Exercise is Medicine for Lower Back Pain
(Image thanks to https://philmaffetone.com/fixing-low-back-pain/).
Low back pain (LBP) is very common, affecting up to two-thirds of adults at some point in their life (Brinjikji, et al., 2015). It may present as an acute onset due to completing a new or heavy activity, or due to a gradual build-up of stress and repetitive loading on the lower back. Chronic injuries involve back pain for longer than 12 weeks which may also have a short term flare up of symptoms. It is important to remember that your back pain will most likely resolve in a few days to weeks, however it is worthwhile seeing a physiotherapist to reduce duration and severity of symptoms, prevent recurrence and rule out any serious problem.
Do you need an X-ray?
Your physiotherapist or doctor will determine if an x-ray or other medical imaging is necessary. It is important to note that as we age, we are more likely to have signs of pathology on imaging. This is true even in people who do not have any symptoms (Brinjikji, et al., 2015). Hence, pain can be complex and why it is not solely determined by imaging.
Here is a nice table from the Sports Medicine Conference of 2019 thanks to pain neuroscientist Tasha Stanton showing that as you age it is very normal for asymptomatic patients to have findings such as disk degeneration and disc bulges if they were to be scanned, in fact 80 percent of 50 year olds had disc degeneration on imaging yet had no pain or symptoms!
When it comes to treating your LBP it is important to remember that you will most likely have a favourable outcome. It is important to continue doing your normal activities, avoid bed rest, and use simple analgesia for the short term, if required (Oliveira, et al., 2018). For cases that do not improve in the early days or weeks check in with your physiotherapist or doctor to determine the most appropriate course of action.
Physiotherapy can be introduced during any stage throughout the episode of pain. In the immediate stages physiotherapists can reduce pain and improve function by assessing movement patterns and implementing manual therapy and gentle exercise as required until symptoms begin to settle. Physiotherapists are skilled in the use of spinal mobilisation and manipulation, massage, postural correction, targeted muscle activation and taping techniques to help relieve initial symptoms and promote more efficient movement patterns. If the patient is progressing well, physiotherapists may further progress exercises with a strengthening program and implement self-management strategies depending on the individual case. Self-management is a key step in recovery to ensure patients are committed to their recovery. For those patients that are slower to respond to treatment or have had chronic back pain for some time it is important to implement further education, cognitive behavioural therapy and self-management strategies to allow patients to manage their condition without heavy reliance on health professionals and passive treatment modalities.
Exercise as Medicine
There are a number of manual therapy and exercise techniques implemented during the treatment of LBP. One technique in particular is Pilates. Pilates itself has been around for some time, yet over the past 20 years Clinical Pilates has developed itself around the large body of evidence promoting the shift away from the traditional “core stability” model promoting the need for rigidity of the spine, and more towards a movement and control model that enhances body awareness. The Clinical Pilates approach draws on movement based classification and treatment, allowing physiotherapists to determine the aggravating and easing factors for a patient and develop this into an individualised exercise program. Through Clinical Pilates, physiotherapists are able to introduce movement that is non-threatening to patients in order to retrain the disrupted body image that may occur in patients with chronic back pain (Moseley, 2008). At Grand Slam Physiotherapy we use a mix of strength and conditioning concepts with Pilates to ensure our patients get a well-rounded exercise program. We pride ourselves on getting patients back to their pre-injury levels with a self-management program suited to the individual.
(Our Physiotherapists designing specific strength exercises for individuals with back pain using a variety of different types of exercise including floor exercises that can be completed at home and our reformer machine that we use in our Pilates classes).
ABOUT THE AUTHOR – Emily Stephens:
Emily is a passionate physiotherapist who enjoys working with people of all ages and backgrounds. Emily studied a Bachelor of Applied Science and Master of Physiotherapy in Bendigo. She enjoys implementing exercise techniques and Pilates to her rehabilitation plans as well as manual techniques such as dry needling.
Almeida, M., Saragiotto, B., Richards, B., & Maher, C. (2018). Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Medical Journal of Australia, 208(6). doi: 10.5694/mja17.01152
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Moseley G. L. (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140(1), 239–243. https://doi.org/10.1016/j.pain.2008.08.001
Oliveira, C., Maher, C., Pinto, R., Traegar, A., Chung-Wei, C., Chenot, J., van Tulder, M., & Koes, B. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal 27(11):2791-2803. doi:10.1007/s00586-018-5673-2