Magazine article The Exceptional Parent

Part 3: Muscles, Back Pain & Exercise-How Are They Related? an Interview with Norman J. Marcus, MD, DABPM

Magazine article The Exceptional Parent

Part 3: Muscles, Back Pain & Exercise-How Are They Related? an Interview with Norman J. Marcus, MD, DABPM

Article excerpt

The most common problem related to pain (a frequent issue among our military servicemen and servicewomen returning with war-related injuries)--for which medical advice is sought--is back pain. Norman J. Marcus, MD, DABPM, believes that muscles are actually the most common source of back pain, but says a thorough examination of muscles is rarely, if ever, done. Dr. Marcus has created a protocol for evaluation and treatment of acute and chronic pain that includes the assessment of muscles as a source of pain. His approach is based on the methods taught to him by his former colleague, the late Hans Kraus, MD, father of sports medicine, and physician to President John F. Kennedy who suffered with chronic back pain.

Here, Dr. Marcus addresses the relation between muscles, back pain, and exercise.

EP: Tell us about Dr. Kraus' theory behind muscle pain treatment and the exercises he developed for treatment.

Norman J. Marcus, MD, DABPM (NM): Dr. Kraus, who originally was an orthopedic surgeon, actually established the first multidisciplinary pain center in the world in the late 1950s, which very few people know. It was at the Columbia University School of Medicine in the department of orthopedic surgery. There were psychiatrists, social workers, psychologists, physical therapists, physiatrists, and orthopedic surgeons, treating and trying to understand back pain.

They found that about 80% of patients presented with nothing that could be demonstrated on an x-ray or physical exam that suggested there was some anatomic pathology, so they tried to understand it from the perspective of conditioning since that was Dr. Kraus' background. They studied about 3,700 patients for 4.5 years and created a test--called the Kraus-Weber test--and an exercise program to go along with the test to deal with what they thought were the types of functional muscle pain that exist.

They broke it down into four types of muscle pain:

* Tension

* Deficiency, which is defined as weakness and stiffness

* Spasm

* Trigger points

They created the Kraus-Weber test to assess a minimal acceptable level of trunk muscle strength and flexibility, which in and of itself, was a very unique concept. They were saying that, in order for a person to function in a relatively normal way, they needed to pass these six test items, which are:

1. Touching the floor with your legs straight and feet together to test back and hamstring flexibility

2. Sitting up with legs extended to test abdominal and hip flexor strength

3. Sitting up with knees bent to test abdominal strength

4. Lying on your back and lifting both legs for 10 seconds to test lower abdominal and hip flexors strength

5. Lying on your tummy and lifting up your legs to test your lower back muscle extensors

6. Lying on your tummy and lifting your head and chest to test your upper back extensors

In looking at those 3,700 patients who had pain but no significant pathology, almost all of them failed the test, meaning failure on any one of the six items.

The group at Columbia then put together an exercise program that was specifically created to address the failures on the test. It came down to 21 exercises for the low back. It started with many more, but they eliminated a number of exercises because they would sometimes cause discomfort for the patient. This work was all predicated on being able to do something simple and not pain producing--not requiring any sort of technology with the least amount of resistance for the patient; meaning most exercises are done on your back to avoid gravity. After 4.5 years, the group at Columbia came up with the 21 exercises, which then intrigued the people at the YMCA, who created a program to deliver these specific exercises called "The Y's Way to a Healthy Back." They delivered it to 300,000 patients with an 80% success rate. …

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