Patients with musculoskeletal pain (MP) often seek relief from chiropractors, general practitioners, physical therapists or orthopedic surgeons. Yet scientific research shows that programs which address functional deficits through reactivation and rehabilitation enhance the coping ability of patients far more than any passive intervention such as medication, manipulation, manual or physical therapy, injections or surgery.1 Today, the public is discovering personal trainers, Pilates, yoga and tai chi, and often finds more pain relief from these methods than from traditional approaches.
This new consumer awareness represents a great opportunity for health care professionals who want to benchmark themselves as MP experts.Even if insurance won't reimburse for ongoing functional training, patients are prepared to pay for this service out of pocket. Health care providers in the MP field should use manipulation, medication or other treatments to facilitate patients' return to activities. However, these passive treatments should be seen as a means to recovery rather than an end.
A new organization, the International Society of Clinical Rehabilitation Specialists, is an example of how multidisciplinary health care providers can demonstrate their unique practice philosophy as MP experts who focus on functional fitness (www.clinicalrehabspecialists.com). Such experts benchmark themselves by adhering to the overarching goals of modern care for neuromusculoskeletal problems, as described by the recent clinical framework document from the Victorian WorkCover Authority in Australia.1 The aims and principles of care are clearly summarized in the following goal statements:
- Treatment must be based on the best evidence available.
- Treatment effectiveness must be demonstrated with outcome measurements.
- A biopsychosocial approach is essential.
- Treatment must focus on self-care or management skills.
- Treatment must be functional and focused on return to work or activities.
Functional fitness is a perfect way for any health care provider to help patients with disabling or activity- limiting MP syndromes resume normal activities. The focus should be on identifying what tissues require stabilization and which require mobilization, rather than routinely giving one or the other generically. In this way, an individualized, patient-centered approach can be prescribed. Excellent resources for performing a functional assessment and giving direction-specific (e.g. McKenzie, yoga) or stabilization exercises (e.g. Pilates, core training) are available.2-4
Functional training is growing in popularity. From adolescents to elite athletes to "weekend warriors" to the elderly, this is an emerging field that perfectly complements the MP specialists' place in the health care field.5,6 Those health care providers who develop and market their expertise in this exciting new field will be benchmarked as the "experts of choice" among active people and those wishing to restore function.
- Victorian WorkCover Authority - Clinical Framework. Available at: www.worksafe.vic.gov.au/wps/wcm/resources/file/ ebd22c435f1ee3c/clinical_framework.pdf.
- Liebenson C. Functional Stability Training in Rehabilitation of the Spine: A Practitioner's Manual, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
- McGill SM. Ultimate Back Fitness and Performance, 2nd ed. Waterloo, Canada: Wabunu, 2006.
- McGill SM. The Ultimate Back: Assessment and Therapeutic Exercise, Back Fit Pro. Waterloo, Canada: Wabunu, 2007.
- Gambetta V. Athletic Development. Human Kinetics. Champaign, Ill.: Human Kinetics, 2007.
- Liebenson C. Functional-Performance Training Handbook. Philadelphia: Lippincott Williams & Wilkins, 2008 (in press).
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