The Philosophy of Spine Stabilization
The name Progressive Physical Therapy is no accident. It was named that in 1986 by myself, Barry Fitch, DPT, its founder and owner. It was named that in an effort to capture the spirit of its purpose: To never be satisfied with the status quo, to continually improve the quality of our service and patient outcomes, to embrace innovation and technology and the construction of new evidence-based effective treatment protocols. While remaining in the mainstream, we lead the charge in Physical Therapy to construct more effective treatment techniques. We seek to elevate Physical Therapy through competence and effectiveness and to emerge as the primary rehab providers in our area.Back injuries represent a problem of epidemic proportions in the U.S. It is one of the most common and costly musculoskeletal disorders experienced in the U.S. Back injuries account for 10% of all chronic health conditions and visits to a doctor. Approximately 80% of all Americans will suffer at least one occurrence of low back pain in their lifetimes.(4,5,6) Four to five percent of the population has an acute low back pain episode every year.(4,7) Occupational injuries represent an enormous problem in the U.S. They are second only to the common cold for lost workdays and account for a disproportionate share of workers compensation costs. While diagnoses related to LBP account for 16-19% of workers compensation claims, they represent as much as 50% of costs.(8) "Accident Facts:, a publication of the National Safety Council, reported that there were 770,000 disabling injuries to the back in the U.S. in 1993. The average cost per disabling injury was $27,000. Estimates of annual costs for LBP in the U.S. have been as high as $100 Billion.(4,7,8,9,10, 11,12) These costs continue to rise. According to the American Society of Orthopedic Surgeons, back injuries are the most costly medical condition in America.
Most patients who have experienced ongoing back problems don't have to be told that there exists a great big gaping hole in healthcare concerning effective treatment of the back and neck. Most conventional treatment practices whether by physical therapists, chiropractors or medical doctors, simply do not work very well. A study completed in 2003 concluded the following: "Certainly, the historical lack of success of the rehabilitation and medical professions in treating low back pain should serve as sufficient motivation to look to more evidence based models."(1)
Most problems of the spine originate from a localized instability. The cause of the instability is generally not from a single incident trauma. Studies show that as little as 4% of spinal problems are caused by a single incident trauma.(2) The vast majority of spinal problems are caused by accumulated micro-trauma.
The source of the micro-trauma may be from repetitive stress injuries or from what we at Progressive Physical Therapy call "Creep". "Creep" is generally caused by poor postural habits, which stretch the supportive ligaments and muscles of the spine. This produces areas in the spine, which are hypermobile (have too much motion). Hypermobility and instability are not one and the same. Instability is the inevitable consequence of hyper-mobility if not addressed. Eventually, the supportive tissues of the spine stretch to the point that aberrant (abnormal or unwanted) motion occurs. This is the defining moment of instability, when aberrant motion occurs.
Aberrant motion, left untreated, causes a progressive deterioration of spinal components and leads to what Dr. Stanley Paris calls a "cascade of symptoms".(3) The further down the cascade, the worse the problem and the less likely that conservative intervention can be effective.
The cascade of follows the general course as outlined below:
1. Poor posture causes transition zones at the apex of the spinal curves.
2. Hypermobility then develops at these apexes.
3. The hypermobility, if left alone, progresses to a local instability
4. Instability allows aberrant motion.
5. Aberrant motion initially causes pain and inflammation
6. Aberrant motion causes progressive wear and tear on the spine.
7. Wear and tear manifests itself as bony spurs or osteophytes and/or disc degeneration.
8. Progressive wear and tear leads to lateral foramen stenosis (narrowing) and/or herniated discs.
9. Continued progression can lead to stenosis of the central canal and/or multiple disc herniations,
Note: It should be mentioned that there are a number of healthcare providers including some physical therapists that deny the existence of spinal instability. There is an even larger group of physical therapists that acknowledge its existence, but really don't understand it adequately. This is where we at Progressive excel. We understand spinal instability and the problems that develop as a result. We have developed evidence-based and effective protocols for the conservative treatment of most neck and low back problems.
Note: It must be mentioned that there are other musculoskeletal changes that occur as the result of poor posture that affect shoulder and even hip function. This will not be discussed further in this section.