Chiropractors can effectively rehab their patients using inexpensive, take-home exercise equipment

In the last 20 years, research has clearly established a connection between the postures required by certain job tasks and repetitive stress injuries. These investigations form the field of ergonomics. The word “ergonomics” is derived from two Greek words: ergon, meaning “work,” and nomoi, meaning “natural laws.”

Great Britain’s Ergonomics Society defines ergonomics as, “The application of scientific information concerning humans to the design of objects, systems and environment for human use.”¹ Paul Hooper, DC, MPH, describes it as being “about adapting and making our environment more suitable, more comfortable, more efficient and more productive.”² Underlying all ergonomics concepts is a careful analysis of human function.

Ergonomics and Posture
Two major elements are evaluated in ergonomic studies: “static work” and “force.” Static work refers to the musculoskeletal effort required to hold a certain position. For example, when we sit at work, keeping our head and torso upright requires either small or large amounts of static work, depending upon the efficiency of the body positions we choose. “Force” refers to the amount of tension our muscles generate. For example, tilting the head forward or backward quadruples the amount of force acting on the lower neck vertebrae. The increased force is due to the additional muscular tension needed to maintain the flexed or extended posture.

A large body of literature shows the advantage of corrective exercise to improve postural control for many types of musculoskeletal conditions. These benefits include restoration of range of motion, decreased pain, decreased neural inhibition, quicker return of muscle function, and improved performance in sports and all daily activities. Rehabilitation concepts now emphasize functional activities and ergonomic retraining of normal loading and movement patterns, and take into account the patients’ postural patterns at work and at play.

Effective Home Exercises
The best rehabilitative exercises for a specific patient are those that will help him or her to regain normal postural alignment and easy, natural movement. A successful exercise program for the back and/or neck does not require expensive, joint-specific equipment. With an understanding of normal spinal function, knowledge of the involved muscles, and the application of corrective exercise concepts, chiropractors can effectively rehab their patients using inexpensive, take-home exercise equipment.

Studies have found elastic tubing to be a safe and effective method of providing progressive resistance exercises.³ Elastic tubing provides a unique form of dynamic exercise, since the resistance varies significantly with the amount of stretch applied.⁴ This property is used most effectively by starting a patient exercising with some initial slack in the tubing, thereby ensuring relatively low resistance.⁵ As the patient improves, the tension is increased, progressing the resistance gradually and safely, and activating a more widespread neurological response to the exercise movement. In this way, most patients can advance through their entire joint rehab program with just one piece of exercise tubing, rather than having to purchase several different levels.

Exercising the Spine in a Functional Position
The proprioceptive input from mechanoreceptors in the muscles, connective tissues, and joint capsules is very different between standing and lying down. This is why it is so important to bring neck and back rehab exercises closer to real-life ergonomic positions. In addition, it explains why patients generally make much more rapid progress when they are taught to exercise in a functional (upright and weight-bearing) position.

When the spine is bearing weight, it is part of a closed kinetic chain. This is the manner in which we use the joints and connective tissue of the spine during most daily and sports activities, and it requires the cocontraction of accessory and stabilizing muscles. Weaker or injured muscles can be quickly strengthened with the additional use of isotonic resistance to stimulate increases in strength.

Floor-based exercises (open kinetic chain), by comparison, generally do not train muscles and joints to function efficiently in normal ergonomic postures. The neurological patterns that are developed on the floor or in a pool are considered not as effective when needing to improve upright activities. Stimuli from articular and muscle mechanoreceptors must be modulated with efferent responses to maintain “dynamic joint stability.”⁶ The time and effort patients spend on open-chain exercises may be wasted, since learning new skills and habits on the floor may not translate to better functioning during usual, upright activities.

Separate Professions, Similar Goals
Although chiropractic and ergonomics are separate disciplines, they share some common interests. In fact, a reasonable assumption has been made that many people seek chiropractic care for musculoskeletal problems because of a lack of sound ergonomics in home or work settings.⁷ At-home chiropractic rehab programs can be enhanced when they are geared toward strengthening injured areas of the body and addressing ergonomic factors of poor workplace design or injurious repetitive body motions.

Elastic resistance training is very nonthreatening, and has been safely used in home-based exercise programs for older adults.⁸ Since setup is easy to learn, and requires little manual dexterity, it can be used by patients with no gym or weight-lifting experience.⁹ Appropriate and progressive rehab programs should be started early in the treatment of all patients with joint conditions—acute and chronic. Ergonomic postural retraining programs comprised of simple, dynamic resistance techniques don’t require expensive equipment or great time commitments. A closely monitored home-exercise program using take-home exercise tubing is ideal, since this allows the doctor to provide cost-efficient, yet very effective and specific rehabilitation care. CP

Kim D. Christensen, DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Wash. He has participated as team chiropractor for high school and university athletic programs, as a postgraduate faculty member at numerous chiropractic colleges, and as past president of the ACA Rehab Council. Contact him at kchristensen@peacehealth.org.  

References
1. The Ergonomics Society. Ergonomics. Available at: http://www.ergonomics.org.uk/ergonomics.htm.   Accessed February 23, 2006.
2. Hooper P. Ergonomics and change. Dynamic Chiropractic. October 21, 2004;22(22):32.
3. Roy S, Irvin R. Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation. Englewood Cliffs, NJ: Prentice-Hall; 1983:195.
4. Hughes CJ, Hurd K, Jones A, Sprigle S. Resistance properties of Thera-Band tubing during shoulder abduction exercise. J Orthop Sports Phys Ther. 1999;29:413–420.
5. Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am. 2001;32: 527–538.
6. Laskowski ER, Newcomer-Aney K, Smith J. Refining rehabilitation with proprioception training. Phys Sports Med. 1997;25: 89–102.
7. Oakley PA. Assessment of ergonomics and occupational health teaching and research practices within the chiropractic profession. J Chiro Ed. 2003;17(1):25–26.
8. Mikesky AE, Topp R, Wigglesworth JK, et al. Efficacy of a home-based training program for older adults using elastic tubing. Eur J Appl Physiol Occup Physiol. 1994;69:316–320.
9. Skelton DA, Young A, Grieg CA, Malbut KE. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. J Am Geriatr Soc. 1995; 43:1081–1087.