Originally written and posted to the former website, “RemedyFind.com” in 2005. To the best of my knowledge, this program is still being used at New England Baptist Hospital.
After exhausting all surgical routes to ease my continued back pain, my surgeon referred me to a physiatrist at New England Baptist Hospital in Boston, MA that is one of the strongest nationwide proponents of the “back boot camp” recovery programs. Since I had seen much about this program on television, and read about it in the local newspapers, I was willing to give it a shot. I was anxious to get back into a “real” gym with the clanking of iron weights, as I was a competitive power lifter in the 1990’s. (And, no, that is NOT what led to my back injury!) I longed for the feeling of the post-workout muscle soreness and to LOOK, once again, like I was a chick that worked out!
Intensive rehabilitation, or “boot camp” programs, are being prescribed more frequently as therapy for back pain and other back conditions instead of the standard “take-it-easy” technique. The theory behind this approach is that aggressive exercise will help patients overcome fears about lifting and moving about in daily life. The program challenges muscles each session to the point of failure – this is how strength is gained. Strengthening the muscles around the injury can compensate for the injury in many cases.
A therapy “session” usually starts with 20 to 30 minutes of aerobic activity, followed by one hour of supervised weight-training exercises on Cybex-type machines that isolate back, hamstring and gluteus muscles, and finally a half-hour of stretching. In some clinics, participants lift milk crates containing steel bricks to simulate lifting objects in and out of car trunks and loading and unloading the dishwasher. Participants attend one to two sessions per week for one to two months.
These programs have gained lots of attention recently, and have been featured on local and national television stations and in several respected magazines: Health (2004); Alternative Medicine (Nov/Dec 2004); The New Yorker (April 8, 2002); Forbes (2004); Health Journal; and, The Saturday Evening Post (Jan/Feb 2005).
Eighty-five percent of people experience back pain at some time in their life. When back pain becomes so severe that daily tasks like taking out the garbage or doing the laundry are unbearably painful, most people seek medical attention. When this type of pain reoccurs over several months, usually these people begin to worry if they will need surgery. Out of all the people who seek medical attention, about 15 percent fit this profile. These are the people most likely to benefit from boot-camp therapy.
When you think about it, the less you move, the more your muscles atrophy. The more atrophy you experience, the less support your bones have and the less strength you have, the weaker you will be, and the more prone you will be to re-injury and more pain. It is a vicious cycle, so working out to preserve muscle mass does make sense. Learning that you CAN move about safely and that not all pain means injury is a good thing. This is what I learned from my participation in the boot-camp program. I also regained my strong back muscles that I had before my four surgeries. I can now unload my dishwasher without sitting on the floor, and climb a flight of stairs without holding on to the rail. It doesn’t sound like much, but to me, it is a huge accomplishment. I now know I can go back to the gym and slowly begin to lift weights in a safe manner. I will never be what I was before my surgeries, but I am no longer “taking-it-easy.” I am proof that back “boot camp” rehabilitation programs can help individuals regain strength in their back muscles, which in the end can help people to regain strength in their daily lives.
I must emphasize that these programs are NOT for everyone. Do NOT attempt to create your own “boot camp” program without seeing a doctor or therapist that is specifically trained in intensive rehabilitation. Only about 10 percent of the doctors in the United States currently feel that this treatment is beneficial (2005 statistics). Below are a few of the U.S. clinics that are known to endorse and prescribe intensive rehabilitation or back “boot-camp” programs:
New England Baptist Hospital’s Spine Center Boston, MA
Physician’s Neck and Back Clinic Minneapolis, MN
Texas Back Institute Plano, TX
CAVEAT: However, my story does not end as I cartwheel off into the sunset, pain-free. During one session, I was pushed by one of therapists to use more weight in a certain exercise than I felt comfortable using. I mentioned this to the therapist and was told to “not be so scared.” [As a former professional power lifter and a personal trainer for 10 years, I am acutely aware of the nuances of my body, and which twinges of pain mean “hey, something is wrong,” and which ones mean, “Stop, you fool! That is not a good idea!” ] So, I proceeded with the exercise and feel a ripping sensation down the inside back of my leg and up into my ‘nether regions.’ I had NEVER had any type of pain there before. I was unable to complete the aerobics class that day, and limped home to apply ice and my trusty Tiger Balm patch. Although the initial pain settled down after about a week, ever since that day, I had difficulty urinating. It was painful, and I couldn’t use the usual mechanisms to start and stop the flow. An average trip to pee now took 10 minutes to painfully coax the urine out of the bladder. On top of the discomfort and pain, my bladder never felt empty. I contacted the physiatrist – who told me to take an Advil and ignore the pain and continue therapy. I went one more time and was treated as if I was making up the whole scenario. I was told by one trainer that I was trying to “sidestep efforts to make myself better.” Yeah, that’s right. Me, a former gym rat, trying anything I can to not touch a weight ever again and become a couch potato (NOT). It would be nice if these trainers actually took the time to learn who their patients were.
A year later, I saw a urogynocologist that specialiszes in femal bladder issues. I was told that one of my nerves in the “nether regions” had been “compromised” in some way and recommended surgery to implant a Medtronic InterStim® Neurostimulator so that I could go potty like a normal human being. After much research, I decided to forgo this pee-pee pacemaker and continue on my quest to find a doctor that would listen to me and take my symptoms seriously.
I had recently located a neurosurgeon on the internet that had developed a way to image peripheral nerves by tweaking the settings on an MRI. His process is called an MRN – for Magnetic Resonance Neurography – and he was able to see peripheral nerves that often caused all the symptoms I was experiencing. There were actually other patients out in the world with histories similar to mine. His studies and experience had demonstrated that not all back and leg pain originates from the spinal nerve root and not all back pain needs to be addressed by multiple spinal surgeries. The problem was that he was in California – of course – and that even though he was educated at Harvard, and other medical schools, only Europe and the West Coast had embraced his studies, despite them appearing in several well-respected peer-reviewed medical journals. I did not know that in 6 years, I would have the honor of being operated on by this brilliant man, who validated the MRN that clearly showed that my problem was NOT spinal in nature, but in 4 peripheral nerves that were tangled in atrophied and hardened muscle tissue and scar tissue. (More details will follow in another post.)
Although I had a negative experience 5 weeks into the program, it was not a total waste of time and effort. Several of my co-sufferers did quite well without any setbacks. There were three other people in my group (there were approximately 20 of us) that had similar experiences to mine, although I do not know any of the details of their incidents. I still would recommend this program to anyone with a clearly diagnosed problem (unlike mine) that would benefit from strengthening the supportive musculature around the injured area, as well as the core muscles (abdomen, primarily). As a former personal trainer, I know the importance of having strength in these areas and work to maintain this strength on a regular basis.