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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

Christmas Holiday Cookies Gingerbread

Managing Stress This Holiday Season

With the holiday season fast approaching, you need to learn how to positively deal with your holiday stress. Why? Keep reading to learn more.

The nervous system’s response to stress is commonly called the “fight or flight” response. This response is a heightened activation of the sympathetic nervous system (SNS) which is responsible for getting the body ready for survival. When stressed, our heart rate and blood pressure rises, our pupils enlarge, and our muscles tense.

When the body relaxes, the heart rate and blood pressure reduces, muscles unwind, and our breath deepens. In a state of relaxation, our nerves quiet, more oxygen is exchanged in the body, and the sensation of pain is reduced.

Prolonged physical and mental stress can contribute to headaches, nausea, fatigue, nervousness, indecision, and poor job performance. Emotional stress can contribute to increased muscle contraction, leading to weakness and fatigue. Under intense stress, muscles may become tight, inelastic and prone to injury and pain.

Stress management becomes a very important piece to daily life and pain management.  Here are some tips to help manage your holiday stress:

Stress Management Tips:

  • Identify and acknowledge the factors that may be causing stress in your life.
  • Prioritize your activities and commitments.
  • Set attainable goals.
  • Schedule time for yourself and enjoy a relaxing activity.
  • Maintain good nutrition. Avoid high levels of caffeine and sugars.
  • Use relaxation techniques to reduce the negative effects of stress and allow recuperation.
  • Use the three natural tranquilizers– music, laughter, and exercise. Research has shown that people who exercise regularly are more emotionally stable, less tense, and more creative.
  • Practice deep breathing using your diaphragm (belly) versus using your chest to breathe. Combine deep belly breathing while you exercise and stretch a few times a day.

With all this said, PDR Clinics wishes you and your family a happy holidays! We look forward to serving you and your family during another exciting holiday season.

Microphone Mic Interview Outdoors

The Role of Rehabilitation in Spinal Care with Lindsay Haugen, PA-C

This is a photo of Lindsay Haugen, PA-CLindsay Haugen, P.A.-C, one of our providers at Physicians Diagnostics & Rehabilitation Clinics (PDR), was recently interviewed on her experience in moving from a surgery-based practice to a rehabilitation practice that emphasizes intensive, non-surgical management of spinal disorders. She received her P.A. degree from the University of St. Francis. Lindsay Haugen joined PDR Clinics in February, 2012.

Question: What type of practice were you in prior to joining PDR?

Answer: Orthopedic Spine Surgical Specialty.

Question: Approximately how many surgical cases were you involved in per week?

Answer: I would assist in approximately 8 to 15 cases per week.

Question: Has your philosophy/scope of management of spinal conditions broadened since joining PDR? If so, how?

Answer: The patients that I see at PDR come in with similar spinal conditions that we would direct toward scheduling for surgery. After surgery these patients would then be potential candidates for non-MedX physical therapy. I would typically send patients for MedX therapy if they needed to return to work without restrictions. I often thought MedX therapy was too aggressive for my post-operative patients. After working with PDR and the MedX rehabilitation program with specialized protocols, I am finding patients can start therapy prior to surgical intervention and sometimes avoid surgery altogether. I am also finding patients can regain function, return to work and life activities whether they had a surgical procedure or not.

Question: Can you explain what MedX therapy is and how it is used in PDR’s rehabilitation program?

Answer: MedX therapy uses specific MedX equipment which is designed to isolate and strengthen the supporting spinal muscles and discourages the typical compensatory movement patterns. Using MedX exercise allows for improvement of mobility, stability, and strength of the spine and surrounding support structures. MedX therapy is the core of the PDR program in addition to a home exercise program to maximize a patient’s recovery potential.

Question: So, even if a patient had a surgical procedure, you are now finding they can still benefit from intensive spinal rehabilitation?

Answer: Yes. I’m finding that many patients can avoid surgery all together and if a procedure has been done, a patient can benefit from intensive rehabilitation by returning to previous home, work and leisure activities earlier and more successfully. In addition, I’m finding that even if a patient goes on to require surgery, prior spinal strengthening can help patients recover from surgery more quickly. These post-operative patients tolerate MedX therapy well. They demonstrate a greater reduction of post surgical pain symptoms compared to patients that do not attend therapy after the recovery phase as determined by their surgeon. I am finding patients can improve their quality of life.

Question: Based on your broad experience treating patients with neck and back pain, what do you see as the future of spine care?

Answer: The trend is toward multidisciplinary spine care, with the exhaustion of conservative care, including intensive spinal rehabilitation, before resorting to more invasive options. Good medical oversight and continuity of care will be an important aspect management of spinal conditions.


Lindsay Haugen, P.A.-C, currently treats patients at Physicians’ Diagnostics & Rehabilitation. If you’re interested in setting up an appointment with Lindsay, speak to our excellent front desk staff at +1 (952) 908-2700.