Exercise and Lower Back Pain
Back pain is common, and especially lower back pain (lumbago). Back pain is frequently reported as being the most common cause of loss of workdays.
An initial visit to a doctor or chartered physiotherapist or other clinical specialist will involve the clinician looking for less likely but serious underlying problems. The vast majority of lower back pain cases are not serious and improve within weeks or months. 65% of lower back pain cases get better in 6 weeks. Overall the outcome for low back pain is positive.
Lower back pain is more common between ages 40-80 with an increasing risk as we get older. However, an increasing number of younger adults are also reporting back problems with typical onset between 20 and 40 years. Disc problems (slipped disc, prolapsed disc, herniated disc) are more common between the ages of 30 and 50.
If you have been to the doctor with lower back pain it is likely he/she will suggest exercise as a way of managing the problem as part of your treatment plan. In the long term lower back exercises will provide lower back pain relief and improve outcomes for the vast majority of cases.
What causes lower back pain?
Every individual’s movement pattern is different. How you move is unique, and the cause of your lower back pain can be difficult to determine.
Often there is no clear cause, and the problem may be related to a complex number of underlying issues. Clinicians will refer to this as non-specific lower back pain. You may also hear the terms lumbar pain, or lumbago. However, some of the following can lead to or contribute to lower back pain:
Pregnancy
The hormone relaxin in the body during pregnancy loosens ligaments supporting the joints and this together which a change of point of balance and carrying additional weight can lead to lower back pain. Read our detailed blog on exercise during pregnancy.
Disc Injuries
Disc injuries often occur with manual lifting of heavy objects, bending forward and twisting, but can also occur from cumulative pressure over a long time from poor posture (especially when seated), or repetitive actions ( such as bending down often).
Poor posture is an environmental risk, and in particular posture whilst seated, working at a desk or driving can be an underlying cause and/or contributory factor.
Some professions result is a higher number of back problems, so your doctor, physiotherapist or exercise instructor may ask about your job.
Poor Sleeping Position
A poor sleeping position can also lead to lower back problems.
Weight Gain
Weight gain can also be a contributory factor.
Genetics
And unfortunately, bad backs can also run in families so there may be a genetic disposition towards a lower back problem.
Can I exercise with lower back pain?
In an effort to protect pain, the back may become fixed or stiff in some parts, and flexible in others, likewise the supporting muscles may become imbalanced. If imbalance occurs inevitably more force is placed in some areas than others and over time this can lead to pain as force or tension is no longer evenly balanced.
Distribution of movement = Distribution of force
Exercise can help counter imbalances and retrain your body so your posture and movement distributes tension evenly, and will lead to less likelihood of recurrence.
Staying active and continuing activities of daily living is an important part of getting better. Normal activity should be continued as much as pain will allow. Exercise for lower back pain relief is thought to be especially effective in those with pain that has lasted more than six weeks. Exercise can help decrease pain and increase long term function. It also reduces recurrence rates.
Appropriate exercise can be effective for the management of back pain in the earlier stages of treatment, and on going exercise will help reduce the likelihood of recurrence.
What type of exercise is beneficial for lower back pain relief?
Appropriately selected exercises for strengthening, and flexibility together with low impact gentle cardiovascular exercise is a good combination.
Modified Pilates – many Pilates exercises will be especially effective for strengthening and stretching the right muscles and to retrain the body to achieve the correct balance to learn to support the spine. Pilates will also help correct and reeducate posture. However, not all Pilates exercises are suitable in the earlier stages of rehabilitating from lower back pain. A suitable approach in Pilates may include selected exercises for:
- Spinal articulation
- Axial elongation
- Hip dissociation
- Postural Muscle Strengthening
- Mobility in hip and pelvic area
- Posture re-education
Although more expensive, a few private or one to one Pilates sessions are highly beneficial to start with and will allow a good Pilates teacher or trainer to select appropriate exercises. Once you have progressed you can move to a recommended group class.
Pilates is not the only exercise that may help, you might also consider:
– Walking (in suitable footwear on flat surfaces, avoid steep hills to start with0
– Aqua Exercise (especially if pain is still an issue)
– Tai Chi
– Yoga (if modified)
– Supine stability exercises
– Redcord
– Selected strengthening and flexibility exercises
Could exercise make my back pain worse?
If the exercise is appropriate, consistent and progressive the benefits will provide a much better long-term outcome. You will need to work sensibly with your Pilates instructor, exercise coach or trainer. A good approach includes:
- not expecting too much of yourself
- developing a healing mind set
- exercises which are appropriate, simple, slow and well controlled
- exercises which progress sensibly, step by step, and gradually
- using breath control
- exercise that is well balanced
- exercise which relates to activities of normal function and daily living
- exercise that creates and develops self awareness
What else can I do to help reduce lower back pain?
Your doctor, therapist or Pilates instructor are also likely to advise you to avoid sitting or driving for too long, and to take regular breaks and move around. You may need a referral to an occupational therapist to help examine your work environment.
Your doctor might also advise controlled weight loss.
How often should I exercise with lower back pain?
Consistency will lead to positive results. In the early stages, avoid doing too much. A little and often approach is usually most helpful.
How often may depend on circumstances, environment, budget and more. Ideally, twice weekly instructor or therapist led sessions for 6 weeks, plus a small amount of ‘homework’ in between of 10 to 15 minutes per day of simple back exercises will in the vast majority of cases help establish effective exercise.
Once some strength, flexibility and movement awareness has been achieved you can then progress to a once weekly private session combined with a recommended group Pilates class, and in the long term move to group Pilates classes with perhaps a once monthly or less frequent private session to check back on technique and movement execution. Group classes have the benefit of social exchange and sharing with others who are learning to live with managing lower back pain.
Continuing exercise is considered important in maintaining a healthy back and being pain free.
Blog article by Celia Carron, Celia is a Pilates instructor at Basel Pilates, and lives and works in Basel, Switzerland and previously director of Little Venice Pilates and Physiotherapy in London.
References:
www.nhs.uk/Conditions/Back-pain
Absenteeism Report 2010, http://www.wido.de
Wells C, Kolt GS, Marshall P, Bialoerkowski A.
The definition and application of Pilates exercise to treat people with chronic lower back pain: a Delphi survey of Australian physical therapists.
Geweniger V, Bohlander A. Pilates – A Teachers’ Manual Exercises with Mats and Equipment for Prevention and Rehabilitation
Paterson J. Teaching Pilates for Postural Faults, Illness and Injury
www.physio-pedia.com/Exercises_for_Lumbar_Instability