People don’t love the Burpee Reverse Lunge but it’s different for everyone. Some people have better upper body strength and others lower body so it depends on what shape you’re in, everyone’s different. However, the Burpee Reverse Lunge usually gets people. It also depends on where it is in the segment of the five exercises; of course towards the end you’re feeling it a bit more.

Q: Who is the ideal candidate for HIT Pilates? Do you need to be in amazing shape?

A: There is actually a fitness test called the Five Key Moves Test and that determines whether or not someone is fit enough to do the class. Generally, if you work out a couple of times a week and have a bit of a background in Pilates then you’re a good candidate. Will it appeal to the geriatric population? Not really. You’re looking at people 60 and under. Of course there are people over 60 who can do it too if they’ve got good control and are in good shape. One benefit of this program and also something that makes it a bit different is that it’s not like your general aerobics where everyone has to move at the same pace. Everyone can move at his or her own rate as long as you’re controlling it and keeping the form and function, meaning that you’re doing it safely.

Q: Who should not participate in HIT Pilates?

A: With this course you can’t have any current problems, so if you have back or neck pain, or a knee injury, or are hurt in any way, HIT Pilates isn’t suitable because there is high intensity. It’s also not ideal for someone who is desk bound, sitting in an office and hasn’t done a lot of exercise in a while.

Q: How often does one have to participate in HIT Pilates in order to see and maintain results?

A: I’d say that a six-week program, twice a week, is enough to show benefits in your cardiovascular system. You’ll generally see an increase of 40-50% in your cardiovascular capacity.

Q: How long will those changes last you?

A: Well like anything, unfortunately, it takes longer to make your improvements and easier to lose them. If you don’t keep it up, you’re looking at keeping results for a month or so. But keep in mind muscles have a memory so once you’ve trained your muscles to a certain level it doesn’t take long to regain those benefits. You could do this program between 3-4 times a year to stay fit, but it doesn’t always have to be Healthy HIT Pilates. You could go do something else. The secret to fitness is mixing it up, keep it changing!

Q: What’s your elevator pitch for why someone should participate in HIT Pilates?

A: If you want to get the maximum benefits in a short period of time, for pretty much every part of your overall fitness including: Endurance, power, strength and stability.

Q: Do you foresee this becoming a popular work out trend in Spain?

A: High intensity training, especially the boot camp stuff is starting to emerge as a popular trend, so yes I do see it becoming more of a ‘thing’. HIT Pilates has been scientifically proven and I like that. This is a well thought out well-balanced regime it’s really the first of its kind. I think with the right marketing and right exposure it could take off in Spain.

Q: Why would this class appeal to women?

A: Primarily because of the fat burning benefits. It’s really good for getting the metabolism going. Sometimes guys want to bulk up and for women it really is a weight loss program. In 35-40 minutes (a short period of time) you have an entire work out, which you’re getting a lot out of and doing all four components of your fitness. There aren’t many classes that incorporate: Pilates, endurance, strength and power in a short period of time. I’d say that another aspect that attracts women is the fact that it’s safe.

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Athletics

HIT Pilates

Healthy HIT Pilates, ‘Hits’ The Mediterranean Coast

By: Sam Mednick

Editor’s Note: This Is Part One of a Two Part Interview. Part Two Will be Published Next Week

Australian native, Shay O’malley has brought a unique and revolutionary workout to Barcelona. The forty-one year old Physiotherapist, Pilates instructor, Acupuncturist (and a host of other qualifications) has now become Spain’s first and only certified Healthy HIT Pilates Trainer. We had the privilege of sitting down one-on-one with the Aussie to get her take on this innovative new exercise program and its incredible benefits.

Quick HIT Explanation: Healthy HIT Pilates was created by Glenn Withers, a Physiotherapist and one of the co-founders of the Australian Physiotherapy and Pilates Institute (APPI). This new workout regime is a combination of High Intensity Training (HIT) and traditional mat work Pilates movements. The class is approximately 45 minutes in length with 20 minutes of high intensity workout, which is a mix of 30-second cardiovascular bursts and a 30-second Pilates recovery moves.

HIT Pilates BarcelonaQ: Why did you decide to get involved with and become a Healthy HIT Pilates Instructor?

A: I started doing some research about the benefits of it and I found a few exercise programs online, which I started doing myself. I ended up tearing a hamstring in the process. So I did more research and realized that this could be done more safely. I had done my original Core Pilates training at the Australian and Physiotherapy and Pilates Institute in London and by coincidence this was the first time they offered a course in HIT Pilates. I flew to London to become certified, as I trusted their model. This is a very evidence based exercise regime as it’s founded on actual scientific research.

HIT Pilates interests me because in general, Pilates alone doesn’t address your cardiovascular system. It’s fantastic for your core stability muscles and general strength, but not your cardiovascular system. This is another way of addressing that other side of fitness that Pilates doesn’t touch on and it’s also done in a short period of time. It’s 20 minutes of intense exercise that still combines the Pilates principles but allows you to get a lot more out of it than say a slow 60-minute run. And most importantly it’s all done in a safe way.

Q: What would you say is the defining difference between HIT Pilates and other types of workouts?

A: If you’re training for a good level of general fitness, Healthy HIT Pilates is really good for you. I’d say the biggest advantage is safety, but still getting the benefits to your cardiovascular system. Sometimes you don’t need to go too intense and so hardcore. What are you trying to achieve? The core of the Healthy HIT Pilates is that 20-minute period and that, twice a week, is enough to make significant benefits to your cardiovascular system. HIT Pilates is great because it’s done in a short period of time and all the movements are done safely, IF performed correctly with the proper form and function.

Q: How is the 30-second recovery period beneficial?

A: There is a lot of research being done now about the benefits of the down time in workouts and they’re discovering just how good the results are. In HIT Pilates, you’re getting a little bit of recovery to your heart rate. You’re developing a lot of toxins and lactic acid during the workout and this is what makes us hurt the next day. If you don’t get the efficient removal of it, you get high levels of acidity in the blood, which can often result in a lot of pain and can even be dangerous. Sometimes people exercise so intensely that they start vomiting and that’s when your acid levels get really high. So the 30-second recovery period helps to get rid of all the toxins and get your blood pH back to a certain level before you do the next bout safely.

Q: What are your thoughts about recovery time between workouts in general?

A: There are so many theories and it depends on what you’re training for. If you’re an elite level athlete your training will be very different from myself. I believe in rest periods. I think if you’re looking at working out anywhere between 3-4 times a week that’s significant and will give you a really nice level of fitness. Having said that sometimes doing a little 15-minute routine every day to stretch the body and using some of your core muscles is good. But do to an hour-long regime every single day, I don’t think that gives your body enough time to recover. Rest is so important because our bodies rebuild themselves again.

Q: HIT Pilates is designed to get you ‘cardiovascular fit’ and lose weight. Are those the two primary benefits of doing this type of exercise? Are there others?

A: That’s true and there are several other areas we’re also addressing such as your strength, power, endurance and core stability, which is very different from your core strength.

Q: What is the difference between Core Stability and Core Strength?

A: There are two types of muscles in the body. Your core stability muscles are the deeper muscles, the small ones, which have great endurance. They are the ones that hold us up and can work 24 hours a day. Then you’ve got your larger muscles like your biceps and quadriceps and these are designed to move joints. These muscles have good core strength but poor endurance. In Healthy HIT Pilates, you’re working on your core strength, core stability and cardiovascular exercise. You’re addressing pretty much all aspects of fitness.

Q: More aspects than any other type of fitness regime?

A: I think it’s very unique actually. During my time at the Australian Institute of Sport we’d see that a lot of our athletes had good strength but not good stability, which would make them more prone to injury. You have to sometimes build somebody from the inside out and that’s the stability. Those muscles are your deep muscles, the core muscles and then the others build out and you’ve got your core strength like your rectus abdominis, which is quite superficial and designed to flex the trunk. This is core strength it’s not core stability.

Q: What are the tangible benefits of HIT Pilates? If you had to name three changes people should expect to see what would they be?

A: For one, increased muscle tone. Then it depends on diet but you should notice a difference in your cardiovascular fitness. It might be easier to walk up the steps to your apartment, or you’ll notice it when you’re biking. You should experience a general feeling of improved endurance and more stamina. Thirdly, you’ll notice general strength – strength of your leg and arm muscles.

 

Q: You’ve said that it boosts your growth hormone (keeping us young) by 450 percent. How does that translate into actual terms for the regular person? Will I wake up looking younger?

A: You’re not going to grow I’m afraid and I don’t know if you’ll wake up looking younger but our growth hormone is what makes us young and helps to keep our skin nice and flexible; the elasticity, the collagen, the cell renewal etc… It’s really important and tends to die off after the age of 30 where you’ll see a very sudden decrease. That’s why most of us get our wrinkles after thirty. So HIT Pilates is good in this sense because you’re exercising at that very high intensity and as human beings that’s what we were designed to do. If you go way back to when we were hunters and gatherers, we’d be running a lot trying to hunt down a herd. We’d do short bursts and stop and shorts bursts and stop, rather than just run all day. If you think of children what to they do? They don’t go for 60-minute runs they spurt and that’s a way of waking up our metabolism. It’s unfortunate, but unless you’re playing a form of sport that requires you to stop and run and stop and run, we’re not doing it in our general lives enough and that’s why many of us have problems with our metabolisms. It starts to drop so this is a really good way to kick start it and say ‘yeah ok we’re getting our metabolism going.’

Q: Another advantage to HIT Pilates is that it keeps the heart rate going for the next 24 hours. Why is this beneficial for someone?

A: Exercising at a higher level of intensity with your heart rate over 150/160, kick-starts your metabolism. When you’re exercising at that particular intensity your cells have to renew and so you’re really seeing lots of metabolic changes. After the class, because we’ve worked so hard, our bodies are trying to get rid of all the lactic acid to change the acidity levels in the blood stream and that’s why it has to stay high. It stays high for another 24 hours after class. Your heart rate stays high, your metabolism stays high and we’re burning that extra fat because we’re in that fat burning zone.

Stay Tuned for Part Two…

Shay O’Malley has been working as a Physiotherapist for almost 20 years. She’s also completed postgraduate training in Acupuncture and Pilates and currently works out of Studio Australia, in Barcelona. The next Healthy Hit Pilates, six-week program will take place in Parc de La Ciutadella at the end of May. To register for the class contact Shay directly as spots are limited – shayphysio@gmail.com.

Sam Mednick is a professional Life Coach specializing in time management and motivational coaching as well as lifestyle design, healthy living and transitional coaching. She has studied with Coach U, a university based in Europe and the United States. A Toronto native with a background in journalism, Sam has worked and lived all over the world including Fiji, Argentina, Ireland, Africa, Lebanon, the Philippines, Panama and Spain. Her international experience helps bring an open minded and fresh perspective when working with her clients.

Before embarking on her coaching career, Sam worked in Ghana as a foreign correspondent for a Canadian NGO (Journalists for Human Rights), as well, she was the Executive Radio Producer for an internationally syndicated lifestyle show based out of New York City. See Sam’s coaching philosophies at www.blueprintcoaching.ca

 

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