If you suffer from back pain as an estimated 80 to 90% of people in the U.S. will in their lifetime, you know how hard it can be to keep moving when the pain flares up. Lower back pain can be especially difficult to move through, but the numbers don’t lie. Exercise really is that important for lower back pain. Here’s why.
While it may seem like a contradiction, working the specific muscles that support and move the spine – the ones that may be painful – actually helps reduce lower back pain. This type of exercise is called motor control exercise. Motor control exercise begins with simple functional movements guided by a physical therapist and gradually adds more complex actions.
In a meta-analysis of 29 studies involving over 2,400 patients with lower back pain, researchers at the Cochrane Library found that those patients who participated in this type of targeted exercise. They found that they experienced greater improvement in pain and less disability than those patients with minimal interventions.
Physiotherapist Bruno Saragiotto, lead author from The George Institute at the University of Sydney, believes that this approach offers a cost-effective and positive treatment option for patients with lower back pain, noting:
“Targeting the strength and coordination of muscles that support the spine through motor control exercise offers an alternative approach to treating lower back pain. We can be confident that they are as effective as other types of exercise, so the choice of exercise should take into account factors such as patient or therapist preferences, cost and availability.”
Many couples with a partner experiencing back pain will put intimacy (including sex) on hold rather than risk more pain. While this may seem like a good idea, many couples may find that celibacy for long periods of time affect the relationship in negative ways. In excellent research news, scientists have used X-rays and other techniques to find the best ways that partners can remain intimate while one partner is experiencing lower back pain.
For the 84% of men and 73% of women who report a significant decline in sexual intercourse during episodes of lower back pain, this research is welcome news. As always, patients need to read the research and find out what works for them. Natalie Sidorkewicz, a PhD candidate at the University of Waterloo in Canada and lead author on the paper, believes that this research can help improve the quality of life for patients experiencing lower back pain, saying:
“For the first time ever, we now have very solid science to guide clinicians on their recommendations for patients who suffer debilitating back pain, but still want to be intimate. This has the potential to improve quality of life — and love-life — for many couples.”
It turns out many patients prefer pain relief over increased mobility. A study from the University of Rochester Medical Center indicated that when surveyed, patients experiencing spinal stenosis overwhelmingly chose pain relief over increased mobility.
John Markman, M.D., director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery and lead author of the study believes that this makes clear the direction of pain relief, noting:
“There has long been a debate in the medical community over striking the right balance between pain relief and physical function. While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief.”
While the University of Rochester study indicated patient preference for immediate relief, often in the form of steroid injections. The fact remains however that for long-term pain relief, exercise reduces lower back pain. One researcher at the Sahlgrenska Academy, University of Gothenburg conducted a small-scale study of 109 patients with lower back pain to see if exercise or rest were more effective.
One group of patients was advised to continue to move as much as possible, and the other group was advised to adjust their activity level based on the pain. Both groups kept a pain diary for a week, recording the number of steps they took and their general activity levels. Both groups also completed an exercise to determine if they felt depressed or not.
Across the board, the group that moved more recovered more quickly and felt less depressed than the group that restricted their movement. Olaya-Contreras, a researcher at the Sahlgrenska Academy’s Department of Orthopaedics, noted that some patients who normally experience depression may feel a heightened pain sensitivity. This can be exacerbated by limited physical activity:
“I think that if you’re suffering with acute low back pain you should try to remain as active as possible and go about your daily business as well as you can. If you don’t keep moving, it’s easy to get locked into a downward spiral, as inactivity combined with pain can, in a worst case scenario, turn into long-term disability and an inability to work that, in turn, can lead to depressed mood and more pain.”
If exercising to help reduce lower back pain when it flares up isn’t enough, how about preventing pain in the first place? A new review of clinical research by Daniel Steffens, Ph.D., of the University of Sydney and coauthors looked at 21 clinical trials with nearly 32,000 participants. They found that, when combined with education, exercise reduces the risk of lower back pain. They also found that exercise alone was indicated as effective in preventing lower back pain as well.
Although the evidence for exercise alone (without education) was not as strong, Steffens noted that both have a preventative effect on lower back pain, in both the short- and long-term, saying:
“Although our review found evidence for both exercise alone (35 percent risk reduction for an LBP [low back pain] episode and 78 percent risk reduction for sick leave) and for exercise and education (45 percent risk reduction for an LBP episode) for the prevention of LBP up to one year, we also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year). This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required.”
It is clear from the research that, as challenging as it may be, exercise is a great way to help prevent and treat lower back pain. To incorporate exercise into your treatment plan for lower back pain, talk to your doctor today.