MedX Exercise Provides Superior Spinal Strengthening

MedX equipment was developed to provide superior isolation of the spinal musculature, that would allow for specific muscle testing and rehabilitation of the spine. Most of the research done on the training specifications, reliability, and validity of strength testing was completed by the University of Florida- Gainsville and University of SanDiego’s exercise physiology departments beginning in the early 1990’s.

MedX Validity

MedX equipment is specifically engineered to improve the isolation of the spinal musculature. Without the specific design of the machine components, other muscle groups may compensate which would lead to poor validity. Counterbalance systems off-set the affects of gravity when testing and exercising in the forward plane. The CAM system provides variable resistance that optimally loads the isolated muscle throughout the range of motion. Together the restraints, the counterbalance, and the CAM provide accurate isolation and strong validity for assessing the spinal musculature. Research provided by Graves, 1994 compared three different types of lumbar strengthening equipment including Nautilus, Cybex, and MedX and found superior isolation with MedX equipment.

MedX Reliability

Inter-reliability and intra-reliability has been established for each MedX machine.  Legget et al, 1991, and Graves et al, 1990, studied the repeatability of strength testing. They found high correlation coefficients for each machine at every testing angle (r= 0.90 – 0.97). Therefore, MedX testing is considered very accurate both between testers and examiners.

The MedX Advantage

As providers using MedX to treat neck and back pain, we have identified many advantages in using this equipment to strengthen the spine. MedX allows us to safely isolate the spinal muscles at a much greater intensity level without compromise to the disc.  This initiates remodeling and rebuilding the paraspinal muscle tissue and breaking the pain cycle.  Secondly, the therapists are able to deliver calculated doses of exercise which increases safety, efficacy, and the ability to gauge the patient’s progress. Without this isolation provided in the MedX, other muscle groups tend to compensate which make it impossible to improve the patient’s spinal health. Finally, the positive feedback to the patient is very motivating and rewarding, as patients can visually see their progress in strength and range of motion.

Nonspecific Low Back Pain

Most people will experience back pain at some point in their lives, unfortunately.  Odds are that if you don’t have back pain, you know at least one person who does.  Different studies estimate that between 60% and 80% of people will experience back pain.  It can range from a nuisance to debilitating.

Oftentimes, patients with low back pain ask about getting an imaging study of their spine, such as an X-ray or MRI, to help determine the cause of their pain.  Oftentimes, degenerative disc disease will be seen on imaging reports – particularly if the patient is 40 years old or older.  Disc bulges or herniation’s are another common finding, which can make patients quite anxious and worried. 

As it turns out, these findings are actually quite common – even for someone who has no back pain at all!  Let me say that again:  These are things we can see on a spine of someone who is not in pain!  On the other hand, sometimes a patient in terrible pain can have a perfect looking X-ray or MRI!  So, what on earth does this mean? It means that there is something else that is causing the pain.  We refer to this as nonspecific low back pain.

That is sometimes why you hear stories of friends and family who have had back surgery that failed.  The surgeon, in a good faith effort, eliminated what looked iffy on the MRI, but it didn’t help!  That’s because the bulging, degenerated disc wasn’t the problem, and why many doctors are reluctant to order MRI’s.  Not only are MRI’s expensive, but they can lead us down the wrong path – away from the path of recovery and down a path of injections and surgery instead.

What studies show (and what we at PDR see everyday) is that muscles and soft tissue are the root of many problems, which don’t even show up on imaging studies.  If you have tight muscles, weak muscles or imbalanced muscles, that can create a lot of strain on the spine.  And that strain can hurt a lot!  Sometimes that pain will even refer down into your buttock or thigh (oftentimes referred to as sciatica), which can seem even scarier. 

Muscular problems can happen to anyone.  An athlete can sprain a muscle, an otherwise healthy person can slip on the ice and irritate a muscle, a worker can strain their back by using poor body mechanics and/or sit with poor posture all day at work.  The wonderful news is that these problems are very manageable!

At PDR, our physicians, physical therapists and occupational therapists are highly skilled at helping you get your spine back into shape.  We are experts at knowing which stretches, strengthening exercises and manual therapies to use to get you back on track.  So try not to worry if your imaging studies show a problem, we can help

Post Surgical Rehabilitation

Post surgical rehabilitation is essential for maximizing outcomes of surgical intervention.  Surgery is aimed at correcting a structural problem within the spine, however the musculature is left often times in a weakened state.  It is essential for the post surgical patient to be educated in a proper exercise program to completely regain functional use of the spine.

PDR has developed several MedX post surgical protocols that have been successful in allowing patients to regain full motion and strength following surgery.   Physical rehabilitation following spinal surgery is necessary to restore strength and range of motion while protecting the surgical site and improving repair.  Avoiding physical activity can result in muscular fibrosis, adaptive tissue shortening, loss of function, and increased risk of re-herniation.

Axial strengthening is necessary to return patients to physically demanding activities in their daily life or occupation and avoids re-injury.  Typically, along with the disc injury there is also a soft tissue injury, specifically to the paraspinal musculature. The MedX equipment allows us to isolate and administer calculated doses of exercise to the paraspinal muscles at a therapeutic level without compromising or overloading a post-surgical disc.  Isolated mechanical loading allows us to safely break up random alignment of the collagen fibers (myofacial adhesions). Continued loading during the healing process stimulates the new collagen fibers to lie down along the lines of mechanical stress, thus forming a stronger and more functional repair.

Inducing controlled segmental motion also produces facet motion, breaks up capsular adhesions, promotes the production of synovial fluid, and ultimately normalizes facet range of motion. Reintroduction of controlled activity also allows us to address the fearful patient and demonstrate that post-exercise muscle soreness is not injurious pain. Several studies have demonstrated that exercise increases levels of encephalin, endorphins, serotonin, and norepinephrine that help control pain.

Phase I: Reintroduction of Spinal Motion

The goal of phase I is to reduce inflammation and pain while slowly reintroducing normal inter-segmental spinal motion.  The patient is instructed in proper postures and body mechanics to safely return to light activities of daily living. 

Phase II: Restoration of Spinal Strength and Function

The goal of Phase II is to promote spinal AROM, continue cardiovascular conditioning, and introduce extremity and spinal extension exercises. Progressive resistance exercises (PRE’s) are used.  During this phase it is crucial to restore motion at the level of the disc, promote imbibition of fluids, and to restore normal facet motion.  Specific stretches are instructed to prevent adaptive shortening of soft tissues.

MedX equipment is introduced in this phase to safely exercise the extensor muscles while ensuring proper segmental loading. The patient’s AROM can be limited to avoid excess flexion, which would increase hydrostatic pressures on the posterior aspect of the disc.  Limiting forward flexion therefore decreases the risk of posterior disc re-herniation.

Phase III: Restoration of Lumbar Strength and Function

After 4 weeks of successful phase II rehabilitation without significant peripheralization, rehabilitation may become more aggressive. The goal of Phase III is complete restoration of lumbar AROM and strength.  This phase includes more aggressive lumbar MedX strengthening, cardiovascular, and total body strengthening exercises.  Rotary torso MedX strengthening may be introduced at week 9 if lower extremity symptoms are minimal and lumbar discomfort is controlled. If return to work is anticipated, job specific (work conditioning) exercises may be ordered. A functional capacity evaluation can be performed at the completion of the program to objectively determine safe work restrictions.