A comprehensive therapeutical concept for chronic spinal pain to restore physical abilites and quality of life back to normal
One of the best longterm-effective therapeutical approaches in the last 15 years in chronic spinal pain is the high-tech-based training therapy with special machines. International studies proved already in the late 90-ies that the most responsible causes for the continous worsening of chronic spinal pain are weakened backmuscles. This happens, because the paindriven relieving postures and movements as well as the painavoidance behaviour leads rather quickly to a major loss of muscle function and mass! The consequent overload of the passive movement apparatus, e.g. capsules, ligaments or tendons cause just more pain by having high concentrations of painreceptors. The painintensification leads directly to more relieving postures and movements, what closes the vitious circle. Leading specialists in the U.S. stated that the most powerful pain maintenance factor for chronic spinal pain after 3 months of pain is not any longer the original "cause" for this pain, but much more the "muscular disusesyndrome", which is established by the a.m. vitious circle.
In December 2000 Dr. Stengg founded the multidisciplinary and multimodal pain-therapycenter pain care, based on the experience of international paincenters mainly in the U.S. and Germany, he could visit the years before. In the following 12 years he and his team permanently improved the trainingtherapeutical movement programs. In particular in the last few years it turned out more and more that just pure strengthening of the superficial spinemuscles, although it's done with the most modern facilities available, was not sufficient in some specific situations:
1) Some patients gained impressing amounts of strength in their outer muscular corset, but had nearly the same pain than
2) But other patients, who were very poor in their gain of absolute musclestrengths, told us that they haven't felt that good in
the last 10 years and admitted to do certain sportsactivities since weeks completely painfree, although Dr. Stengg had
forbidden these sports for at least another 3 months.
3) A lot of patients felt perfact after the program, but their risk to "hurt" their backs in unexpected fast and reflectory
movements due to a lack of stablilisation in these situations.
4) Very similar to that sportsmen felt much better and safer in their particular disciplines, unless they stumbled, lost their
balance after unexpected disturbance or they needed fast reflexes like fast turning in all stop-and-go-sports.
It turned out that these events occured, because the deep, segmental and reflextory stabilizers were still weak and often totally out of order. After we felt sure about this, performing some clinical tests, we established a new, softwaresupported coordination test, that indirectly is able to show the grade of coordinative lack. Overall we have tested more than 1500 patients up to now - everyone at the beginning and the end of the strengthening program. This additional measurement method together with the standardized maximum strenth- and strength endurance measurement enables us, to select the optimum type of program.
Before the patient is allowed to perform these tests, he or she should not have permanent pain, and if, then not higher than a 3 on a painscale between 0=no pain and 10= worst imaginable pain. During your first contact with the pain care concept, Dr. Stengg will perform the medical history and investigate you in a 60-minute first investigation. After more than 7000 pain patients since 2000, we know from our databank that more than 90% have been suffering from >6 years of chronic pain and spent >5 physicians, until they came to Dr. Stengg. He has been using the biopsychosocial painmodel in the last 15 years, so the paintherapy also comprises of more than one single modality. In the a.m. 7000 patients with this approach Dr. Stengg needed no more than 2-4 therapeutic sessions, until they could be switch to the active modalities.
One important differenciation is that the therapeutic sensomotoric trainingprograms at pain care have definitely nothing to do with a fitness center. The equipment is adaptable extremely individually and allows it also, to care successfully for e.g. a 75-year old, overweighted lady with a history of 3 spinal operations and a major osteoporosis with two fractured thoracic vertebrae. During the training therapeutic session one experienced therapeut cares for a maximum of 2-3 patients unless just for one. pain care was definitely designed to perfectly care for patients with chronic and complicated spinal paindisease. Dr. Stengg from the very first contact with the patients is around most of the opening times. He not only creates every single training therapy plan at the beginning and the recommendation plan for further handling at the end. If there is need for an acute help, he up to now guarantees an appointment for an acute intervention for latest on the other day.
One of the most important differences to normal muscletraining in a gym is the fact that even a 3-dimensional strengthening under intensive care covers just appr. 60% of the necessary input in a neuromuscular system that has suffered of pain over years. The reason, why even high-quality muscle strengthening is not sufficient at all, lies in a very fascinating ability of the central nerve systeme (CNS), in particular of the spinal cord. It is called the "neuronal plasticity", which in every situation tries to adapt the system "human being" as good as possible to outer circumstances - but: the central structures and programs are not really sure about it, whether it is good for us or not. Pain comes to the system unexpected, but especially the spinal cord adapts itself within hours and constructs an anatomical "painfactory", that can seen in a normal microscope just after 8 hours of pain! This changed the theory of how to use analgesic medication. But for our central mechanisms of moving it has another, not less meaningful consequence - the relieving movements at the beginning are categorized as wrong by our "high-performance-programmer" spinal cord. But in the development of chronic pain, as we know, the stimulus for the relieving postures and movements doesn't solve up again. After estimated 3-5 weeks our central "programmer" seems to get the order, to overwrite the normal movement patterns and take the wrong relieving habits and put them instead of these.
What could that mean?
If we just focus on strengthening, we will also come to a positive result, but: the longlasting effect is rather poor and the wrong movement patterns will come up again. Further more, one is not safe in fast unexpected reactions.
So we treat the muscular deconditioning syndrlome much more complex: in the first 2-3 weeks we just utilize low weights, but HOW the movement is performed in every plane, is very exactly corrected by the therapeuts, so that the "healthy pattern" can overwrite the wrong one completely. If then the goal for strength endurance is reached, we work increasingly on the musclehypertrophy as well as we start with complex sensomotoric training therapy. Following these basic rules we could create very effectful movement programs in the last years.