Functional rehabilitation of low back disorders

Musculoskeletal disorders of which low back pain (LBP) accounts for more than 50% are now the most common cause of chronic incapacity in industrialized countries. The traditional approach in looking for the reason (etiology) for musculoskeletal disorders is to search structural failures but, in most cases, it is difficult to find an explicit reason for back pain. Many scientists now consider spine disorders as multifactorial, bio-psycho-social problems. Pain has clear effects on motor control. Therefore, LBP can also induce changes in neuromuscular control and motor performance, i.e., causing various functional deficits. Another feature, which deserves special consideration with reference to back problems, concerns the numerous psychological factors, which are involved in mediating the relationships between physical impairment, pain and disability. The new scientific knowledge on functional deficits is increasingly being transferred to clinical applications, where the aim is to reverse them with physical rehabilitation. As a result of the recognition of the behavioral (psychological) problems with LBP, psychological, behavioral and educational interventions are commonly combined with the physical rehabilitation for LBP also. Basically, functional rehabilitation includes systematic quantification of both the physical function and psychological factors, which drive the therapeutic process. The exercises used in the functional rehabilitation usually revolve around the treatment of the spine as a functional unit. Thus many programs for functional rehabilitation use rehabilitation equipment (iso-inertial/isokinetic) by properly trained physiotherapists. However, some centers use regular fitness equipment or aerobics-type exercises. Furthermore, some relaxation and ergonomic exercises are typically proposed, and psychological support provided along the treatment. There exists both an outpatient and an inpatient functional rehabilitation approach. They are described in the paper together with the first results obtained in Italy with the outpatient approach.