“Selective Stabilization” is a clinical framework of patient care designed to meet unmet needs for appropriate outlier chronic pain patient populations.
A treatment plan involves usage of the patented Backsmith Selective Stabilization Support™ exercise device to enhance therapeutic exercises potential (get the patient moving appropriately) and to help break cycles of restrictive chronic pain while reducing fear and promoting positive and adaptive neuroplastic changes. Often short-term usage is highly effective.
By understanding the concept and how to best configure and use the support to meet individual patient needs, a qualified health care provider (i.e. physical therapist) can more effectively meet the individual needs of responding outlier patients (helping to improve exercise potential, reduce pain, improve function, reduce fear, improve quality of life, and increase self management).
The Backsmith Selective Stabilization Support™ device is designed to provide effective localized and concentrated support to the trunk allowing patients to have improved functional mobility and stability (i.e. with functional walking, standing, squatting and extension exercises).
The more specific concept is to provide the right amount of support, at the right level, and in the right direction (no more and no less).
For many with chronic pain, the concept and device combination can be very useful as a clinical tool to meet goals, as well as an enhancement to an appropriate graded instructed home exercise program to improve quality of life and self pain management (reference Fulcher, K, 1997).
Short-term and longer-term indications for patients who can potentially benefit from the Selective Stabilization clinical framework (and the Backsmith Selective Stabilization Support) include the following:
- Patients who habitually are putting their hands or fists in their back regions for pain relief (the “Backsmith Sign”) or to improve ability to stand up straight.
- Patients who consistently receive 20% or more pain relief
- Motor strength improvement with provider localized posterior-to-anterior fist pressure to the trunk (positive “Backsmith Test”).
- Patients who can have increased exercise tolerance with the Backsmith Selective Stabilization Support allowing appropriate graded clinical exercise progression (i.e. aerobic walking and extension exercises) to enhance functional mobility, aerobic circulation, appropriate proprioception neurological input, endurance, and strengthening of weak and deconditioned tissues.
- Patients who demonstrate improved posture, reduced gait deviations, and improved functional stability (i.e. with ambulation on flat surfaces and steps as well as with functional squatting) allowing improved safety and reduced fear and/ or discomfort with exercise or activities of daily living.
- Patients who do not have sinister pathology (i.e. unhealed fractures, cancer, severe osteoporosis).
The Backsmith Selective Stabilization Support device is presently not recommended for pregnant women. It also is not recommended for usage around industrial machinery in which it could get caught leading to injury or death.
The device can be used in sitting but primarily is designed (and most effective) for trunk extension and stabilization exercises and activities in standing (such as graded aerobic walking exercise).
Backsmith Sign
Patient often uses fit for more localized and firm posterior-to-anterior pressure.
Backsmith Test
Test can also be done prone, on side, or in supine. It most commonly is positive at the thoracoumbar junction and L5/S1 levels.
Loaded Repeated Extension Exercise in standing position with therapeutic lower lumbar Selective Stabilization Support.
Prone “Press-Up” Exercise with Selective Stabilization pressure in desired / effective lumbar region.
Squatting Exercises with upper lumbar Selective Stabilization.
“Prone on Elbows” Extension with upper and lower lumbar therapeutic Selective Stabilization.
Lower Abdominal Trunk Stabilization Exercises with therapeutic localized / concentrated Selective Stabilization Support to increase exercise tolerance.
HOW DOES IT WORK?
The exact method(s) of how Selective Stabilization works is unknown and will require extensive research at the cellular level to optimally qualify how the body responds to this intervention.
However, current research (see references) does begin to paint a clearer picture of how this dampens down pain and modulates the nervous system in positive adaptive ways.
The primary needs of a healthy nervous system are normal movement, space, and blood flow, as well as minimal fear.
In the process of clinical examination, patients often present with directional preferences. The most common clinical directional preference is spine extension (2012 reference Surkit) which Selective Stabilization can help to enhance in unique ways.
In many recurrent chronic pain patient populations (i.e. with extension directional preferences), Backsmith Selective Stabilization can help meet unmet needs improving exercise tolerance, function, pain, and spinal mechanics.
First, with localized (posterior-to-anterior) Backsmith Selective Stabilization Support, responding patients can receive vertebral space needs by enhancing intervertebral disc hydration (see Beattie reference, consistent with biomedical model).
Second, science and researchers suggests appropriate segmental localized and concentrated (posterior-to-anterior) spine pressure can provide improved natural neurological descending antinociceptive control from the mid brain (See Fields reference).
As a neurological container, with appropriate input (under the right conditions), the spine can provide both positive segmental and cord sensitivity changes.
Natural opiates made by the body in the midbrain are called endorphins and are involved in descending inhibition; this descending inhibition control often becomes impaired in many chronic pain states and can be improved with appropriate changes to the spine container anatomy.
We believe appropriately used (localized and concentrated pressure at effective level) Backsmith Selective Stabilization can significantly improve natural descending inhibition from the midbrain (endorphins) by providing segmental dimorphine counter irritant input (see before/after patient videos at backsmithphysicaltherapy.com).
Also, this sustained localized (posterior-to-anterior pressure) input can help reduce secondary hyperalgesia resulting from chronic maladaptive neuroplastic changes in the nervous system (caused by a morphed body image and chronic central sensitivity); this is consistent with the biopsychosocial model (see Butler and Mosely references, as well as recently provided before/after patient at backsmithphysicaltherapy.com).
One of best examples of a chronic maladaptive central sensitivity condition is phantom pain where a given individual experiences pain in a body part which no longer exists.
This can be attributed to the virtual body representation in our sensory cortex which is highly plastic and quickly changes based on neurological input or lack of input.
Again, the nervous system works normally (adaptive neuroplasty) based on normal afferent input or abnormally (maladaptive neuroplasticity) based on abnormal input or lack of input.
The continuous tree-like nervous system needs adequate movement, space, and blood to be healthy; when part of it is not healthy it can highly impact other parts throughout the body.
The central nervous system needs normal neurological input and position sense to avoid maladaptive neuroplastic changes in the brain (which can lead to a morphed body image in the virtual body contained in the sensory cortex).
In many chronic pain populations, the resulting maladaptive central sensitivity, poor descending antinociceptive control and secondary hyperalgesia starts in the spinal cord which is a primary gait to brain afferent nociceptive input to the brain. This gait can be (and is) changed with appropriate input involving changes to the spine container.
To better meet needs, sometimes psychosocial issues must also be addressed. Persistent abnormal nociceptive input and/or psychosocial fears (psychosocial “thought viruses”) can also reduce normal descending inhibitory control overwhelming the central nervous system and contributing to chronic pain conditions, deconditioning, and dysfunctional pain behaviors.
Too often health care providers fail to appreciate central influences which have become a reality long after peripheral tissue healing has taken place.
This usually is a result of central nervous system mechanisms ramping up and creating maladaptive central sensitivity and leading to dysfunctional pain behaviors (i.e. depression, anger, anxiety, poor posture, withdrawal, reduced physical activity, tightness etc.).
In these instances, the problem no longer is primarily in the peripheral tissues but in the central nervous system maladaptive neuroplasticity.
To break this cycle, health care providers need to use tools like Backsmith Selective Stabilization to dampen down pain, get them moving and posturing appropriately, and promote adaptive neuroplastic changes.
It’s important to be reminded that because the spine ultimately is a neural gait and container, it can (and does) have a major influence on how ascending neurological nociceptive (“danger receptor”) input in to the brain is processed; appropriate input and changes to the spine container can increase or reduce ascending nociceptive input to the brain.
We believe by providing clinically appropriate changes to spine mechanics (including Backsmith Selective Stabilization and the “Backsmith Test” segmental input) many individuals can receive counter irritant dimorphine segmental input resulting in improved descending inhibitory control (natural opiates/ endorphins from the mid brain).
This also can lead to less threatening and more normal posture and movements (and adaptive central nervous system neuroplasticity) resulting in improved function, reduced pain, improved (sensory cortex) virtual body image, and potentially reduced need for pain medications (please see before/after patient videos).
Traditional and current medical interventions have placed a huge emphasis on medication and imaging as strategies for treating both acute and chronic pain.
With regard to medication, according to Dr. Fields (See Douglas Fields, MD reference), “It now is becoming clear that many drug therapies are ineffective in treating chronic pain because scientists failed to appreciate the role of glia in pain and drug addiction. Neuronal pain killers address only part of the problem; they overlook the other brain.”
Well over 2 million people in the United States are currently addicted to opiate medication. This cultural drug epidemic concern is largely reinforced by a very recent EPA/ JAMA reports on addiction (see Hayes JAMA research reference) as well as in a book by Abramson (See Abramson’s Addicted America; The Broken Promise of American Medicine as well as other below references).
With regards to clinical imaging, degeneration changes revealed with testing often are not at all consistent with a given patient’s pain expression or presentation (See Jensen, et al (1994) and M Englund (2008) references).
It may actually increase patient fear and anxiety (adverse nervous system responses due to catastrophic “thought viruses”) in chronic patient populations when imaging signs and results are not put in proper perspective (to the patient) by their health care providers.
We believe the bottom line is the current multimedia driven pharmaceutical industry (in combination with the modern day multimedia manipulated medical culture) has led many individuals down the drug addiction opiate road; the resulting temporary relief patients have received has to often led them to a prison of dependency and despair (and in many cases physically, mentally, and financially bankrupt).
We believe quality health care promotes appropriate lifestyle changes and independence and not dependence and addiction.
For non-sinister mechanical back pain, we suggest that a number of other common current health care intervention devices (and care approaches) have often been too passive in nature and/ or have provided long-term generalized support to the spine, often excessively limiting movement (immobilization); as previously discussed, our nervous system needs appropriate movement to stay healthy as do synovial joints in the body (“motion is lotion”).
Over restricting normal movement can quickly lead to weakness, adaptive shortening of joint tissues, maladaptive neuroplasticity, and reduced joint synovial flow to cartilage.
In contrast, Selective Stabilization is an innovative option to provide optimal support at the individual’s appropriate level (no more and no less) to dampen down the nervous system pain expression, enhance appropriate movement potential, and foster adaptive exercises and neuroplasticity progression.
It’s important to re-emphasize that for responding patients with chronic pain, Backsmith Selective StabilizationSM can provide a treatment option which can drastically improve motor control and reduce compensatory movement patterns providing more normal afferent input to the nervous system and reducing perceived threat by the nervous system.
In some patients it can even eliminate chronic pain and apprehension with breathing. One can logically conclude this also leads to improved overall psychological status as many patients feels more in control of their conditions and empowered (and less fearful) with their pain management (with improved exercise and movement tolerance).
Research on Chronic Fatigue Syndrome has shown individuals able to perform aerobic exercises can reduce pain sensitivity through a graded aerobic instructed exercise program (see Fulcher reference).
However, individuals with chronic pain frequently become unable to walk well (due to their pain and/ or weakness and compensations) leading to progressive deconditioning and disability. Appropriate Selective Stabilization can help break this common downward cycle.
The economic burden of low back pain alone (not even considering instability) is increasing with the annual cost in the United States estimated to be at least 100 billion (Surkitt, April 2012).
With respect to this costly epidemic, we believe more adequate reimbursement for innovative and unique Backsmith Selective Stabilization Supports could lead to dramatic improvements in Medicaid and Medicare by making this noninvasive treatment tool option available for those who need it the most.
In comparison to most specialized medical equipment devices, this is a relatively small requested price to pay for the potential return on the health care investment. The cost is comparable to one 8 minute physical therapy ultrasound treatment.
When used appropriately, it truly potentially can transform and improve how we approach health care for outlier patients promoting more independence and cost savings and less dependency on medication and invasive procedures.
It’s important to keep in mind when patient needs are not met, they frequently end up in emergency rooms which are the most expensive entry in to the health care system. The bottom line is the Backsmith Selective Stabilization Support™ has a tremendous amount to offer many outlier patients under the direction of a qualified health care providers.
Research / References
- Butler, D. S. and G. L. Moseley (2003). Explain Pain. Adelaide, NOI Publications.
- Fulcher, K., et. al (1997). “Randomized Control of Graded Exercise in patients with Chronic Fatigue Syndrome.” BMJ; 314: 10.1136
- Beattie, Paul, (2010). “The Immediate Reduction in Low Back Pain Intensity Following Lumbar Joint Mobilization and Prone Press-ups Is Associated With Increased Diffusion of Water in the L5-S1 Intervertebral Disc.” JOSPT, May 2010, Volume 40, pages: 256-264.
- Melzack R., (2001). “Pain and the neuromatrix in the brain” Journal of Dental Education 65: 1378-1382
- Moseley, G. L. (2003). “A pain neuromatrix approach to rehabilitation of chronic pain patients.” Man Ther 8: 130-140.
- Maitland, Geoffrey, et. al, (1985), Australian Journal of Physiotherapy, Volume 31, Number 6, pages: 215-219.
- Nee, R. J. and D. Butler, S. (2006). “Management of peripheral neuropathic pain; integrating neurobiology, neurodynamics and clinical evidence.” Physical Therapy in Sport 7: 36-49.
- Nudo, R. J., G. W. Milliken, et al (1996). “Use-dependent alterations of movement representations of primary motor cortex of adult squirrel monkeys.” Journal of Neuroscience 16: 785-807.
- Gifford, L. S. (1989). “Pain, the tissues and the nervous system.” Physiotherapy 84: 27-33.
- Latremoliere, A. and C. Woolf (2009). “Central Sensitization: a generation of pain hypersensitivity by central neural plasty.” The Journal of Pain 10: 895-926.
- Lindstrom, I. C. Ohlund, et al. (1992). “The effect of graded activity on patients with subacute low back pain; a randomized prospective clinical study with an operant-conditioning behavioral approach.” Physical Therapy 72: 279-293.
- Moseley, G. L. (2003). “Unraveling the barriers to reconceptualization of the problem in chronic pain; the actual and perceived ability of patients and health professionals to understand the neurophysiology.” JPain 4 (4): 184-189.
- McKenzie, R. A., The Lumbar Spine Mechanical Diagnosis and Therapy, Spine Publications, 1981
- Fields, R. D., The Other Brain, Simon & Schuster Publications, 2009, pg. 192.
- Martin Englund (2008). “Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons.” N Engl J Med. (359 (11): 1108-1115.
- Jensen, M.C, et al., “Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain,” New England Medical Journal 331; 69-73, 1994.
- “Encouraging the Entrepreneur In Every PT,” (2011) PT in Motion (December 2011/January 2012.)
- Hayes, M. J., et al., (April 2012). “Epidemic of Prescription Opiate Abuse and Neonatal Abstinence.” JAMA, 2012.4526.
- Abramson, John., MD, Overdosed America., Harpercollins Publishers (2008).
- Volkow, Report From National Institute on Drug Abuse to Congress, May 14, 2014
- Glantz, Chicago Tribune, “Pain Killers Handed Out Like Candy at Wisconsin VA Hospital”, Jan 9, 2015
- Surkitt, Luke D, et al., (May 2012). “Efficacy of Directional Preference Management for Low Back Pain; a Systemic Review.” Physical Therapy, Volume 92, Number 5, pages 652-665.
- Johnson, Robert, Noi Lecture, “Mobilization of the Nervous System”, Stevens Point, Wisconsin, March 2012.
- Latremolier, A., et. al, (2009), “Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity”, Journal of Pain, Vol 10, No 9 (September) 2009: pp 895-926.
- Katzman, W., et. al, (2010), “Age-Related Hyperkyphosis: Its Causes, Consequences, and Management,” JOSPT, June (2010): pages: 352-358.
- Before/ after client videos, Overview and usage video, Website: backsmithsupports.com and backsmithadvancephysicaltherapy.com
