Functional Restoration Programmes and Lower Back Pain
A functional restoration programme (FRP) is defined as a customized program of pain management, designed to help patients suffering from chronic pain.
The programme typically consists of a combination of structured back pain education, an introduction to the concept of pain and the use of coping strategies.
The key aims of a functional restoration programme for lower back pain include:
Increasing activity and participation Reducing emotional stress Reducing deconditioning Encourage self-management
Significance of FRPs
Effectively planned FRPs for lower back pain serve the most important role of helping the patient return to work and improve work abilities.
Also referred to as work or physical conditioning, work hardening or functional exercise programs, these FRPs simulate work tasks ad primarily include physical and muscle training exercises. Most often, a cognitive behavioral approach is followed, which includes attitudes and behaviors such as fear of movement and failure.
According to a vast series of research reports, the functional restoration programmes for chronic low back pain (CLBP) have proven to be quite successful in improving function and to some extent, in reducing pain.
A study was undertaken amongst the patients who enrolled in the 4-week outpatient Munich Functional Restoration Program (MFRP). The study concluded that as compared with the standard treatment, a functional restoration program for CLBP significantly improved important aspects of health-related quality of life.
In a yet another research report regarding patients of chronic lower back pain enrolled in a limited FRP, the treated patients were found to be ready for work, jobs and training much earlier as against those undergoing conventional forms of treatment.
Meanwhile, additional published evidence also suggests that an intensive FRP is the first-line of treatment for chronic low back pain. The underlying aim for such an approach is the expectation that for most of the patients, the pain will reduce substantially.
Overall, the techniques of a functional restoration programme resulted in a massive decrease in pain and pain-related disability in patients with both a recent as well as a long tern history of chronic lower back pain.
Functional Restoration Programmes – Key Aspects
A properly structured functional restoration programme for lower back pain lays emphasis on a series of crucial aspects. These include:
Quality information Restoration of normal spinal function Improvement in aerobic fitness Stress management Use of pacing strategies
The functional restoration programmes for lower back pain are generally conducted by a team of professionals including:
Doctors Psychologists Physiotherapists Nurse Fitness instructor Occupational therapist
The key components or treatment modalities that form a typical functional restoration programme for lower back include:
Occupational therapy Physiotherapy Kinesiology Behavioral therapy Biofeedback Psychology Return to Work Coordination
For patient safety and optimum output of the functional restoration programme for lower back pain, patients in the following conditions are generally advised against enrolment:
Patients with unresolved medical issues or awaiting further investigations Patients suffering from strong psychological issues Patients involved in substance abuse
Structure – Functional Restoration Programmes
A typical functional restoration programme for lower back pain has a well-structured format comprising of a series of elements. Here we’ve briefly explained each one of them.
Stretching and strengthening exercises form the key component of the exercises as a part of the FRPs for lower back pain.
Apart from the core stretching exercises, patients are introduced to strengthening exercises for main muscle groups. These mainly include heel raises, squats, lunges, bridging, stomach curl ups and the like.
Patients are made aware of their postural habits and trained to point out the inaccuracies.
Those with a prominent faulty posture are taught to stand and walk in the correct manner along with the way to change postures at the head, neck, shoulders and the pelvis.
Along with corrective and strengthening exercises, the patients are also taught techniques to manage flare-ups.
Key concepts taken up in this part of the programme include the reason for flare-ups, stimulating factors and the techniques to handle the same.
Various psychological factors of lower back pain are examined in this section. Patients’ ability to perceive and handle pain is observed and proper techniques are demonstrated to maintain the right psychological set-up throughout the treatment.