Device offers relief from low-back pain
By Nina Olson, PT, DPT, CPI, and Andrew Coster
As featured in Advance for Physical Therapy & Rehab Magazine (Vol. 23 • Issue 7 • Page 32)
In the history of rehabilitative medicine, there have been some complex modalities developed to improve strength and proprioception of various muscle groups that ultimately lacked in providing functional benefit to the patient. Some of the more simple and functional treatment options have withstood the test of time and become tried and true treatments prescribed by clinicians.
There is often beauty and sophistication in the most simple and functional treatment options. One such option is a laser-pointing device, attached to the pelvis, that the patient guides through a series of patterns using dynamic pelvic tilts and rotations. In tracing the patterns, the patient activates the stabilizing muscles of the spine (lumbar multifidi, transverse abdominus and pelvic floor).
Dr. Paul Hodges found that accurate control of the lumbar spine and pelvis is dependent not only on the capacity of the muscle, but also on the sensory system that provides information about the status of stability, recognition of perturbation and the development of the “internal model of body dynamics” that provides the CNS with the capacity to predict the outcome of mechanical events and predict the interaction between the body segments and the environment.1 Furthermore he reported that patients suffering from low-back pain resort to spine stiffening to provide lumbopelvic control, whereas healthy subjects move to regain pelvic stability. It is this stiffening of the spine that contributes to the chronic nature of low-back pain.2
Dr. Hodges’ findings have been verified in clinical trials that evaluate low-back pain and therefore it is reasonable to conclude that physical therapy strategies for low-back pain should include exercises that functionally strengthen both the intrinsic and extrinsic muscles of the lumbopelvic region and seek to restore proprioception of the lumbopelvic region.
There are numerous benefits to exercises that activate the deep stabilizing muscles of the spine. Regained proprioception is the one benefit that virtually all patients experience. Whether it is an older patient who has diminished proproception as a function of age or a high-level athlete seeking to refine pelvic stabilization, re-educating these muscles can help accomplish their goals. Improved pelvic propriocetion is especially important in the geriatric population as a method of reducing the patient’s predisposition to fall related accidents.
For weekend warriors on the golf course or at the local pick-up basketball game, these exercises promote improved lumbopelvic proprioception and mobility, which not only leads to improved physical performance but also contributes to injury prevention. Most people, injured or not, could benefit from including in their workout/rehab regimens lumbopelvic proprioceptive, stability and mobility exercises that activate the deep stabilizing muscles of the spine.
In the clinic, numerous exercises for low-back pain can fulfill both requirements set forth by Dr. Hodges. These traditional exercises range from simple supine pelvic tilts and clocks, lumbar stabilization exercises utilizing various pieces of equipment to provide added challenge, to Kegel exercises with patients hooked up to a biofeedback device to ensure the neuromuscular re-education component. The constraints of traditional modalities are that they require different pieces of equipment and one-on-one instruction from a therapist. A device that would provide a patient with a series of exercises targeting the muscles of the lumbopelvic region while providing biofeedback would be an excellent adjunct to traditional treatment.
New Laser Modality
A lumbopelvic stabilization and proprioceptive device uses the beam of a laser to guide a patient through a series of pelvic exercises while providing constant, easy to interpret biofeedback. Although no clinic trials have been conducted in low-back pain using the product, ultrasound imaging has shown that while patients are completing the prescribed exercises the pelvic floor and transverse abdominus are engaged. Since it has been empirically demonstrated that using the device activates these intrinsic muscles and it inherently includes a simple biofeedback component, it has the potential of being an excellent tool in the treatment of low-back pain. The company is conducting a controlled clinical trial to validate proof-of-concept findings in low back pain using this new modality.With the laser pointing device snugly strapped around the patients’ hips, the patient uses a series of pelvic movements to trace the prescribed patterns on a target in front of them. The patient, starting in a neutral position with the laser pointed at the center of the target, guides the beam of the laser up and down the vertical line using anterior and posterior pelvic tilts.
Once the patient has successfully completed the pelvic tilts, the next foundation exercises are pelvic rotations. Once again, starting in a neutral position with the laser beam centered on the target, the patient traces the horizontal line to the left and then back through the origin to the right. The most important part of this exercise, and all the sequential exercises, is that the patient keeps their shoulders perpendicular to the target, with the goal of creating hip and shoulder separation.
After the patient has completed the two foundation exercises, they will be ready to start the other exercises of tracing shapes ranging from circles to vertical figure-eights. These non-linear shapes create a training experience in which the patient dynamically transitions between pelvic tilts and rotations, all while having the benefit of direct visual proprioceptive feedback. These movements are functional movement patterns seen in everyday life-picking up an item off the ground and coming back up to standing, walking, and weight-shifting to maintain balance.
In addition, these movements are often seen in various sports-the golf and baseball swing, tennis, and swimming. Practicing these movements with direct visual feedback can improve the individual’s ability to efficiently and precisely move in a functional and sport-specific pattern. Assessing patient progress using the device is as simple as measuring the distance from the target that the patient can complete all the exercises. The closer a patient stands to the target, the more difficult the exercises become.
What makes this product unique is that it uses “direct visual feedback.” With the beam of the laser, the patient is not only instantly aware of how their body is moving, but is also able to reconnect neuromuscular constructs by correlating the visual cue with a kinesthetic experience. Additionally, doing the exercises is fun. Patients experience “reward-based” therapy, challenging themselves to complete the exercises by tracing the patterns more accurately or with more resistance (stepping closer to the target). This “built-in” biofeedback component along with the strengthening results of the movements allows the device to satisfy both the muscle capacity and CNS component of pelvic stabilization prescribed by Dr. Hodges.
Although the laser training device is not currently being studied in other conditions besides low-back pain, its potential for physical therapy is promising. Based on the muscles activated by using the laser, patients suffering from conditions associated with poor pelvic floor health could benefit from its use in addition to traditional treatment. These conditions include but are not limited to urinary/fecal incontinence, stress incontinence, post-partum rehabilitation and pelvic organ prolapse. There are also initial case reports that suggest in some male patients with erectile dysfunction, using the laser has reduced their need for ED drugs. Further research is required to investigate these other applications.
1. Hodges, P. (2003). Core stability exercise in chronic low-back pain. Orthopedic Clinics of North America, 245-254.
2. Hodges, P., & Moseley, G. (2003). Pain and motor control of the lumbopelvic region: Effect and possible mechanisms. Journal of Eletromyography and Kinesiology, 13, 361-370.
Nina Olson joined Freedom Physical Therapy Services in Fox Point, WI, in 2005. She is a certified Pilates instructor and earned her Certificate of Achievement in Pelvic Physical Therapy through the American Physical Therapy Association. Andrew Coster is responsible for executing the Core Laser brand strategy along with the overall mission of Laser Gym