Exercise and Low Back Pain
Low back pain (LBP) is one of the most common complaints Americans face each year and is one of the most prevalent reasons people will go to healthcare providers such as their doctor, chiropractor, physical therapist, massage therapist, or others in the allied health community.
Being one of the most frequent complaints, LBP has a significant economic burden on our community at large and contributes a to large portion of our medical GDP.
Estimates have been made that the cost is north of $100 billion annually when considering cost of health care, lost wages during time off of work, decreased production from LBP sufferers taking time off of work, as well as the decrease in production of those who struggle through the work day with LBP.
Common treatments that contribute to the cost are prescription medications, chiropractic and osteopathic manipulation, phyiscal therapy, and eventually surgery.
These differing treatment options all have varying levels of success, yet the amount of people complaining of LBP is still increasing and our costs are still on the rise, indicating a different look needs to be taken at how to effectively treat LBP.
In order to treat LBP, we need a better understanding of what pain is and how it presents.
If we were to look in a neuroscience textbook we would find a definition somewhere along the lines of “A negative emotional and physical experience that is associated with tissue or potential tissue damage.”
Potential is the key word here because it means that not all pain means damage has been done.
Pain is a warning signal sent from the brain indicating a looming threat, alerting the organism that action needs to be taken to ensure safety.
This idea that pain is sent from the brain is a relatively novel idea that has recently gained traction in the clinical world.
This signal can also be amplified or dampened depending on the physical state of organisms system, psychological, and social factors.
These factors and how the interact with pain is referred to as the biopsychosocial (BPS) approach.
The BPS approach is a way of looking at all the contributing factors to pain; mechanical factors, social stress, chronicity of the pain, fatigue, feelings about pain, behaviors, etc.
These all play an important role in the perception of pain and should be addressed by the clinician in order for the patient to have the best chance of combating their LBP.
If one of these factors is the dominant pain mechanism and it is not being addressed by the clinician the odds of the patient recovering will undoubtedly decrease and their risk of going to acute pain to chronic pain increases.
The combination of these factors and their contribution to pain should highlight something that many clinicians seem to forget, that there is no catch-all, quick fix.
What works for one person may not work for another.
Treatment inside the clinic should be multifaceted and equip the patient with the tools he or she needs to help themselves outside the clinic to effectively reduce the pain response.
Effective treatment of LBP should always start with education on pain, what it is, what it means, how it presents, and where to go.
This starts with reassuring the patient that they are not broken. I can’t tell you how many people I have come across who have given up hope on any sort of activity because their MRI reports showed a few bulging discs and maybe a herniation here or there in their lumbar spine.
It needs to be screamed from a mountain top that just because the MRI shows disc bulges or herniations it does not mean that they are the pain generator.
A recent study out of the Journal of Spine took MRIs on asymptomatic Air Force cadets aged 18-22 and found that 77% had signs of disc bulge, herniation, disc extrusion, or other signs of degeneration.
Lets say that again…77% of people with absolutely no pain or other symptoms had signs of disc disease.
Does this mean they should have surgery?
Should they stop moving and exercising to avoid a pain response?
Odds are they were better off not knowing about the state of their spine due to how it can cause them to manifest on the image, lead to fear avoidance behaviors, and stop doing otherwise healthy activity.
This study isn’t the only one to show a minimal association with imaging findings and pain.H
How do we treat low back pain? The current best evidence for patients dealing with LBP is to stay as active as possible. This means clinicians need to find an activity that the patient CAN do without pain, and encourage that motion. It needs to be understood that a mobile spine is a healthy spine, and the more prolonged the rest, the higher the chances is the pain becomes chronic. These activities may start with gentle, restricted range of motion exercises such as the hip-hinge or cat-camel (I have found success in these two motions but the list is literally limitless because each and every patient responds differently). These small movements can cause small increases in patient confidence as well as provide a therapeutic effect on the spine. Once the small motions are tolerated the range of motion needs to be increased until it is full and
After the ROM is full and pain-free strengthening the patient is generally a good place to start. A large “chicken or the egg” debate is prominent in the rehab community on if
When considering strengthening the posterior chain, there are few better ways this is done than by utilizing the movements of the deadlift and/or the squat. Not only do these two exercises recruit an incredibly large amount of muscles they are two of the most functional movements the human can perform as they translate to activities people do (or at least should do) every day. Think about how many times you bend down to pick something up, or how frequently you stand up from a seated position. Training these two movements not only do an excellent job at strengthening the posterior chain and the muscles that make up the core, but they also prep the patient for movements that they will be doing every day of their life.
Now, this does not mean anyone suffering from LBP should just go get under a barbell and try to set a PR. That is a recipe for disaster and would likely lead to more low back pain. The concept of progressive overload that is known in the world of strength training needs to be applied in the world of rehab. Loading the deadlift or the squat to a tolerable weight is the key focus here in order to make sure the patient does not do too much too soon. This is where working with a professional who 1) knows how to properly teach these movements and 2) understands the concepts of progressive overload can help turn someone who is scared to put their socks on for fear of “throwing their back out” (whatever that means) to picking up 200+ lbs.
Core1Chiro specializes in treating low back pain by getting our patients pain free and STRONG. If you have Low Back Pain and would like to see if I can help click this (FREE Low Back Pain Exam) and schedule today!
