Exercise for low back pain
I see lots of patients who ask me what exercises to do for back pain. My reply is as formulaic as the exercises are. I generally reply firstly with,
"Will you do them?"because it is my experience both personal and professional that folks just don't. And therefore I argue to myself why go through a very specific well thought out exercise regime with people who, with the best will in the world, are not going carry them out in any therapeutic fashion.
It is better in my book to get the message over that any exercise is better than none. It may be that the 55 year old slightly cuddly lady whose idea of exercise is to wind her own watch may well respond to the suggestion that a Salsa class can be as helpful as a leotarded aerobics body-pimp session. Or that a brisk walk to the shopping centre is as valuable as getting on the lounge floor and creating work for the Hernia surgeon.
I am always keen to provide pointers to those of my patients who want more information and also are serious about working through a regime of exercise (see the Big 3) but I consider it as helpful as anything physical I do in the consulting room to guide people through the principles of self management of back pain.
There are loads of interesting and (probably) helpful exercise regimes out there from core stability to hyperextensions and none of them demonstrate a body of evidence that says they are exclusively therapeutic. The fact is that activity in whatever guise is generally helpful and whilst there are always caveats (mogul skiing, cage fighting, international rugby) keeping going is demonstrably and evidentially beneficial.
I was intrigued to see a campaign launched in Wales to help with treatment of acute low back pain. Or perhaps the word should be management rather than treatment as they don't seem to mention any treatment for folks who have acute low back pain at all. Quite correctly they (and they are "a joint initiative developed in response to Health Challenge Wales") point out that the medicalisation of back pain is a bad thing and therefore "treatment' can be unhelpful in the resolution of the back pain symptoms.
Quite correctly they talk about keeping active, keeping positive and understanding that pain does not equal damage. There is even a section on better breathing. There is some helpful advice for both patients and GPs alike about the likely outcomes and what is useful in terms of diagnosis.
The glaring omission from this worthy initiative is that there is a place for manual therapy and spinal manipulation in the management of acute back pain. People with back pain need advice and some demystification of the problems associated with back pain sure enough but many of them would also benefit from manipulation or acupuncture/dry needling. The only mention of spinal manipulation is in a short piece by Jonathan Pryce, the actor, who says that he seeks the care of a qualified chiropractor when he has pain. Sensible chap.
The NICE guidelines for nonspecific back pain mention keeping active, manual therapy and acupuncture. I would have thought that the website ought at least give a little advice about how to seek help and who from and what to expect.
I hope the good folk of Wales are happy doing breathing exercises when their backs are killing them. I, for one, would rather see my local quack.
Keith Walker is a chiropractor and manual therapist . He provides evidenced based care for his patients in Plymouth, Devon.
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