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.
Core stability is a buzz phrase in rehabilitation circles and part of the core stability programme for the abdominal muscles often involves doing sit-ups or modified sit-ups (Crunches).
Professor Stuart McGill, a leading biomechanics researcher established that the compressive load on the lumbar spine when doing a sit-up or a crunch is in excess of 3300N (about 730lbs). The USA's National Institute of Occupational Safety and Health has set the action limit for low back compression at 3400N. It has been found that repetitive lifting loads that generate this sort of compressive force on the lumbar spine is linked to higher injury rates in workers.
So should we do abdominal exercises at all? Well, yes probably but it is a case of doing a safe exercise that doesn't potentially do us more harm than good. An example of a safe abdominal raise is demonstrated by the excellent Dr Phillip Snell in the YouTube video below.
The jury is still out on what type of exercise helps back pain, however it is probably true that keeping active is better than not. Most people would be very surprised at the lack of evidence for any type of exercise as a therapy for back pain.
From experience exercises help as long as they don't compress their spine considerably as so called flexion exercises do or indeed the traditional extension exercises do. Just keep active without doing any chores - delegation, that's the key!
For more on exercise see my Advice page.
For the National Institute of Occupational Safety and Health click here http://www.cdc.gov/NIOSH/
Keith Walker is a chiropractor and manual therapist . He provides evidenced based care for his patients in Plymouth, Devon.
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