Patients who are injured often gain weight over time. This is secondary to inactivity as well as a variety of medications including anti-depressants and membrane stabilizers which may induce weight gain. Once the patient has gained a significant amount of weight, it becomes very difficult to lose it since they are not able to be as active because of their pain. Finally, unauthorized drug usage and alcohol usage may contribute toward dysphoria and other functional impairment. All these issues must be addressed in conjunction with the other treatments.
Exercise is certainly the backbone of treatment in the conservative management of spinal disorders.
Patients with axial pain should be mobilized within two to seven days. Patients with radicular pain should not be at bed rest for a prolonged basis. In general, the patient should be mobilized within a comfortable level as rapidly as possible. Bed rest causes deconditioning and muscular and joint stiffness. Exercises to strengthen and stretch the back should be initiated as rapidly as possible.