In this session we had a discussion about the pedometers (did they help or were they more of a hinderance?), conducted a step test using the Borg scale to assess how hard the patients were working, considered the pain cycle, tried nordic walking and completed stretches that were specific to rotation of the spine.
Reflective Summary
It has previously been suggested that pedometers have been successful in increasing physical activity levels, predominately in female adult populations (same as the intervention group participating in the back pain clinic). This is because it can be used as motivational tool to not only increase physical activity levels but to help raise awareness of the importance of physical activity (Lauzon, Chan, Myers & Tudor-Locke, 2008). Despite this, the group that we were working with found that using a pedometer was demotivating as they did not believe the equipment was giving an accurate reading – they found this frustrating. Similarly they are less useful for running, cycling and walking activities and can produce inaccurate results for older adults who walk too slowly (Sallis, 2010). Although, the patients needs to remember that not everything will work for them, we are providing them with different tools so they know what is effective and what to avoid.
Nordic walking is a form of activity in which conventional walking is supported by the use of poles (Pellegrini et al., 2017). A study by Tschentscher, Niederseer & Niebauer (2013) found that nordic walking has many health benefits such as short and long term effects on the cardiorespiratory system compared to brisk walking. Current literature has also identified it to be a safe, feasible and a readily available form of endurance exercise training. This type of exercise is specific to our group as it has been shown to significantly reduce non specific lower back pain, therefore can improve quality of life (Tschentscher, Niederseer & Niebauer, 2013). This is because patients with chronic pain who complete a combination of endurance and strength training has been effective; nordic walking is a combination of strength and mobility training (Henkel, Bak & Smolenski, 2008). Not only does nordic walking help the lower back, the use of the poles actively engage the upper body in order to propel the body forward during walking, which leads to longer strides, high speeds and increased ground reaction forces with respect to conventional walking, again emphasising the added benefits of nordic walking (Pellegrini et al., 2017).
The final activity that the group participated in were rotational stretches of the spine including a cat-cow pose, cervical rotation and thoracic rotation, while in a seated position. The practitioner explained that these type of stretches can activate the the deep trunk muscles, which can develop core stability, therefore improve lower back pain, however it has not always been possible to detect a deficit in core muscle strength (Wirth et al., 2017). Interestingly, there is little evidence within the literature to support the use of trunk-rotation exercises and actually present more drawbacks; trunk rotation elicits high force on the intervertebral discs which could be the main reason for disc damage and lower back pain (Wirth et al., 2017) . Despite this, the patients we are working with have experienced back pain for years, thus the tissue healing process has been completed so these movements may not be as damaging as we thought, especially if they work within a tolerable range of motion.
When reflecting on these sessions I have been impressed with the amount of dedication and motivation the group has, despite the pain they are experiencing. I know I will find it frustrating if the patients see no improvement in there pain, especially as I have got to know them on a personal level and have begun to understand how it affects there lives.
References
Henkel, J., Bak, P., Otto, R., & Smolenski, U. C. (2008). Effect of selected prevention concepts on functional health of persons with nonspecifıc chronic recurrent neck pain. Manual Med, 47(1), 57– 66.
Lauzon, N., Chan, C. B., Myers, A. M., & Tudor-Locke, C. (2008). Participant experiences in a workplace pedometer-based physical activity program. Journal of Physical Activity and Health, 5(5), 675-687.
Pellegrini, B., Peyré-Tartaruga, L. A., Zoppirolli, C., Bortolan, L., Savoldelli, A., Minetti, A. E., & Schena, F. (2017). Mechanical energy patterns in nordic walking: comparisons with conventional walking. Gait & posture, 51, 234-238.
Sallis, J. F. (2010). Measuring physical activity: practical approaches for program evaluation in Native American communities. Journal of public health management and practice: JPHMP, 16(5), 404.
Tschentscher, M., Niederseer, D., & Niebauer, J. (2013). Health benefits of Nordic walking: a systematic review. American journal of preventive medicine, 44(1), 76-84.
Wirth, K., Hartmann, H., Mickel, C., Szilvas, E., Keiner, M., & Sander, A. (2017). Core stability in athletes: a critical analysis of current guidelines. Sports medicine, 47(3), 401-414.