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'Slow' Physical Therapy
Fights Tough Back Pain


Moving beyond fine wine and creamy cheese, France may have given the world a whole new way to make life better: a specific form of physical therapy that promises relief for millions of people now suffering the crippling effects of severe back pain.

A new study out of Argentina focuses new light on the potential benefits of the Souchard global postural re-education method (GPR) -- a not-so-new regimen of stretching and strengthening back muscles, developed over a quarter-century ago by French doctor Philippe Souchard.

Study author Dr. Conrado Estol said preliminary research suggests the GPR technique quickly improves quality of life for a majority of patients disabled by chronic lower back and neck pain.

"I am extremely enthusiastic, said Estol, who presented his findings April 14 at the American Academy of Neurology's annual meeting in Miami Beach. "It's a very safe method, and I think we're proving it works."

The GPR method addresses posture correction in problem areas by targeting entire muscle groups, rather than individual muscles. These muscle chains are slowly stretched and elongated over multiple therapy sessions to relieve pressure on pinched spinal nerves. The technique is non-surgical and does not involve prescription medications, Estol said.

As director of the Neurological Center for Treatment and Rehabilitation in Buenos Aires, Estol treated 102 Argentinian men and women, aged 25 to 91, between 2000 and 2004, for his study. All had been afflicted with severe back pain for an average of seven months prior to the study period.

Patient diagnoses covered a range of disc diseases, including spinal disc protrusions and spinal canal stenosis -- a narrowing of the vertebrae channel, or spinal canal, surrounding the spinal cord.

Prior to receiving GPR, all the men and women had already been prescribed at least one traditional remedy for a minimum of six months, including such non-surgical treatments as regular physical therapy, anti-inflammatory drugs, acupuncture, epidural injections, or simply rest.

Estol stressed that neither rest nor any of the previous treatment options had helped diminish symptoms among the 82 patients treated for lower back pain and the 20 with neck pain. More than a quarter of these patients said they had experienced major disruptions to their daily routine as a result of their pain, such as ceasing to be able to work, exercising, or walking more than five blocks without stopping. The remaining 75 percent were forced to forego some work or some exercise, and could not walk more than 10 blocks without stopping.

Following an initial week in which they received two therapies, all the patients were placed on a five-month regimen of once-weekly GPR administered in a combination of standing, sitting, and lying positions. Therapy sessions also included breathing instruction, and patients were also instructed in a special home-exercise program.

According to Estol, 85 percent of patients noticeably improved after the first three weeks of GPR. By the end of the study period, 90 percent of the men and women were able to resume their normal daily routines. Six percent said they continued to experience some pain when engaging in demanding sports activity, while four percent gained no apparent benefit from GPR.

The researcher reports that after almost two years of in-person or telephone follow-up, none of the patients who appeared to benefit from GPR reported any back pain relapse.

"This technique would probably be good for almost anyone," suggested Estol, who has been exploring the promise of GPR for more than 14 years. "It corrects posture, and can help with all kinds of back pain."

But he also emphasized that his study only focused on people experiencing the most severe and enduring kind of back disease.

"Most cases of lower back pain and neck pain go away spontaneously while the patient is being worked up or just starting physical therapy," said Estol. "Intractable back pain is very rare nowadays, but these people were not going to improve on their own in four or five days. Some of these patients couldn't walk."

Estol described GPR as a softer, less brisk alternative to traditional physical therapies, as well as an effective non-surgical answer to back pain intervention. In his opinion, surgery involves a substantially higher amount of risk, as well as costing more.

"GPR appears to be effective, but, of course, people should always get evaluated first by a physician with expertise before they choose a treatment," he added.

Dr. Arya Nick Shamie, chief of spine surgery at Veterans Administration Wadsworth in Brentwood, Calif., agrees that informed medical advice is in order whenever back pain persists beyond two weeks or is the result of an accident. But once in the doctor's office, he's not so sure GPR is a patient's best option.

"Back pain is such a mixed soup of various problems, and this study lumps all sorts of diagnoses into one group," cautioned Shamie, who is also medical director at UCLA Spine Center. "A patient with sciatic pain, and another with degenerative disc disease, and another with a cyst in his spine -- if you group all of these patients together and suggest this one form of physical therapy is going to treat them all, it's not so compelling."

Shamie also expressed concern that no other form of therapy was studied alongside GPR as a point of comparison as a "control" group. And he stressed that back pain is an extremely complex, often misdiagnosed phenomenon that defies easy solutions.

"But I don't want to totally dismiss this study," he said. "Ninety percent of patients get back pain sometime in their life. It's a very common problem. And you depend on your back anytime you move or do anything.

That's why it makes patients so desperate, because they can't function," he said. "So this is interesting, and it might tell us that physical therapy, overall, does help patients, and we shouldn't disregard it as a technique."



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