The ultimate goals of rehabilitation are to relieve pain and improve function. To accomplish these goals, your therapist can implement a variety of treatment approaches. Patients should not expect to receive every treatment approach offered. Instead, treatment will vary based on the particular structure causing your pain, as well as the degree of impairment present in your posture, range of motion, and strength. After a thorough evaluation of these factors, your therapist will recommend one or more of the following treatment approaches.

• Ergonomic assessment and modification
• Modalities: TENS or Laser
• McKenzie-based movements for the spine
• Joint and soft tissue mobilization/manipulation
• Spinal traction
• Motor control exercise
• Graded exercise training

Treatment is typically administered during a 45-minute session, two times per week. Patients complete an average of eight visits over the course of 4-8 weeks. Some improvements in pain and function are often achieved in the first few weeks of treatment; however, full pain relief should not be expected in the relatively short timeframe that therapy is being administered.  The greatest improvements in pain and function often occur in the weeks and months after therapy has been completed, when patients continue to carry out the home exercise programs given to them by their therapists. Through gradual alterations in postural alignment, strength, and mobility, patients can achieve long-term, significant improvements in their pain and function.

Ergonomic assessment and modification: Patients are provided with education on maintaining adequate support during sitting and sleeping postures that tend to aggravate pain. Click here (Work Wellness Document)  for recommendations on maintaining constant foot support, seat support, back support, and arm support while sitting. Sleeping posture is often improved by placing a pillow under the neck (rather than the head), between the knees or under the side (if sidelying), or under the knees (if on the back).  Ergonomic adjustments can provide significant long-term reductions in pain.

Modalities: Transcutaneous electrical nerve stimulation (TENS) and laser may be applied in instances of high pain intensity. TENS can provide temporary, short term reductions in pain via sensory and motor nerve stimulation. Laser can provide short-long term reductions in pain by facilitating healing in damaged tissue.

McKenzie-based movements for the spine:  Patients with pain of disc origin may benefit from specific movements of the spine to create short-term reductions in pain. Your therapist will direct you on the most appropriate movement for you to perform. Care should be taken with these exercises, as performing the incorrect movement can result in increased pain.

Joint and soft tissue mobilization/manipulation: Patients with pain and limited mobility in joints or muscles may benefit from specific techniques to create short-term reductions in pain. After receiving manipulation, your therapist will ask you to perform home-based stretching exercises to create longer-term pain reduction.

Spinal traction: Spinal traction may be applied to the neck or low back of patients presenting with nerve compression. Traction provides a longitudinal stretch to the spine, and is often associated with temporary, short-term changes in pain.

Motor control exercise: Motor control exercise seeks to re-establish a patient’s awareness and control of individual muscles that contribute to breathing, improved postural alignment, and movement. These exercises form the foundation of the strengthening approach used in the pain program.  Click here (Core Training) for an example of exercises for the upper and lower trunk.  Patients must maintain regular compliance to these exercises to realize gains, as improvement from this form of treatment is not always realized immediately.  Rather, this form of treatment seeks to create long-term improvements in pain and function. Click here (Cervical Flexor Training)

Graded exercise training: Graded exercise consists of aerobic training, traditional strength training, and incorporation of functional tasks such as lifting.  Patients are given targeted goals for activity completion at each visit. These goals increase in difficulty as the program progresses. Like motor control exercise, this form of treatment seeks to create long-term improvements in pain and function.