If you suffer from chronic low back pain, you may think that rest is the best remedy. But for most people with back pain, being active is far better. Exercise can help reduce back pain and, perhaps more important, prevent recurrences—at least as well as other conservative treatments. The question is, which exercise is best and how much? After all, low back pain varies widely from person to person, and there is no standard exercise protocol.
Still, unless you follow certain guidelines, exercise can end up doing more harm than good—which is why anyone with long-standing back pain should be medically evaluated before starting an exercise program.
Often a mystery
Sometimes back pain occurs from known pathologies, such as a herniated disc (which can cause sciatica), arthritis, scoliosis, fractures (as from osteoporosis), tumors, or infections. But in most cases, after the initial evaluation, no specific diagnosis is made. Called non-specific or simple low back pain, it may be set off by lifting something, twisting the "wrong" way, or just bending over—or by doing nothing in particular that you are aware of. The pain is localized or radiates just a bit into the buttocks or thighs. Though the cause cannot be proven on objective tests, contributing factors may include weak muscles or a muscle imbalance that throws the back off kilter, chronic overuse of muscles, sitting too much, poor posture, or cumulative wear and tear. Some people may have pain due to restricted movement in their spine, pelvis, or associated muscles, while others may have pain due to problems controlling excessive movement in these same structures.
Back pain can also become chronic due to a vicious cycle—if you fear that movement will cause or increase your pain, you are likely to avoid activities and be more sedentary, which only makes things worse by further weakening muscles.
Exercise may help not just by strengthening and stretching muscles, correcting posture and imbalances, and stabilizing the spine, but also by addressing psychological factors (such as depression and anxiety) often associated with chronic pain. It can help build confidence that you can move without pain, so you can get back to your daily activities, which itself can have a positive effect on back pain.
Getting your back into shape
An exercise program for the back may include different types of exercise:
- General exercise to improve strength, flexibility, and endurance. This involves aerobic exercise (such as brisk walking or cycling), strengthening main muscle groups (including the back, gluteal, and abdominal muscles), and stretching tight muscles that play a role in low back pain (notably the hamstrings and the hip flexors, in addition to the back muscles themselves).
- Core stability exercises that target the trunk muscles—that is, the muscles in the back, abdomen, and pelvis that keep the spine stable. Some classic core exercises are abdominal crunches, the plank, and the bridge. Certain exercises work the multifidus muscle, a specific core muscle important in spine stability.
- Movement control exercises help correct faulty movement patterns, so that you learn how to move through daily activities and sports in ways that don’t injure your back. The exercises, which incorporate core and other muscles, usually involve slow, low-force repetitive movements. The McKenzie method, Alexander technique, and Pilates are types of movement control exercises.
Is one type of exercise better than another? It’s hard to say, since studies have used varying exercise regimens and have had conflicting results. For instance, a study in Medicine & Science in Sports & Exercise found that both general exercise and Pilates significantly decreased pain and disability in people with low back pain, while another study, in Clinical Rehabilitation, found that brisk walking twice a week for six weeks relieved chronic low back pain as much as a more complicated muscle-strengthening program. On the other hand, a review of five studies involving more than 400 people, published in PLOS ONE, concluded that core stability exercise relieved pain and improved physical functioning better than general exercise in the short term, but that no significant differences between the two were observed in the long term.
According to a 2013 review paper in Physical Therapy, exercise is better than no intervention for preventing recurrence of back pain, though the authors point out that "the precise parameters needed to achieve this effect or the appropriate dose to achieve the desired outcome are not yet known."
A back care plan
If the pain is tolerable and you have no symptoms suggestive of something other than simple low back pain (such as numbness, tingling, or weakness in the legs or feet), you can try doing some basic, easy exercises on your own. Walking is also good for the back, as is swimming (avoid the butterfly and breast stroke, which can put excessive strain on the lower back). But generally it may help to be supervised by a physical therapist or athletic trainer who can design a program based on your particular needs and abilities and advise you about which activities and exercises you should avoid or at least modify.
Begin any exercise program slowly. Stop if your symptoms worsen in any way. Initially avoid any exercises that increase stress on the spine, such as straight-leg toe touches or backward bends, as well as activities and sports that involve lifting, twisting, excessive bending of the spine, jumping, sudden starts and stops, or collisions with other players. And remember: Don’t stop exercising when your back pain goes away. Being active will help keep your back healthy.
See also: 5 Minutes to a Better Back