Exercise Therapy Protocols for Chronic Back Pain

Exercise helps back pain, but not all exercise is equal. Credit:Getty

"There was evidence that Pilates and stabilization or motor control exercise training were the best of these exercises for reducing pain."

"The least likely treatments to be effective included hands-off treatment, such as only educating people about chronic pain or doing psychological interventions alone, and hands-on treatment, like manual therapy, massage and acupuncture."

"Importantly, stretching and McKenzie exercises, which is a treatment approach that uses a classification system to prescribe exercise, were found to be the least effective kinds of exercises."

"Low back pain affects 80 to 90 per cent of Australians in their lifetime and while the majority of spinal pain cases resolve without specific intervention, it's chronic or persistent low back pain that presents the greatest challenge."

"In the vast majority of chronic low back pain cases the pain is 'non-specific' meaning that clinicians cannot define a specific diagnosis, or cause, of the pain."

"There is a common misconception that if someone is in pain, they should be resting, but our research shows that when the pain has been there for a long time, exercise is an important part of treatment."

"Active exercise where the person is taken though a structured program to regain confidence with their body and movement can help reduce pain."

Associate Professor Daniel Belavy, Deakin University, Australia

Exercise can provide relief for lower back pain and be a preventive measure too.   (Supplied: Lissanthea Taylor)

Conventionally, people experiencing back pain tend to depend on home remedies such as bed rest, over-the-counter pain relievers and heat or cold compresses. Massages have their place in the gentle treatment of back pain as well. Evidence is mounting that pampering that sore back is not quite the solution. There is nothing particularly new in the message that exercise will relieve chronic back pain, but most people have a tendency to avoid exercise in the thought that it will serve to exacerbate, not help, back pain. 

Increasingly, health care professionals are steering their back-pain patients in the direction of exercise to relieve their symptoms. The kind of activities recommended, however, tend to be in the direction of  yoga and Pilates for back pain that persists. The impression is that gentle exercise is preferable to high-energy engagements such as weight training or interval workouts. Physical activity, however, tailored to the individual in the sense that their choice generally reflects the type that succeeds in relieving pain, is an integral part of any back pain therapy.

 

When Dr.Belavy and his colleagues set out to conduct their own research into exercise as therapy for back pain they decided to study the science relating to the effectiveness of types of exercise to treat chronic back pain and to that end their review looked at 89 studies with 9,543 subjects aged between 20 to 70 who rated how effective in reliving back pain specific exercise types turned out for them. They also took into account improved physical function, mental health and core strength.

 

Exercises that included strength training, Pilates, yoga, core training, cardiovascular conditioning and water-based training such as aqua fitness and stretching were all covered in their study. All those they looked at included a control group comprised of non-exercisers or subjects who had been given treatment from a physiotherapist, osteopath, chiropractor, massage therapist, or acupuncturist. Once the data was reviewed, the researchers reached the conclusion that while physical activity is indeed effective in the reduction of chronic low-back pain, no specific exercise was identified as superior to another.

 

Those who suffer persistent low back pain are instead encouraged to experiment, trying out as many exercise routines as they find useful until such time that they discover one in particular that appears to give them the optimum improvement. "Our study provided evidence that various exercise training approaches are effective and should be incorporated into usual care for adults with non-specific chronic lower back pain due to its potential for improving pain physical function, muscle strength and mental health", wrote the researchers published in the British Journal of Sports Medicine. 

"Active therapies" such as Pilates, weight training, core stabilization exercise and aerobic conditioning appeared to the researchers as most appealing where the individual is "guided (and) actively encouraged to move and exercise in a progressive fashion". Once a training regimen is established including weight training, core stabilization training, yoga, Pilates, water-based training and/or cardiovascular conditioning, physical function appeared to see the most profound improvement. 

As for the most effective exercise options in the improvement of mental health, cardiovascular conditioning and weight-training were singled out as the best choices.