Low Back Pain
Most people in modern society experience non-specific low back pain (NSLBP). It is a complicated and poorly understood phenomenon involving the interaction of a wide range of physical, social, and psychological factors.
NSLBP is an umbrella term that includes pain in the lumbosacral area caused by a variety of somatic (musculoskeletal) dysfunctions. A specific origin of pathology, such as herniated disk, vertebral fracture, congenital malformation, or general medical condition, has not been identified. There appear to be as many different theories about causation as there are structures in the back. Indeed, "the actual origin of the pain is more of a philosophic statement of the training of the practitioner than hard, scientific fact" (1). Also, most often "low back pain is not a symptom of a disease or degenerative process.it is a syndrome whose major and sometimes only symptom is pain" (1). The best definition of NSLBP may be simply pain experienced in the lumbosacral region in the absence of major identifiable pathology.
Chronic low back pain causes a great amount of suffering, loss of productivity and independence, as well as costs- to individuals and to societies. Its prevalence is increasing, partly because of the aging of populations and partly because of changes in lifestyles and environment. Heavy physical work is one of the predisposing factors for low back pain but, paradoxically, exercise is now regarded as a first line therapy for sufferers. The most recent review of randomly controlled trials found strong evidence that exercise was as effective as conventional physiotherapy and more effective than usual care by a general practitioner (10). In contrast, exercise therapy is no better than other treatments for an acute episode of back pain.
Multiple risk factors for low back pain have been reported (3, 7, 9). Many cases of low-back pain appear to be due to unusual stresses on the muscles and ligaments that support the spine of susceptible individuals. When the body is in poor shape, for example, weak spinal and abdominal muscles may be unable to support the spine properly during certain types of lifting or physical activities.
Prevention of low-back pain has typically involved several recommendations (3, 7, 9):
- Exercise regularly to strengthen back and abdominal muscles
- Lose weight, if necessary, to lessen strain on the back. Most studies have shown that obese people are at greater risk for developing low back pain
- Lift by bending at the knees, rather than the waist, using leg muscles to do most of the work
- Avoid sitting, standing, or working in any one position for too long
- Maintain a correct posture (sit with shoulders back and feet flat on the floor, or on a footstool or chair rung. Stand with head and chest high, neck straight, stomach and buttocks held in, and pelvis forward)
- Try to reduce emotional stress that causes muscle tension
- Undergo a gradual progression when attempting to improve strength or athletic ability
Low Back Pain and Exercise
There is some indication, however, that low levels of musculoskeletal fitness are predictive of recurrent low back pain (9). In other words, when an individual of any age suffers a low back problem and then, as a reaction, engages in very little exercise, the likelihood of further episodes is enhanced. This can set up a vicious cycle, leading to chronic back problems.
Some researchers advocate an intensive back-muscle-strengthening exercise program to treat low back pain (5, 6). Patients cannot exercise strenuously at first, but after various pain control measures are initiated, patients are gradually progressed through an increasingly difficult series of resistance exercises to improve back muscle strength. In one study of 105 low-back-pain patients in Denmark, 30 sessions of intense back extensor exercises, over a 3-month period, led to a significant improvement, relative to groups exercising less intensely (6). Other studies have shown that lumbar extension strength training over a 2-to 3 -month period is associated with decreased low back and leg pain and an improved ability to perform daily activities (2). Some researchers have urged that strengthening the entire trunk area over an extended period of time is critical to treating low-back pain (4, 8).
At present, a balanced approach involving strengthening most spinal musculature and lower extremity muscles is arguably the most popular strategy, usually in combination with stretching exercises and recommendations for some form of aerobic conditioning. When prescribed based on an individual evaluation, exercises are hypothesized to have multiple beneficial effects, including reduction of disk herniation, improved joint mobility, strengthening of weakened muscles, and stretching of adaptively shortened ligaments, capsules, and muscles.
If you have Low Back Pain, learn about how Low Back Pain is a chronic disease which is eligible to receive a Medicare Rebate when seeing an Accredited Exercise Physiologist:
Did you know you could get up to 50% off with a Medicare Rebate?
Learn how an Accredited Exercise Physiologist can help you to begin and maintain exercise in your life, so you can enjoy the health benefits of Exercise for Low Back Pain:
What Does an Exercise Physiologist Do?