Low Back Pain and Physical Activity Avoidance - Why This Is Not Such A Good Idea
It is not uncommon for individuals with low back pain to avoid all activities. On the surface this might seem intuitive, however; in reality, it is not such a good idea. The prevailing thought for nearly 100 years was that when you have back pain you need to rest. That might be true if the pain is moderate to severe (on a pain scale of 1-10 your pain is greater than a 6), but even with intense pain it is important to get some form of “pain free” activity. One of the most common themes of activity avoidance is that the individual will do nothing for days or even weeks. At that time, they may feel better and as soon as they go back to their “normal” activity then the pain returns. So what do they do - they rest again or take medications to try and block the pain and “work through it”. This is not the answer.
Most of the literature today supports an active return to normal activities with low back pain. The focus is to do activities that help heal the pain while preventing the inevitable deconditioned syndrome. When muscles are not used they begin to atrophy and become weaker. This cycle will perpetuate itself even when the individual returns to their normal activity. The key to returning to your normal activities is to get the care you need for starters. Consult a practitioner who understands the condition and can help guide you back to your normal activities with treatment and modified activities to help strengthen and support while reducing the low back pain.
Treatments for acute low back pain are spinal and muscle manipulation. The literature is overwhelming that these two treatment approaches and it usually is effective enough that the patient is at least out of acute pain within 3-5 treatments. Once you are feeling around 50% better, then this is where therapeutic exercise is critical. This exercise is a combination of flexibility, strengthening, and balance. These pain free activities are encouraged to be done daily and should be of low intensity initially and then can be slowly built up over 4-6 weeks. At this point you should be 80% + improved and then other progressive strengthening and aerobic exercises should be included. The aerobic exercises that come from an assortment of modes may be best. In fact, in a large scale study of 4,246 Finnish men and women (average age 34), those who engaged in multiple activities and sporting events- especially aerobic (cycling, walking, hiking, running), had reduced radiating and non radiating back pain when compared to those who just focused in on one exercise. The conclusion is that a variety of exercises and activities are probably best as opposed to just one ‘targete’ exercise such as low back stretching.
Another study analyzed 4,022 middle aged men who demonstrated a clear relationship between chronic low back pain and low physical activity level. The findings persisted even after researchers controlled for obesity which is another risk factor in chronic low back pain.
Another study done this year analyzed 7,565 older men and the results were similar. In this study the researchers calculated total movement during the day and chronic low back pain. You guessed it. There was an inverse relationship between movement and chronic low back pain. The more they moved (within reason) the less low back pain they had.
My advice is get the care you need, feel better, move to the basic stretches and strengthen the low back, but then begin to add different modes of training. Rowing, cycling, walking, theraband work, circuits, etc. Do these activities 4-5 times a week for 30 minutes and check in with your sports chiropractor and you will have managed your back pain conservatively, while conditioning your body.
Example of spinal stretch in early phase 1: It is not rest it is “relative rest” with movement.
Example of spinal strengthening and balance (proprioceptive) exercises in early phase II.
Examples of early phase 3 progressive spinal strengthening exercises.
Examples of aerobic (walking, running, cycling) and anaerobic (resistance training) introduced in phase 3 that may help low back pain and improve overall mental and physical health!
