The terms “exercise”, and “back pain”, are extremely popular keywords or search topics these days, and have been for decades. And they probably occur together with one of the highest levels of frequency. Pursuant to this, I just read a brief article from PT in Motion News entitled “Separate Studies Support Exercise to Treat, Prevent LBP” and I found it thought-provoking.
Citing a meta-analysis in the Journal of the American Medical Association, reviewing 23 studies and nearly 31,000 people, the article stated that exercise can be 35% successful in preventing LBP, and the combination of exercise and education increases that success rate to 45%, for up to one year. The article went on to emphasize the authors’ opinion that long-term exercise behavior is important for the continuation of these potentially protective benefits. This is certainly not new information to me or the people who read this blog, but it is very strong affirmation that our regular exercise habits are healthy for us on many levels, including our spinal regions.
The article went on to discuss how “motor control exercise” (MCE) is effective in treating chronic LBP. MCE is known by multiple terms such as “lumbar stabilization training”, etc., and is essentially the type of exercise that teaches us to engage our core muscles and optimize our posture and body mechanics. When coupled with aerobic exercise this training has been very effective in the clinic at optimizing recovery amongst LBP patients. One thing I have seen often with any of these types of exercise programs is what the literature sometimes calls “heart attack syndrome”. This is the observation that cardiac patients are absolutely the most compliant with their exercise and rehab programs, and many will say they are “scared to death to even consider not doing their exercises”. We see a lesser extent of this phenomenon in the rehabilitation of back pain. Initially, when back pain patients are injured and significantly disabled, they behave similar to the heart attack patients. However, over time, most back pain resolves (most of the time no matter what, if anything, a person does!) and that motivation to stay consistent with training tends to wane. I’ve experienced this personally a number of times. Having had some back issues for decades, I’ll occasionally get a little complacent with my own self-care, and that often has been correlated with an exacerbation of symptoms. Human nature!
The last point of the aforementioned article was that despite the documented efficacy of exercise for the prevention and treatment of low back pain, it is rarely prescribed by physicians to their patients with LBP. I think there may be more to this observation than such a blanket statement. While we may need to increase awareness amongst some physicians regarding exercise and back care, most doctors that I know are strong advocates for exercise. It’s just in how they make the exercise prescription. They tend to refer their patients to physical therapists, who are the experts trained in the management of back pain, particularly with MCE and other exercise. So the observation that exercise is not prescribed may in fact be incorrect.
The greater challenge is in getting LBP patients access to PT, and in optimizing both the practice patterns and treatment methods of the therapist. This, in conjunction, with an increase in education and empowerment toward effective self-management on the part of the patient, can really allow us to reduce overall back pain in this country and significantly decrease its associated costs. I’ll be offering up a number of specific recommendations on how this can be done in a future post. Thanks for reading!