When patients report low back pain, it has often already impacted their quality of life. They are challenged by daily tasks and common activities. When pain begins to manifest, a person's first response may be to take over-the-counter pain medication and rest. This, however, may only increase the duration or intensity of the pain.
Thus, it becomes the challenge of the clinician to communicate to patients that over-the-counter pain medication and rest may not be the answer to lower back pain - or back pain in general. With proper diagnosis (ruling out spinal issues, such as herniated discs), the best instruction for the patient may be increased movement. This could include a daily exercise program.2'3
It becomes crucial to educate and evaluate patients on proper exercise and stretch techniques. Clinicians should evaluate movement and ensure the patient is exercising properly and safely and getting the benefits of the exercises, the primary one being a reduction in low back pain (LBP).
Numerous studies have confirmed that movement, including high-quality aerobic exercises, calisthenics, hydrotherapy, and even daily walks can be effective at reducing pain and restoring function. This includes both clinic-based programs and at-home exercises. Individually designed strengthening and stabilizing regimens have been shown to be just as or more effective than other conservative treatments.3,4,5
There has been some debate as to whether or not exercise is just as effective as simply staying active (e.g. the patient resuming their normal daily activities or prior exercise). For chronic LBP sufferers, a structured exercise program may be more effective.
Patients with acute LBP typically respond better when resuming their normal daily activities and not just "taking it easy" or lapsing into a sedentary lifestyle in an effort to heal or avoid the pain. An official diagnosis should determine the course of action regardless. 5
Many people who experience chronic low back pain also experience issues related to trunk strength, diminished flexibility, and limited endurance. Developing an exercise program that targets these areas may be advisable. By improving strength, flexibility, and endurance, patients should begin to see a reduction in pain.
In studies of chronic LBP, subjects who participated in an exercise intervention, namely strength/resistance and coordination/stabilization interventions, were noted for having the greatest impact on reducing low back pain. Clinician monitoring rs recommended.
LBP is a group of conditions that affects millions of Americans. With improved education and intervention, we can better address LBP with movement-based programs. One major hurdle to overcome is patient fear - fear of pain, which can lead to a short-term or long term sedentary lifestyle. Movement is the answer to many forms of LBP. If you have a patient who is suffering from a low quality of life due to LBP, contact our office today to see if physical therapy is the right choice.
1. Costa L da CM, Maher CG, McAuley lH, Hancock Ml, Smeets, RJEM. Self-emcacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. European fournal of PaiIr. 201 I;15(2);2I3-219. doi:10.1016/j. ejpain.20l0.06.0l4
2.Cote JN, Hoeger Bement MK. Update on the Relation Between Pain and Movement: Consequences for Clinical Practice. The Clinical lournal ofPain 2O10;26(9):754-762. doi: 10.1097/ajp.0b013e3l8le0l74f
3. Hayden fA, van Tulder MW, Malmivaara AV Koes BW Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain. Annals of Internal Me dicine. 2005i142(9\ 765-775. doir0.732610003-4819-142-9-200505030-000 I3
4. Liddle SD, Bdter DG, Gracey JH. Exercise and chronic low back pain: what works? Pain. (2004);107(l):w176-190 doi:10.1016/j.pain.2003.10.017 5
5.Searle A, Spink M, Ho A, Chuter V Exercise inteilentions for the treatment ofchronic low back pain: a systematic rcviewandmeta-analysisofrandomisedcontrolledtrials.ClinicalRehabilitation 20l5;29(12\:1155-1167, d,ol lO.l 17 7 / 026921. 5 5 I 557 O37 9