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Isolating a Source of Relief from Back Pain

Hello visitor! In our constant effort to provide better patient care, we’ve updated this article to make it easier to read and to provide additional details. This article was originally posted on March 8, 2013. This article was updated on January 17, 2016.
Todd Ginkel - Cropped Photo
Dr. Todd Ginkel, D.C.

Todd Ginkel, D.C., CEO of PDR Clinics, explains that exercising and strengthening the spine musculature to resolve back and/or neck pain can be difficult because larger and stronger muscles in the back may activate before the cervical or lumbar muscles are isolated. MedX machines, however, like those used at PDR Clinics, addresses this obstacle by directly isolating a patient’s muscles, eliminating interference by other muscle groups that are not directly involved in the patient’s back or neck pain.

“MedX machines, which include the Lumbar Extension, Rotary Torso, Cervical Extension and the Cervical Rotation, isolate spinal muscles so effective rehabilitation may occur,” Dr. Ginkel explains. “Without proper isolation, compensatory muscles are activated with little to no effect on the muscles that need to be targeted, such as the multifidus in the lower spine.”

Software resides in the MedX equipment and allows clinicians to collect data throughout all phases of rehabilitation, Dr. Ginkel says. Initially, therapists conduct a physical test and compare the results to age-, gender- and weight-based norms. These scores and comparisons enable therapists to tailor a rehabilitation plan to each patient. Because the software gathers data throughout the exercise process, therapists compile empirical evidence quantifying how each patient responds to therapy, which enables them to determine if and when patients meet their rehabilitation goals.

“We don’t take our patients beyond their ability levels,” Dr. Ginkel says. “We bring them back to where they should be to perform the activities of daily living, and then their home maintenance program maintains that. It’s not like strenuously working out your biceps so they get huge, and then when you stop, those muscles return to normal. We try to return our patients to their normal ability levels.”

After completing an eight- to 12-week rehabilitation program using the MedX machines at PDR, patients maintain progress through the practice’s Maintenance Program, which allows patients to use the MedX machines once a month. Dr. Ginkel notes that an internal study of PDR patients showed that 97% of those who used the MedX maintenance program successfully maintained their strength gains or had gained additional strength at one-year follow-up.

Stabilization is the Key

To help a patient achieve proper lumbar isolation during exercise, the MedX lumbar extension machine, for instance, keeps the pelvis and legs fixed in place through a system of padded restraints.  Therapists may adjust the machine to fit each patient, preventing disc herniation or further injury. Dr. Ginkel explains the motion of the exercise actually reduces disc bulging and helps direct blood flow to the injured area, loosening ligaments, muscles and connective tissue.

Jennifer Missling, M.S.P.T., Director of Rehabilitation at PDR, says limiting patients’ range of motion also helps allay fears of movement that may have been reinforced by constant pain.

“The MedX machine is a great tool because only therapists can get someone who is guarded in their range of motion in the machine, which only allows them to move in an isolated way,” Missling says. “Patients feel safe, work one on one with their therapists, and objectively see their range of motion improve every week, which gives them confidence and spinal strength to be more successful when we move them into more functional movements and activities.”

Reducing Downstream Costs

Tom Kraemer - Cropped Photo
Dr. Thomas Kraemer, M.D.

Thomas Kraemer, M.D., Medical Director of PDR, explains that back pain is complex because as the pain essentially shuts painful muscles down, other muscles activate to carry the burden. Therapists at PDR use the MedX machines to reactivate the muscles that have been dormant and inhibit those muscles that were never supposed to activate to begin with. Doing so renormalizes movement, prevents further exacerbation and, by encouraging blood flow to the weakened musculature, encourages the reduction of  myofacial adheasions and restoration of muscle mass.

Ultimately, PDR teaches its patients the techniques and exercises that enable them to take control of their therapy.

“From their first consultations with physicians on day one of the program through the rest of therapy, we teach patients how to be their own therapists,” Dr. Kraemer says. “We want them to be independent, self-sufficient and maintain their health on their own. We’re trying to build independence so they don’t have to keep utilizing health care.”

Patient education does not stop at the proper training regimen, Missling says. Patients also learn self-management techniques for addressing painful muscle flare-ups and receive training in proper functional movement that prevents patients from suffering additional strain caused by improper lifting, standing or sitting.

Things Have Changed

Over the years, approaches to treating back pain have changed, Dr. Kraemer remarks. Whereas the old approach was marked by timidity, he says the new method is predicated upon aggressive treatment, depending on patient comfort. At PDR, the MedX machines play a significant role in providing effective and aggressive treatment, enabling therapists to more quickly move patients with chronic or recurrent back pain to standard exercises.

“If patients are weak in isolated areas, such as the back, then it will be difficult to be successful with normal exercises,” Missling says. “By using MedX equipment to bring them up to a normal level of strength and range of motion, those exercises become much more effective.”

Pre- and Postsurgical Utility

Dr. Kraemer notes that some patients respond well to standard exercise, and for these patients, therapists at PDR provide comprehensive therapeutic services to facilitate their recovery. For those who have not responded well to standard exercise or are recovering from surgery, a therapy that includes exercises using the MedX machine may present the best therapeutic option.

Dr. Ginkel emphasizes that patients considering surgical intervention for back pain may experience relief through therapy using the MedX machine, thus eliminating the need for surgery.

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Manage Back Pain in Four Easy Steps

This article was originally published on March 4, 2013. In an effort to provide the best possible information to our patients and web visitors, we’ve spruced up the article with a few updates regarding how to manage back pain. This article was updated on January 17, 2016.

We know that experiencing chronic back pain can be the worst thing imaginable. However, here are a few simple steps you can take to help manage back pain, whether you’re experiencing a flare-up or your typical daily pain.

  1. Control inflammation:  Avoid heat if you’re flared-up.  You can apply an ice pack over a painful area for 20 minutes, several times/day. For a homemade solution, you can make an ice pack with 5 parts water to 1 part rubbing alcohol in a zip lock bag, then place it in your freezer. For daily pain, moist heat can be helpful with relaxing tight muscles.  A hot water bottle or towel soaked in hot water are preferred over heating pads to minimize the risk of skin burns.
  2. Keep moving!  In general, bed rest should be avoided in order to maximize blood flow and maintain your mobility.  Try to perform your normal daily activities if you can.
  3. Stretch the affected muscles gently (without increasing pain) 2 – 3x/day, followed by icing the aching muscles. Just like doing your daily activities, stretching will help you maintain mobility.
  4. Breath!  Both an effective relaxation and pain management technique, therapeutic breathing helps to relax tight muscles and reduce stress, and as a result, decrease pain.

Manage back pain with a deep breathing technique

Step 1:  Lie down or relax in a chair.  Place one hand over your belly, which you should feel rise and fall during each breath (avoid breathing with your chest).  Breathe in 4 seconds through your nose, and out 4 seconds through pursed lips.

Step 2:  Practice this technique when stretching to make them more effective by helping to relax tight muscles.

Step 3:  Use this technique when experiencing increased pain for better pain management.


Did these tips help? Do you have anything to add? If so, send us a tweet at @PDRClinics. We’d love to hear from you!

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Focus on Function: Our Treatment Philosophy

This article is a revised version of a post published on January 07, 2013. We have updated the article so that it is easier to read for most web visitors. This article was updated on January 16, 2017.

We believe that if we focus on pain and structure alone, patients suffering from chronic back pain are led down the wrong road, often leading to unnecessary treatment with little improvement in outcomes.  Reducing the surgical incidence of low back pain, and being the leader in non-surgical treatment of low back pain is PDR Clinics’ vision. The primary goal of our treatment approach is to restore a patient’s function so that they may avoid costly surgical interventions, ongoing use of medications, and continued use of medical services. To do this, our focus is on functional restoration both of the spine and of the whole body.

Our Focus on the Pain Cycle

When a person experiences low back or neck pain, the natural response is muscle guarding and compensation.  An initial “disc injury or back strain” becomes a widespread neuromuscular problem. This leads to more problems and more pain. Altered muscle activity leads to systemic and predictable patterns of muscle and postural imbalance. Persistent imbalance to the motor system creates tissue changes, particularly inhibition and atrophy of the supporting multifidus and transverse abdominus musculature, and chronic spasm and tightness of other muscle groups such as the psoas or piriformis. Connective tissue fibrosis also results from abnormal movement, leading to more pain and dysfunction. Weakness and decreased range of motion change joint mechanics and place abnormal stress to the spinal segments.  As a result, more pain and inflammation ensue. [i][ii][iii][iv][v]

Our Focus on the Recycle Cycle

For recovery to occur, the treatment must focus on both spinal function and whole body function. In the recovery or treatment cycle, we introduce isolated MedX exercise to focus on improving the mobility (range of motion), stability, and strength of the spine (spinal function). The MedX exercise literature demonstrates superior isolation in strengthening the supporting spinal muscles and discourages the typical compensatory movement patterns. [vi][vii][viii] Research has clearly demonstrated patients with low back pain develop wasting of the multifudus muscles of the spine which correlates with onset of low back pain. [ix] Furthermore, the muscle wasting occurs early and does not reverse automatically, even when symptoms resolve. [x] Isolation and strengthening of the multifidus and related spinal muscles with MedX equipment results in improved spinal function and a reduction in pain and future episodes of low back pain. Concurrently, we begin to progress around the treatment cycle with home based activities and patient education. Mobility, stability, and strength activities are introduced along a progression, based upon concepts of lumbar stabilization. [xi][xii][xiii] Training the patient in stretching, core initiation and progression into trunk stabilization and strength is a key to regaining normalized motor patterns. PDR’s training and education in protective and proper body mechanics with movement helps restore whole body function.


[i] Langeven H, Sherman K.  Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms.  Medical Hypotheses 2007: 68: 74-80.
[ii] Kader DF, Wardlaw D, Smith FW.  Correlation between the MRI changes in the lumbar multifidus muscles and leg pain.  Clinical Radiology 2000: 55: 145-149.
[iii] Danneels, L, Vanderstraeten G, Cambier D.  CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects.  Eur Spine J 2000: 9: 266-272.
[iv] Kjaer, P, Bendix T, Sorensen J, et al.  Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?  2007.
[v] Flicker,et. al. Lumbar muscle usage in chronic low back pain.  Magnetic resonance image evaluation. Spine. 1993 Apr;18(5):582-6.
[vi] Graves J, Webb D, Pollock M, et al.  Pelvic stabilization during resistance training:  Its effect on the development of lumbar extension strength.  Arch Phys Med Rehabilitation 1994: 75: 210-215.
[vii] Carpenter D, Graves J, Pollack M, et al.  Effect of 12 and 20 weeks of resistance training on lumbar extension torque production.  Physical Therapy 1991: 71: 580-587.
[viii] Russel G, Highland T, Dreisinger T, Vie L.  Changes in isometric strength and range of motion of the isolated lumbar spine following eight weeks of clinical rehabilitation.  Presented at the North American Spine Society Annual Meeting,Monterey,CA, 1990.
[ix] Kamas et. Al.  CT measurement of trunk muscle area in patients with chronic LBP. Diag Interv Radiol. 2007 Sep;13(3):144-8.
[x] Hides, J. , Richardson, C, Jull G.  Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.  Spine 1996: 21: 2763-2769.
[xi] Richardson C, Hides J, Hodges P.  2004.  Therapeutic Exercise for Lumbopelvic Stabilization:  A Motor Approach for the Treatment and Prevention of Low Back Pain.  Elsevier Science Health Science
[xii] O’Sullivan et al. 1997. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:2559-2976
[xiii] Risch et al. 1993. Lumbar strengthening in chronic low back pain patients. Physiologic and psychologic benefits. Spine 18:232-238