الله بسمالرحمن الرحيم

Dr. Hany ElbibanyM.D /D.CHelioplis /Cairo87 El-Mirghany St., HeliopolisTel/fax :4146885Mobile: 0123175197

Though the word rehabilitation conjures up images, of hospitals, serious disability, and months of full time work, nowadays, the word is being used differently by the Chiropractic profession.

Incidence of LBP

There is some evidence that the incidence of LBP may indeed be growing

Analysts suggest nursing as one of most hazardous professions for LBP.

or because health care providers are usually accessible in this fitting

It is possible that the higher back injury rates are reported in the health care industry simply because its workers are more alert to symptoms

Economic Impact of low back pain

LBP’s impact on health care and economy has changed as LBP is much more costly than before.

The high cost of LBP

Medical costs Workers’ compensationLegal expenses

Personal suffering Production losses and related costs borne by industry

Worker might return to same productive job or remain completely out of work force.

Direct costs: Indirect cost

In Quebec Spitzer described the recovery process from industrial workers back injury as follows

Duration of Absence

Percent

74.2% of workers were absent less than one month

Recovery Curve

Reduced to 9.4% over next month

Duration of Absence

Percent

Recovery Curve

Duration of Absence

Percent

Recovery Curve

Curve flattens out for absence of more than 3 month indicating that workers still absent from work at that time tend to remain absent

Recovery Curve

Percent

Duration of Absence

After one year, 4.3% of workers remained absent from work

Data implies if worker has not recovered within several months of back pain the probability is high that he or she will go on very protracted disability

In the past, rehabilitation was used in sports medicine to allow sports stars with minor injuries to go back to their fitness and ability to regain their competitive form.

During the last few decades this sports medicine approach has been applied to the average patient with back pain

Rehabilitation

The restoration of an ill patient to self-sufficiency or to gainful employment at his highest attainable skill in shortest possible time.

The restoration of normal form and function after injury or illness

Whatever there is no need to have a specific injury or illness as a prerequisite for rehabilitation

Defining Rehabilitation

Per Dorland there are 2 definitions:

While in Graig Liebenson’s view: “Rehabilitation is concerned with restoration of musclo-skeletal function in patients with subacute, chronic and recurrent conditions.

Some Neurologist define rehabilitation simply as “ the restoration of function in motor system”

As the chiropractic profession grows application of spinal rehabilitation is acquiring a more prominent role.

The greater majority of patients can receive spinal rehabilitation during a single office visit, without using sophisticated equipment.

Scientific degrees in chiropractic rehabilitation are currently honored by American and Canadian boards.

Dr. Craig Liebenson,(a leader in the field of chiropractic),has developed an outline, which is :based on the following

The cost effectiveness of avoiding high tech testing and training

Partnership of manipulation and exercise

Treating patients with functional pathologies while training them to prevent recurrences represent the cost effectiveness in treating LBP.

The correct approach to this involves the combination of manipulation and exercise

Integration of Rehabilitation and acute care

Secondary functional restoration

The approach involves the following:

Biopsycho-social model

Primary conservative care

Practitioners must be alert to physical , social and psychological causes and emphasizing, return to work and daily activities as soon as possible.

Biopsycho-social model

Aims at reduction of pain and inflammation during the first 3 days using passive treatments, support and rest.

Primary conservative care

Secondary functional restoration

A blend of passive and active care from the subacute stage, which aims at avoiding further deconditioning,, restoring function and preventing disability.

Most patients will have returned to activities of daily living within 6weeks.

Assessment of cases may be carried out by:

Evaluation and muscle imbalance

Identification of psychosocial factors.

Pain and disability questionnaires

Range of motion test

Patient education

Functional capacity evaluation:

Valid base line measurement of function then re-measurement to demonstrate result.

Rehabilitation of motor system and this comprises:

Restoring normal joint mobility .Inhibiting over-reactive musculature ( including trigger points)

Management involves:

Posture reeducation.

Improving muscular flexibility, coordination, strength and indurance.

Stretching retracted soft tissues.

Proprio-sensory re-education.

Cardio vascular training.

Finally

The most recent evidence of competitive effectiveness and patient satisfaction appeared in a large survey of acute, severe back pain patients in the USA

A random study done on a sample of 8067 eligible adults showed that:

11.5% of North Carolina adults experienced low back pain during a one year period.

33% consulted chiropractors.63% consulted medical practitioner.5% consulted other health care provides

99% Vs 8% sought chiropractic helpful 96% Vs 84% were satisfied 14% Vs 27% found themselves less likely to seek other provider cares.