How Can Exercise Help Your Back Pain?

How Can Exercise Help Your Back Pain? Low back pain affects 577 million people worldwide at any given time ¹, so what are the best ways of managing the most common of the most common conditions?

In contrast to the title of this blog, not that long ago, medical professionals would prescribe bed rest for patients with back pain. In fact, treatment for those with low back pain traces back to an ancient Egyptian papyrus from 1500 BC. The Edwin Smith Surgical Papyrus states that “If thou examines a man having a sprain to his vertebrae of his spinal column… Thou shouldst place him prostrate on his back” ².

However, medicine has moved on a significant amount in the last millennia and even more so just in the last few decades. With advancements made in physical therapy modalities, exercise is now considered the first recommendation in the management of low back pain². Gianola and colleagues (2021) found that exercise to be more effective than non-steroidal anti-inflammatories and muscle relaxants for some types of low back pain ^1,2. However, for other types/causes of low back pain, a combination of all these can be the most effective along with physical therapy ^1–3. Whilst it seems paradoxical, the role of physical therapy and exercise along with the standard drug therapies is considered to be the most appropriate management strategy for back pain.

This is the dream, isn’t it? A collaborative care approach between different professionals, your GP, a manual/physical therapist like a chiropractor or a physiotherapist to both provide hands-on therapies and guide you through exercises to help manage your low back pain.

What Type of Exercise is Best for Back Pain?

Here is where things get even better! There is no strong evidence that any particular type of exercise is superior to another in the management of low back pain ^2,4,5. Walking has been repeatedly shown to be effective in the management of chronic low back pain ^6–9. The great thing about walking is that is very cost-effective, so a cheap and easy way to get started with your back pain. Of course, you also gain the other health benefits of walking on your cardiovascular and mental health by getting out in nature.

Other types of aerobic exercise, such as swimming, cycling, treadmill walking, and the use of an elliptical have also been shown to be effective for low back pain ^8–10.

Qin and colleagues (2019) found that Tai Chi alone, or in addition to routine physical therapy can reduce pain and improve functional disability in patients with low back pain ¹¹. Other exercise types, such as Yoga and Pilates have been shown to provide similar results to Tai Chi in the management of back pain ^12,13. All these authors have concluded roughly the same thing, they recommend all these exercise types in conjunction with physical therapies.

There is a fantastic blog post here from a colleague at Chiropractic Biophysics(R) discussing the strengths and weaknesses of doing yoga for back pain.

How Does Exercise Help with Back Pain?

Movement of the body is a complex interaction between the control centres within the brain (motor cortex), which send signals through the spinal cord and peripheral nervous system to the junctions with the muscles of the skeletal system (neuromuscular junctions) ^14,15. Anything that disrupts or interrupts these signals will result in the loss of balanced, smooth control of the skeletal muscles. A loss of normal movement patterns of the spinal joints results in a loss of joint stability. The lack of joint stability leads to the excessive loading of the joints and their supporting tissues, which results in injury ¹⁶. We discussed tissue overload and back pain in a previous blog post. Therefore, addressing the strength and activity of the muscles that support the spine helps with both pain levels at the time of the injury and helps to reduce the risk of future recurrence and flare-ups.

McGill (2007) states that “treatment needs to go beyond the tissue” that is injured. The injury causes a simultaneous change in motor control of the supporting muscles and joints of the spine. Therefore, optimal rehabilitation of the injury needs to include exercises that will re-educate the now faulty motor control pattern ¹⁶.

Blogs like this can be valuable for those suffering from back pain. However, an important take-home message is to get an assessment with a healthcare professional before starting exercises for your back pain to make sure they are right for you. The evidence discussed above demonstrates that exercises should be undertaken with the guidance of a healthcare professional who can monitor your progress. Exercises, in combination with physical therapies and the standard medical care from your GP, are likely to provide a superior result in the management of your back pain. Seek collaborative care with a team of healthcare professionals who will help you to recover from your injury and reduce the risks of future problems.

For more information, please do not hesitate to contact the clinic on 01635 432383 or email us through the inquiries portal on our website.

Mark Spriggs DC, MChiro, MSc

References:

1. Gianola S, Bargeri S, Del Castillo G, et al. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: A systematic review with network meta-analysis. Br J Sports Med. 2021;13:1-11. doi:10.1136/bjsports-2020-103596
2. Essman M, Lin CY. The role of exercise in the treatment of postural low back pain. Curr Sports Med Rep. 2022;21(8):267-271.
3. Mintken PE, Moore JR, Flynn TW. Physical therapists’ role in solving the opioid epidemic. J Orthop Sports Phys Ther. 2018;48(5):349-353. doi:10.2519/jospt.2018.0606
4. Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2019;98(26):e16173. doi:10.1097/MD.0000000000016173
5. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: A systematic review for an American College of physicians clinical practice guideline. Ann Intern Med. 2017;166(7):493-505. doi:10.7326/M16-2459
6. Meng XG, Yue SW. Efficacy of aerobic exercise for treatment of chronic low back pain: a meta-analysis. Am J Phys Med Rehabil. 2015;94(5):358-365. doi:10.1097/PHM.0000000000000188
7. Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthc. 2016;4(2). doi:10.3390/healthcare4020022
8. Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019;41(6):622-632. doi:10.1080/09638288.2017.1410730
9. McDonough SM, Tully MA, Boyd A, et al. Pedometer-driven walking for chronic low back pain: A feasibility randomized controlled trial. Clin J Pain. 2013;29(11):972-981. doi:10.1097/AJP.0B013E31827F9D81
10. Pocovi NC, de Campos TF, Lin CWC, Merom D, Tiedemann A, Hancock MJ. Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2022;52(2):85-99. doi:10.2519/JOSPT.2022.10612
11. Qin J, Zhang Y, Wu L, et al. Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Med (United States). 2019;98(37). doi:10.1097/MD.0000000000017099
12. Lim ECW, Poh RLC, Low AY, Wong WP. Effects of pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: A systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011;41(2):70-80. doi:10.2519/jospt.2011.3393
13. Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;2017(1). doi:10.1002/14651858.CD010671.PUB2
14. Dunn R, Strick P. The Corticospinal System: A Structural Framework for the Control of Movement. In: Handbook of Physiology. Oxford University Press; 1996:217-254.
15. Harrison DE, Betz JW, Harrison DD, Haas JW, Oakley PA, Meyer DW. CBP Structural Rehabilitation of the Lumbar Spine. 1st ed. Harrison Chiropractic Biophysics Seminars Inc; 2007.
16. McGill SM. Lumbar Spine Instability: Assessment and Exercise Based Rehabilitation. In: Functional Soft Tissue Examination and Treatment by Manual Methods. 3rd ed. Jones & Bartlett Publishers; 2007:461-472.