"Back Pain: Where Do We Stand?"

The cover story on Back Pain for the April 2009 edition of Advance For Directors In Rehabilitation refers to a number of rehabilitation professionals, including myself, who treat people with back pain. The following quote from the article, by the Advance Editor Jon Bassett, gives a nice introduction to me and my present work in physical therapy:

In nearly 30 years of clinical practice, Bruce Kodish, PT, PhD, has spanned the range of patient populations, from the halls of a Johns Hopkins University outpatient clinic to home-bound patients in the gritty neighborhoods of New York City. Now in part-time practice in Pasadena, Calif., Dr. Kodish treats a small group of patients with persistent pain problems using a movement-based perspective gleaned from his extensive experience in two well-established schools of thought—the McKenzie Method and the Alexander technique.

"Posture and movement are always connected with each other," says Dr. Kodish, author of Back Pain Solutions (Extensional Publishing). "If I had no methods other than postural training and patient education, I'd still be able to make a difference for a large percentage of patients."

Modern patient trials are starting to quantify the potential of movement-based education. A study in the August 2008 issue of the British Medical Journal found that one-to-one lessons from Alexander Technique practitioners were superior to massage therapy and physician-directed exercise prescription in improving disability and pain scores among patients with recurrent back pain. Six Alexander Technique visits were as effective as 24 visits, and results held up at a year post-trial.

Leading Alexander Technique researcher Ronald Dennis, EdD, defines the method as a nonexercise approach to improving body mechanics. "I see the Alexander Technique in Dennis' terms, as cognitive-kinesthetic education," explains Dr. Kodish. "It applies conscious thought and sensory perception to improve posture and performance.

Yet with so many trademarked approaches with flashy names and fierce disciples, how do cliinicians make the right choice for each case? Rather than pigeonholing patients, Dr. Kodish views the approaches he uses on a continuum of posture-movement therapy and education. "Therapeutic and educational methods overlap, and should draw from an up-to-date, research-oriented knowledge base," he says. "I'm relying on this framework to formulate the best overall treatment plan."