This session was very much exercise based, so we could begin to understand what type of exercise works for the patients back pain whether this is aerobic fitness, core stability or general muscle strengthening of the rest of the body.

Reflective Summary

Within this reflection, I am going to utilise Gibbs reflective cycle to improve my critical thinking skills (a full explanation of the cycle can be seen in my placement evidence from 3rd November 2020). The cycle is composed of six stages; describe the event, identify feelings, evaluate the experience, analyse the experience, draw conclusions and compose an action plan (Barksby et al., 2015).

We started off the session with some core stability/strengthening exercises. We used McGills framework which consists of three core stabilisation exercises; curl up, bird dog and side plank (McGill and Karpowicz, 2009). These exercises can enhance spinal stability and activation of the muscles without imposing high loads on the spine (McGill, 1998). Ammar (2012) compared the effects of McGills exercises vs conventional exercises on physical function in patients with non-specific chronic lower back pain. The results from the study suggest that the improvements were statistically significantly greater in the McGill group, although the conventional exercise group still reported an increase in physical function. This research has given me the clarity that I needed to be confident when prescribing these exercises to patients.

For the next part of the session we focussed on general strengthening of all the major muscles. This includes the legs, hips, back, abdomen, chest, shoulders and arms, which should be done at least two days a week (NHS, 2019). Different activities can be classed as muscle strengthening including pilates, using resistance bands and heavy gardening. Resistance training, which is what we implemented in the session, is important to include within an increasingly sedentary and ageing population because it can decrease sacropenia as resistance exercise promotes muscle gain (Westcott, 2012).

The final thing we considered with the group was the link between pain and stress; an important contributor to chronic pain is perceived stress. Many researchers have shown a complex relationship between stress and the symptoms of chronic pain (Crofford, 2015).This emphasises the need for different coping mechanisms whether this is for pain or stress as both can have an effect on one another.

Area for Improvement	Action Plan
Increase knowledge of different exercises used for a variety of populations	Create resources with regressions and progressions of exercises
Improve communications skills when demonstrating exercises to patients	Practice and revise the key points to common exercises
Research chronic conditions	Look at the evidence and research surrounding the effective methods to treat and manage chronic conditions

Closing the Loop

As I have mentioned in other reflections, I have began to record progressions and regressions for different exercises which will be uploaded onto my professional instagram in the near future. Similarly, I have a rehabilitation exam coming up soon so I have been revising the key points that I will use with clients to guide them to complete the exercises correctly.

References

Ammar, T. A. (2012). McGill exercises versus conventional exercises in chronic low back pain. Life Sci J, 9(2), 393-7.

Barksby, J., Butcher, N., & Whysall, A. (2015). A new model of reflection for clinical practice. Nursing Times, 111(34), 21–23.

Crofford, L. J. (2015). Chronic pain: where the body meets the brain. Transactions of the American Clinical and Climatological Association, 126, 167-183.

McGill, S. M. (1998). Low back exercises: evidence for improving exercise regimens. Physical therapy, 78(7), 754-765.

McGill, S. M., & Karpowicz, A. (2009). Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Archives of physical medicine and rehabilitation, 90(1), 118-126.

NHS (2019, October 8). Exercise. Retrived 8th November 2020 from https://www.nhs.uk/live-well/exercise/

Westcott, W. L. (2012). Resistance training is medicine: effects of strength training on health. Current sports medicine reports, 11(4), 209-216.