View Full Version : Functional Restoration Programme

5th September 2006, 09:44 AM
Hello everyone,

I have just returned home after attending the"Functional Restoration Programme" at the Robert Jones & Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire. The RJAH is a centre of excellence for spinal disorders and treats people from all over the Midlands and Wales, in much the same way as the RNOH in Stanmore treats people from all over the southeast of England.

RJAH's Functional Restoration Programme is a 3 week long course designed to help people with severe chronic back pain to better manage their pain so that they can live more fulfilling lives. This is achieved by a combination of physiotherapy, occupational therapy, and education sessions.

Everyone who attends the course has a medical assessment before they are allowed to join in, to make sure that they are not in any danger of damaging their backs through exercise. I had an appointment with a scoliosis specialist, which confirmed that although there are various things that need to be kept an eye on, the metalwork in my back is all still intact (something that had been worrying me) and that my pain is due to muscle spasms and referred pain from the rod. The other ladies on the course all had pain from herniated discs; this pain can be debilitating, but is not actually "dangerous" in most cases, and will not cause progressive problems.

There were six others with me on the Programme, and we were housed in two cottages on the hospital grounds, in which the FRP offfices were also based. We were required to sleep overnight in our rooms, even if we lived or had friends living nearby; this was because they wanted us to live together constantly so that we bonded and could support each other through our pain. I think this was a good idea as we did become quite close and most of us are definitely going to stay in touch now.

The other ladies were all in their 40s and 50s, apart from one girl who was 33 and myself (aged 31). Two of them were nurses and one a police officer who had hurt her back whilst on a raid at a paedophile's house, carrying a computer full of child porn down the stairs. We were a very mixed bunch, but as I said we got on brilliantly.

So, what did we do?....

Hydrotherapy - We had at least one 1.5 hour long session in the hydrotherapy pool once a day. Oswestry's hydro pool is gorgeous; it was only built last year, and it is kept at a constant temperature of 34 degrees. We would start each session with some aerobic exercises along to music (v enjoyable), standing in the shallow end with the water up to our chests. Then we'd line up along the bar at the side of the pool and run through a series of muscle stretches - the warm water really helped with those. After that we'd do a timed walk/swim of widths of the pool, making sure that we paced ourselves so that we didn't tire ourselves out by the end of the time period. This was followed by doing exercises to build up our core abdominal muscles, which took place in the deep end, with us bobbing about wearing floaty belts. Sometimes we played team games such as water volleyball and water polo.

At the end of each hydrotherapy session we were allowed 20 minutes to relax or swim. The pool is equipped with all sorts of floats and swimming aids, so I started off using the time to swim around the deep end using a floaty "woggle" (a long tube thing) and ended up learning to use a snorkel and flippers, which I found amazing. I am definitely buying myself a set!!! I have trouble swimming for more than a width because my shoulder (trapezius) muscles are in constant spasm, but when using the snorkel and flippers I barely have to move my arms, and can swim lengths at a time.

Education sessions - Knowledge is power! We had various education sessions to help us understand our pain; why we were in pain, and the various things that can help us to control and manage it. There was a session on spinal anatomy, which showed how the spine works and why herniated/denegerated discs cause pain (I knew most of that). The session on nutrition taught us that every 1lb you have in weight adds an extra 4lb in pressure on your spine - so if you're overweight and have disc problems, losing weight can help enormously. There was a talk on how being healthy and fit overall can help you cope with pain, and a talk on safe moving and handling of heavy objects. We also had sessions on relaxation, how to choose a good bed for your back, an interesting talk from a pharmacologist on the painkillers that we take and how they work, and a session with a pyschologist on how chronic pain affects people in the longterm.

Physiotherapy - This took place in the gym, where we did exercises on mats that were similar to the ones we did in the pool. We were also shown how to do core stabilising exercises using gym balls, and were taught how to use the gym equipment safely, which I'm very happy about as I have often asked gym instructors for advice as to how to use the exercise machines so that I don't hurt my back, but they never have a clue and tell me to ask my GP, who never has a clue either. We were given heartrate monitors and the physios worked out our best levels for exercising, but I have marked cardiac arrythmia so it was impossible for me to use the monitor effectively. I don't think that's a problem though as I can pace myself quite well and know when I am working out at a productive level.

We also had a couple of sessions on yoga and pilates, and I am seriously thinking of getting hold of the "Yoga for Scoliosis" video that is available in the USA, so that I can help advise people here on SSO how to do yoga with fused spines. During one session we had a choice between bike riding or relaxation, so I chose bike riding even though I've never really ridden one before.....anyway, I had a go and did quite well (I managed to ride it up and down the field without falling off), but wasn't confident enough to go on a ride down the road with the others. It was very helpful to be shown how to adjust the bike seat and handlebars so that they are in a good position for me, as leaning forward as people tend to do when bike riding is bad for my fused spine.

Occupational Therapy - We had several sessions in the Occupational Therapy workshops, in order to help us learn how to do manual work safely. We could choose to work either in the light workshop (card making, watercolour painting, plaster model making, glass painting etc) or in the heavy workshop (woodwork and metalwork) so I chose the latter because I could do all the light crafts at home if I wanted, and I really fancied welding again as I haven't done it for years. I made a wooden house sign with fancy metal scrollwork around it, which involved sanding wood, designing the lettering, burning the house name into the wood using a pyrography tool, hammering metal strips to form a rectangular frame, bending more strips of wood to form fancy scrolls, and then welding the scrolls to the frame. The other ladies working in the heavy workshop made wooden planters and a birdbox. It was great fun, and we all felt a sense of achievement when we'd completed our items, which was especially good for one lady who had fallen into a rut because of her pain and had not done anything productive for months.

Walks/Outings - Once a week we'd be taken out in a minibus so we could go for a walk in the countryside. The area around Oswestry is beautiful so there are loads of lovely places to walk. We went to Ellesmere Mere in the first week, Ty Mawr park in the second, and Llangollen in the last week. Each walk was finished off by having tea and cakes in a nice cafe.

So there, that's it! I had a great time, it was an absolutely amazing experience. I feel a lot fitter and healthier and am a lot more flexible and strong now. I've got into a good routine of eating 3 meals a day and can't wait to get a snorkel and some flippers so I can go swimming....I'm very lucky in that I have access to a great pool here in London, with a jacuzzi and steam room by the side so I can warm my muscles if I need to. There's a gym there too :) I love how my arms look less flabby and my bum looks more pert even after only 3 weeks! It's fantastic to have been given this opportunity on the NHS - intensive training and physio and hydrotherapy like this would cost a fortune privately - but our physios explained that even though it's expensive to put people on the FRP, it saves the NHS lot of money in the long run because we will be able to manage our pain better. Hopefully more hospitals will follow suit and create Functional Restoration Programmes of their own.

Toni xx

5th September 2006, 12:18 PM
wow, what a fantastic and positive story. Sounds a bit like one of those holidays where you go to spain or italy learning to cook pasta or paint landscapes. This must have cost a fortune and it seems a near miracle that such a service can still exist on the NHS.

Big question; how is your trapezius now and have you learned how to relax it better and keep it relaxed??

If you get hold of the yoga and scoliosis video let me know, I looked at it but found it was only available as a dvd not suitable to UK dvd players. Maybe technically clever people on this forum would know how to deal with those.


5th September 2006, 12:29 PM
Hi Gerbo, the FRP couldn't help with my trapezius muscles :( The rest of me is a lot more flexible and comfortable but my shoulders remain as tight as ever.

So, steroid injections remain the only "cure" for them at present, although the Pain Clinic are going to try a technique called "dry needling" on them. This is similar in acupuncture in that it involves inserting thin solid needles into the muscles, but whereas acupuncture is focussed on energy paths called meridians, dry needling involves inserting a needle into a trigger point in order to disrupt the pain signals that the underlying nerve is giving out. It sounds interesting, and the Pain Clinic have had some good results with it. If it works, it would mean that I could avoid the steroids, which would be a very good thing!

The RJAH Hospital is comparitively very well off because it gains a lot of money for research, and is very successful at treating orthopaedic problems, so it's able to run the FRP. However, it's been proved that sending people on the FRP saves the NHS money in the long-run because they are better able to manage their pain themselves, and are usually able to return to work afterwards if they have been taking time off due to pain.

8th September 2006, 03:57 PM
Wow, that sounds absolutely amazing! You are so lucky to have been given the opportunity to do this! It was good to read your story about all hte things that you did! I will also certainly be doing some of those core stability exercises you have posted in your other thread!