Back Pain & Exercise

Whether suffering from the first bout of low back pain or following extensive treatments, the best way for patients to avoid or minimize the severity of recurrences is to rehabilitate the back through appropriate exercise.

Exercise that back!

One of the keys to recovering from an episode of back pain and to help avoid future recurrences of back pain, is to pursue appropriate rehabilitation and exercise. A comprehensive exercise regimen should include a combination of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned.

There are three types of muscles that support the spine:

• Extensors (back and gluteal muscles), which are used to straighten the back (stand), lift and extend, and move the thighs out away from the body.


• Flexors (abdominal and iliopsoas muscles), which are used to bend and support the spine from the front; they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.


• Obliques or Rotators (side muscles), which are used to stabilize the spine when upright; they rotate the spine and help maintain proper posture and spinal curvature.

While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.

For all forms of exercise, it is advisable to see a trained and licensed therapist, chiropractic physician or a physiatrist. Depending on the specific diagnosis and level of pain, the exercise program will be very different, and these specialists are trained to develop an appropriate exercise program and provide instruction on correct form and technique.

Stretching

Any form of inactivity, especially if an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain.

Stretching exercise should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back, so hamstring stretching is an important part of alleviating low back pain.

Strengthening

It is thought that future episodes of back pain are less likely to occur if back strengthening is accomplished than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercise to prevent a recurring cycle of pain and weakness.

Low-impact aerobic conditioning

Conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.

Examples of low impact aerobic exercise that many people with back pain can tolerate include water therapy, walking and stationary bike riding.

What causes back pain?

There are several structures in the back that can cause and/or contribute to low back pain. These include:

Intervertebral discs

Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber during everyday activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting or other trauma), or due to ordinary wear and tear over time. And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.
Making matters worse, the pain often interferes with a patient’s ability to exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities and exercise cause the disc to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate.

Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material.

Spinal muscles, ligaments and tendons

The collective soft tissues around the spine - the muscles, ligaments and tendons - are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibers of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when soft tissues are injured, they can quickly repair themselves.

Since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.

Spinal nerves

When nerves are cut, pinched, or otherwise irritated, the muscles that the nerves control cannot work. For example, when a herniated or bulging disc presses on the L4-L5 nerve root, it may inhibit the nerve’s ability to make the muscles it controls in the ankle and foot work properly, causing what is known as foot drop - the ability to raise the foot or stand on one’s tiptoes.

Acute vs chronic back pain

It is important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but as the injured part heals the pain goes away.

Unlike acute pain, however, chronic pain does not correlate to an anatomical injury. It comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a “neural memory” after the initial source of irritation has resolved. The nervous system adapts to this chronic stimulation by creating an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas.

Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Active exercise also helps to create the physiological conditions that allow the injured structures to heal.

Source: Spine Health 2008