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Help for back pain sufferers with training

21.04.00

General Practice Notebook Medicine

Dr Gabriella Kieser explains how an exercise system she developed may help prevent and treat back pain for certain patients.

Health and well-being depend to a considerable extent on the strength of muscles. The aims of Kieser training are to improve the strength and endurance of spinal muscles, reducing imbalances both within and between muscles. This will increase the range of spinal movements and reduce or eliminate chronic back or neck pain.

Kieser Training is unlike a coventional gym. Its facilities are designed solely to improve musculoskeletal and spinal function, using sophisticated and validated techniques. In a typical centre the assessment and training machines alone cost more than half-a-million pounds. There are a lot of clinics on the continent and we have just opened the first in London.

How do the centres operate?

In each centre we have a medical and a preventative department. The medical department is designed for patients who suffer from chronic pain in the back or neck. Patients may have been referred by their GP or attend independently. They undergo a medical assessment by an onsite doctor, who will use our equipment to assess each muscle group independently for strength through a range of movements. The machines give a detailed printout of the function of each msucle group.

Any contraindications to this type of training will be recorded and an individual training plan constructed for the patient. A course of half-hour training sessions - usually 12 to 18 - is supervised by a trained therapist.

The training is particularly useful for patients who have been resistant to other forms of therapy and live in pain or discomfort. Optimal outcomes can be achieved with as little as 30 minutes a week.

The preventative department

Access to these departments is open to anyone who feels that strength training would be beneficial to their overall health and fitness. For example, they may have had a previous back or neck problem or have a sedentary job and take insufficient exercise to keep their muscles and joints in good shape. We have more than 50 machines in the typical Kieser training centre, designed to strengthen individual msucles.
Before starting a tailored training programme, users have the option of a medical evaluation to assess their specific requirements. Following three introductory, supervised session, they undertake training at their own convenience, with guidance available on request.

Is there evidence that it is effective?

We have published data in peer-reviewed journals that show this type of training works. In one study, 900 patients in Minnesota, US, all suffering from chronic back pain, were given a programme of muscle strengthening on our machines.

More than 75 per cent of the patients, all previously resistant to treatment, were assessed as having made good or very good progress. At follow-up more than a year later, over 90 per cent had maintained their improvement.

Conditions such as chronic back pain, arthritic pain and osteoporosis have been shown to improve with strength training. Exercise and strength training can be continued well into old age and Kieser training has been shown to increase bone mineral desnity in institutionalised patients in their nineties.
So far, no trials against placebo or against osteopathy have been undertaken.

What are the contraindications?

Contraindications include cancer in the spine, unhealed fractures and severe inflammation, such as spondylitis. In addition, people with cauda equina syndrome or in the first two or three weeks after disc prolapse are unsuitable.

Other contraindications are uncontrolled hypertension, unstable cardiac disorders and sever osteoporosis. Mild osteoporosis is a good indication for this type of therapy. We have had one patient who suffered an unexpected fracture from osteoporosis, but fewer than one in 1,000 have increase in lumbar discsymptoms - patients may have irritation of symptoms initially but this only lasts for a few days.

How much does this training cost?

The cost must be borne by the individual. The standard costs £39 a session and, together with the cost of the doctor's assessment, the overall cost for 12 sessions is £568. For the preventative sessions, users can pay for six. 12 or 24 months. They could come daily, but once a week is recommended. A year's training costs £399.

How popular is this type of treatment?

We have just set up our first clinic in London, and plan to extend the programme nationally. More than 80,000 patients world-wide have taken part in the Kieser training. We have 31 clinics in Germany, 18 in Switzerland and one in Luxembourg.

What do you think will be the benefits?

There are 200,000 fractures each year in the UK - a bone broken every three minutes - and 40 per cent of adults suffer from back or neck problems. One in three women and one in 12 men will develop osteoporosis and this is likely to be an even bigger problem as the population ages.

I have no doubt that Kieser training could help reduce these figures and that it will become a popular form of therapy in the UK as more people see the benefits of investing in their long-term health and fitness.

Who developed this type of treatment?

The machines were developed at the University of Florida and are the best of their type. My husband, Dr Werner Kieser, and I developed the training system together

URL

http://www.gpnotebook.co.uk/homepage.cfm

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