While it's official that exercise is good for you, for a lot of people with low back pain, there are mixed messages regarding what is helpful, and what is harmful. Many think the experience of low back pain is always a sign of damage and fear that exercise may cause them more problems. However, scientific studies now indicate that prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work.
In the first few days of a new episode of low back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible and returning to all usual activities gradually is actually important in aiding recovery. While it is normal to move differently and more slowly in the first few days of having back pain, this altered movement can be unhealthy if continued long term.
Should people with low back pain avoid certain movements?
When people have low back pain, they are often told that activities involving lifting, bending, twisting and high impact (eg, jogging, running) should be avoided. However, just because lifting and running might be more sore than usual, this does not mean that the activity is inherently dangerous or should be avoided.
It is now believed that bending and lifting should actually be practised to help strengthen the back, similar to a runner getting back to running after spraining an ankle. Overall, using your back normally (to twist, bend, run, etc) will make it stronger, more flexible and healthier in the long run.
Benefits of exercise for low back pain and general health
Exercise can significantly prevent the recurrence of an episode of low back pain. It also helps reduce low back pain and disability levels, when people start gradually and stick with it in the long-term.
Indeed, the average results for exercise in the treatment of back pain are on par (or better) than the results from treatments such as drugs or surgery; with fewer reported side effects and lower attached costs.
Regular exercise has been shown to do the following:
• Reduce muscle tension and nervous system sensitivity, by activating endorphins, the body's natural pain killers
• Improve mood
• Improve sleep quality
• Reduce fatigue, tiredness and increases energy levels
• Increase muscle strength and flexibility
• Prevent and reduce stress and anxiety
• Reduce the risk and progression of major life-threatening conditions such as heart disease, chest and lung problems, type 2 diabetes, and neurological conditions (eg, multiple sclerosis)
• Help with weight control when supplemented with a healthy diet.
Scientific research is now showing that low back pain can be driven by many related factors, such as lack of exercise, sleep, mood and stress, so increasing your levels of exercise could significantly help reduce back pain.
Which type of exercise is best?
Contrary to popular belief, most types of exercise are of some benefit, with no single type being the best at reducing pain or improving function for people with a low back problem. People should feel comfortable and choose simple options such as walking, running, cycling, swimming, yoga and Pilates; knowing that all are believed to be safe and effective for low back pain.
The amount of exercise you do is probably more important than the type of exercise. The greatest gains result when an inactive person starts doing any exercise, but getting more than 150 minutes a week has the greatest health benefits. Doing the exercises in a relaxed manner (eg, moving normally, not guarding and not breath-holding) and progressing gradually may also be important.
Most importantly, people should do an exercise that they enjoy, that is affordable and easy to access (eg, not too far or difficult to fit into your daily routine). This will increase the chances of sticking with the exercise.
Is exercise safe, and how to begin?
When you are in pain, starting exercise can be hard. Underused muscles get sore more quickly than healthy muscles. Feeling stiff and sore after exercise does not indicate harm or damage to your body - it simply reflects your body not being used to the activity.
You can start by doing some gentle activity and then increase your levels when you feel confident to do so. If you are in doubt about whether you should exercise due to ill health or any other concerns, speak to your doctor/GP or other health professional and they can check if exercise is safe for you. If you feel you need supervision during exercise to increase your confidence, a health can help you form an exercise plan, which will involve increasing your activity levels gradually.
No drug or tablet delivers the diverse range of benefits as exercise - a fact that is often overlooked as part of the management of low back pain. Be aware too that all low back pain is not the same. So if you have tried one form of exercise that has not helped you, talk to a healthcare professional who can set a specific programme.
* Pick an exercise you enjoy
* Choose an exercise or activity that you can afford to maintain it in the long term.
* Pick an activity that can easily fit in with your daily schedule
* Dr Mary O'Keeffe is a physiotherapist at University of Limerick. This article was co-authored by Dr Kieran O'Sullivan (UL) and Professor Chris Maher (The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia)