Back problems cost more disability than any other health problem in the world. In a previous article, we talked about how to reduce your chances of getting a back problem when you can least afford it, and what to do about it if it happened. One big takeaway from that was that exercise was a great answer to both prevention and treatment. Here we talk about what the research says on what kind of exercises to do and when.
Necessary caveat: I’m not a physician, or a physical therapist. What follows comes out of the scientific research literature; it’s not a recommendation on my part.
“Instead” is a good answer for the question of “When”
The old joke goes: “Doctor, I need a good form of birth control!” “No problem. I’ve got a perfect answer. Eat an apple.” “An apple?? That’s all? Great, when do I eat it, before or after?” … “Instead.”
Appropriately used backs are stronger, more flexible, and less likely to cause problems. In other words, regular exercise helps prevent the problem in the first place. The goal of this post isn’t to talk about standard back exercises. There are tons of good sources out there on that question — here’s one from the Mayo Clinic that’ll only cost you five minutes a day. There are a couple of key points for prepping for back health though:
First, the goal as far as back injury is a strong core, not a bodybuilder back. Bodybuilders usually stick to a small number of exercises that get their target back muscles to ‘pop’. For back health, make sure you work the whole core.
Ok, just one favorite back exercise: The Plank. Works a surprising variety of muscles in a very natural way. *
Second, form is more important that mass. In the game of avoiding back problems, there are no points for most lifted. In fact, relatively gentle exercise like body weight exercises and yoga can do a good job of protecting you from back problems.
When is exercise not a great idea?
The literature shows wide agreement that exercise helps prevent injury and that it reduces pain and disability from chronic back pain. What it doesn’t seem to help much is acute back pain. (1) That’s when your back started hurting less than six weeks ago. These acute problems tend to resolve on their own anyway. The authors were guessing that the extra inflammation from the exercise was counteracting the benefits of the exercise; but for whatever reason people seemed to do as well with or without exercise.
Exercise definitely helped when pain persisted after six weeks.
The theme seemed to be that if the pain hasn’t receded after six weeks, a graded exercise program should be started. (2,3) That just means you start in easy and work your way up in time and intensity.
Details varied by study, but across the board, people who are inactive don’t tend to get better later if the pain didn’t improve by itself in the first six weeks. On the other hand, 30 – 60% of people who did the recommended exercise were seeing reductions in both pain and disability. Prescription medications and surgeries don’t even average that much improvement for chronic back pain, so this is not a minor gain we’re talking about.
What kind of exercise? Well, there are three major classes of activity: strength, flexibility, and aerobic. All three of them had some benefits for chronic back pain. In order of average size of effect:
Simple stretching
Seriously. It’s easy, it’s free, it requires no equipment or recovery time, and helped well over half the people with chronic back pain who did it. (4,5) Boom.
Now don’t get scared off when I use the ‘yoga’ word. Yoga can be a strictly physical practice; no particular set of beliefs or co-requirement for tree-hugging involved. I bring it up because the ‘lumbar flexion and extension flexibility exercise’ that helped 58% of women with low back pain (5) is a staple of yoga called something like ‘cat and cow’. I do it myself when my lower back gets stiff.
Child’s pose. Kneel on the ground and strech your upper body forward. Great for a stiff lower back!
The only real caveat I saw here was to avoid forceful or rapid moves. (6)
Strength training
There are a million varieties here. The good news is, there’s not just one right answer. Lots of varieties worked. (7) As in the prevention, it wasn’t about massive strength; just about causing some regular stress to all the core muscles to keep them reasonably strong.
Many studies combined strength and flexibility. Either they just wanted to test both, or they were testing a kind of exercise that trains both, such as yoga and pilates. The combination was very helpful. (8,9) Just 3 hr/week of pilates cut back pain by 52%, for example. (10)
Bonus: Strength exercises are also bone exercises. Vertebral collapse due to osteoporosis is a common cause of hunchback and back pain in the elderly, and these exercises delay those problems.
Aerobic training
You might think aerobic exercise was pretty far from back health … but all of you depends on that blood circulation. Turns out that the increased blood flow during exercise helps the soft tissue repair that is an important part of resolving back problems.(3) Adding aerobic exercise to the flexibility and strength routine caused an even greater improvement in back pain. (9)
References
* Thanks Jaykayfit [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons for the image.
1) Van Tulder M., Malmivaara A., Esmail R., Koes B. Exercise therapy for low back pain: A systematic review within the framework of the cochrane collaboration back review group. Spine. 2000;25:2784–2796. doi: 10.1097/00007632-200011010-00011
2) Hayden J.A., van Tulder M.W., Malmivaara A., Koes B.W. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst. Rev. 2005;20:1–66.
3) Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel, Switzerland), 4(2), 22. doi:10.3390/healthcare4020022
4) Holtzman, S., & Beggs, R. T. (2013). Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain research & management, 18(5), 267-72.
5) Masharawi Y., Nadaf N. The effect of non-weight bearing group-exercising on females with non-specific chronic low back pain: A randomized single blind controlled pilot study. J. Back Musculoskelet. Rehabil. 2013;26:353–359.
6) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Handout on Health: Back Pain. [(accessed on 26 Dec 2018)]; Available online:http://www.niams.nih.gov/Health_Info/Back_Pain/
7) França, F. R., Burke, T. N., Hanada, E. S., & Marques, A. P. (2010). Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study. Clinics (Sao Paulo, Brazil), 65(10), 1013-7.
8) Edwin Choon Wyn Lim, Ruby Li Choo Poh, Ai Ying Low, and Wai Pong Wong. Effects of Pilates-Based Exercises on Pain and Disability in Individuals With Persistent Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy 2011 41:2, 70-80.
9) Lin C.W., McAuley J.H., Macedo L., Barnett D.C., Smeets R.J., Verbunt J.A. Relationship between physical activity and disability in low back pain: A systematic review and meta-analysis. Pain. 2011;152:607–613. doi: 10.1016/j.pain.2010.11.034.
10) Gladwell V., Head S., Haggar M., Beneke R. Does a program of pilates improve chronic non-specific low Back pain? J. Sport Rehabil. 2006;15:338–350.