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What Doctors Don't Tell You

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September 2020 (Vol. 5 Issue 6)

Beating back pain

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Beating back pain image

Most people know that regular exercise will improve their physique and fitness levels, but few realize that keeping active may also be beneficial for low back pain, one

Most people know that regular exercise will improve their physique and fitness levels, but few realize that keeping active may also be beneficial for low back pain, oneof the most common causes of disability in the West.

According to Wisconsin-based spine expert Dr Peter Ullrich, "When done in a controlled, gradual, and progressive manner, active exercise distributes nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments and joints healthy. Consequently, a regular exercise routine helps to avoid stiffness and weakness, mini-mize recurrences of low back pain, and reduce the severity and duration of possible future episodes of low back pain" (

But you don't have to take his word for it. There are numerous studies supporting the benefits of exercise for low back pain.

Indeed, just a few weeks ago, a review by the Lausanne Institute of Sports Science and Physical Educa-tion concluded that exercise is effective for both the prevention and treatment of low back pain. As a treatment, exercise reduced pain and improved physical function in patients whose condition was chronic or recurrent (Joint Bone Spine, 2008 Sep 16; Epub ahead of print).

Other studies have looked at specific types of exercise to find out what works best. According to one, the most effective exercise strategy is an individually designed exercise programme carried out under limited supervision-for example, home exercises with regular follow-up by a therapist. Stretching and muscle-strengthening exercises proved best for improving pain and function (Ann Intern Med, 2005; 142: 776-85).

For those who don't have the time or money for personal training, however, joining a yoga class may be another useful option. In one study, patients participating in a 12-week yoga programme enjoyed significant improvement in back pain and function compared with those given a self-care exercise book. What's more, the benefits persisted for several months (Ann Intern Med, 2005; 143: 849-56).

In yet another study, just one week of intensive yoga practice-including postures, breathing practices, medi-tation and philosophical concepts-reduced pain-related disability and improved spinal flexibility signifi-cantly better than a conventional exercise regime (J Altern Complement Med, 2008; 14: 637-44).

Precisely why yoga is so effective for back pain is not clear, but it appears to be a combination of mind-body factors. As one report noted: "Yoga may be beneficial for back pain because it involves physical movement, but it may also exert benefits through its effects on mental focus." Mental focus may help people to relax tense muscles, relieve mental stress, and increase their awareness of how they are moving and positioning their body (Ann Intern Med, 2005; 143: 849-56).

This synthesis between physical movement and mental focus might also explain the results of a study showing that the Alexander Technique (AT) is beneficial for back pain. This discipline emphasizes the self-perception of movement, and was recently found to be more effective than the usual care or massage as a treatment for chronic back pain. Also, just six lessons followed by prescribed exercises was nearly as successful as 24 lessons of AT on its own (BMJ, 2008; 337: a884; doi: 10.1136/ bmj.a884).

Pilates, another discipline with a focus on posture, has also produced impressive results (J Orthop Sports Phys Ther, 2006; 36: 472-84).

But what about aerobic activity? Do the more vigorous forms of exercise cause more harm than good? It appears not. A study of patients aged from 30 to 60 with low back pain found that those who indulged in aerobic exercise-walking or cycling for 45 minutes four times a week-required significantly fewer pain-medication prescriptions and were given fewer physical-therapy referrals than those who did not exercise. The researchers also noted that exercise improved the patients' mood-yet another excellent reason to stay active (Spine J, 2001; 1: 95-101).

Joanna Evans

Stretch the pain away

According to Dr Peter Ullrich, daily stretching is an important part of any back pain exercise routine. The most important muscles to target in any back pain regimen are:

- hamstrings, which run along the back of the leg, help to correct posture while sitting and standing; they also support the gluteus muscles in the buttocks and the hip flexors, and minimize stress on the low back

- piriformis, which runs from the back of the femur (thigh bone) to the sacrum (the base of the spine); when tight, this muscle can cause sciatica-like pain, and has been linked to sacroiliac joint dysfunction

- psoas major, which is attached to the front portion of the lower spine and can greatly limit lower back mobility if tight, making it difficult to stand for extended periods of time or to kneel on both knees

- gluteus muscles of the buttocks, which support hip flexibility as well as the pelvis.

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