Lower back pain is an issue that affects up to 90 per cent of us, at some point in our lives. It is so prevalent that it is the leading cause of disability globally.
For most of us, it resolves without treatment within six weeks. For others, it becomes chronic, lasting 12 weeks or more.
Exercise helps back pain, but not all exercise is equal.Credit:Getty
Exercise is known to be one of the most effective treatments for chronic lower back pain but what type of exercise is best?
A study published in the British Journal of Sport’s Medicine on Thursday set out to answer this question.
“We knew already, from other work, that exercise is better than most treatments for chronic back pain, but there wasn’t anything out there that told us what kind of exercise,” explains lead author, Associate Professor Daniel Belavy of Deakin University’s Institute for Physical Activity and Nutrition.
So Belavy and his colleagues analysed 5578 patients across 89 different studies to determine the most effective treatment for back pain.
Massage, manual therapy and acupuncture don’t work as well as exercise.
The researchers focused on non-specific chronic lower back pain, which accounts for about 90 per cent of cases.
“It means there is no specific anatomical cause – a bone defect or compression,” Belavy says, explaining that patients typically hurt or strain their back and, for a number of possible reasons, it doesn’t resolve itself.
“When the pain has been there for more than 12 weeks … there are changes that happen in the brain and central nervous system that can cause the pain to stay there,” he adds.
Specifically, they found that Pilates, stabilisation or motor control exercises, resistance training, using weights, and aerobic exercise training, like cycling or walking were the top treatments for reducing back pain. Along with helping people’s pain, these forms of exercise improved physical function and mental health, which is significant given those who suffer chronic pain are twice as likely to experience mental health issues.
“They are active kinds of exercise where a clinician or a therapist is taking them through a program of exercise, where someone develops their confidence in movement,” Belavy explains, adding that fear of movement is common. “And it helps that person to manage their fear of pain and learn that ‘If I do this thing it isn’t going to make my pain worse’. It helps them to break through that cycle.”
And although they found there is no one exercise that is “bad” for back pain, not all exercises were equal.
“Stretching and McKenzie exercises didn’t work at all. Stretching programs that have been created for back pain are not effective,” Belavy says. “And massage, manual therapy and acupuncture don’t work as well as exercise.”
As for rest, Belavy says it has been shown, “over and over again” to be ineffective.
“Even if you’ve just hurt your back, though you shouldn’t be going off and doing exercise, the advice is to keep active and if you have chronic pain, rest doesn’t help,” he insists. “There’s evidence to show it’s detrimental.”
The reason, he explains is because “it feeds into the vicious cycle” of not moving, losing physical function, increasing the perception of pain and the likelihood of fearing exercise.
And while instruction on the correct technique is beneficial for confidence and good function, the type of exercise, it turns out is less important than the movement itself.
“I think a common misperception, that if we work on specific muscles around the spine, that’s going to be the main solution to improving back pain,” Belavy says. “Part of it just getting people moving and helping people to break through the cycle of avoiding movement because they’re scared of making the pain worse … exercise is really important.”
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