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Back in Shape: What Is the Right Exercise Program for Low Back Pain?

Back in Shape: What Is the Right Exercise Program for Low Back Pain?

Healthnotes Newswire (January 19, 2006)—Recreational exercise is better than specific back exercises for low back pain, according to a study in the American Journal of Public Health (2005;95:1817–24). Researchers at the University of California, Los Angeles, studied 681 people with low back pain for 18 months to estimate the effects of recreational physical activity and back exercise on back pain.

Study participants were randomly assigned to one of four treatments groups: (1) chiropractic care with physical therapy; (2) chiropractic care without physical therapy; (3) medical care with physical therapy; and (4) medical care without physical therapy. In each treatment group, the researchers compared the results of recreational exercise with specific low back exercises.

People who engaged in more recreational activity had less low back pain, disability, and psychological distress, while people who engaged in more specific low back exercises tended to have more. The results suggest that general activity might be beneficial for back pain, whereas back exercises might be harmful.

Because of limitations in the study design, however, it is premature to conclude that back exercises are not good for bad backs. Rather than certain types of activity and exercise causing improvement or worsening of back pain, it is possible that the cause and effect is the other way around. In other words, it may be that people who have more intense low back pain are less inclined to engage in recreational activity than people without the acute pain. It could also mean that people with more chronic and disabling histories of back pain are more likely to do specific back exercises. It makes sense that people who are in acute pain would shun recreational sports and instead try to stretch and move to rehabilitate their low backs. Also, the authors didn’t collect information on the specific types of back exercises people were doing, so it is possible that some types of exercises are beneficial and some are harmful.

Low back pain is one of the most common complaints leading people to seek medical care, and it has been reported as the single most common reason people seek complementary care, such as chiropractic. For those who experience low back pain, it is often a recurrent, and sometimes extremely debilitating, problem. There is no consensus among physicians, physical therapists, or chiropractors on how best to treat low back pain. The most common treatment modalities include manipulation, drugs (pain medications and anti-inflammatory drugs), physical therapy, and in severe cases surgery. Contrary to a popular misconception, bed rest is typically not recommended. Sleeping in a fetal position with a rolled towel between the knees may help. Ice is recommended in the first 48 hours. After that, hot applications are preferable. Lifting, twisting, and bending should be avoided when the pain is still acute; walking, swimming, or other regular, gentle motion exercises should be initiated as soon as tolerable.

The strongest finding in the present study is that recreational exercise is good for low back health in people with low back pain. The question of what, if any, specific back exercises should be used or avoided merits further study.

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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