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My Back Hurts, Should I Be Exercising?


Low back pain is the most prevalent musculoskeletal phenomenon in the world. Statistically 80% of individuals will have an episode of low back pain within their lifetime. Low back pain alongside neck pain have been shown to be the top two conditions for overall healthcare cost. Think about that for a second. We spend more money annually treating low back pain than cancer. I say all of this to make the point that low back pain is a HUGE problem.

You could fill thousands of blog posts with low back pain treatments, but today I want to focus on a different question. For individuals with chronic low back pain, should you be exercising?


I want to clarify a few things before I get in too deep. If you have an acute low back injury, or back pain associated with symptoms into your leg/thigh you should be evaluated by a musculoskeletal healthcare provider. There are certainly things and certainly exercises that can make your symptoms worse. This is why you need to be professionally assessed if your pain is acute, severe, or radiating into your leg. For the sake of this blog, I am referring to chronic generalized low back pain. I’m referring to the co-worker or spouse that is always complaining about their back aching or squirming in their seat in the car because they can’t get comfortable. I’m talking about the family member that’s been complaining about their “bad back” at Christmas for the last 10 years. This blog is focused on them.


The common sentiment in our society is that rest fixes everything. My back hurts, therefore, I’m going to rest and “take it easy” for a while. This is how the majority of individuals think about pain and recovery.

Ironically, research focused around low back pain paints a very different story.


According to updated research released from the Journal of Sports Physical Therapy in 2021, there is grade A evidence for multimodal exercise and trunk and muscular strengthening for chronic LBP and chronic back pain with generalized pain. The specifics are quite eye opening. The JOSPT found that across multiple modes of exercise (resistance, aerobic, general, yoga, moderate to high intensity, low intensity, etc…) outcomes were significantly improved at 1 year from those not involved in structured exercise. Another interesting fact was that there was not a single incidence of harm from exercise across the multiple studies. The primary reason many people give up exercising is because of back pain and fear of hurting themselves. The primary reason many people have continued back pain, is because they gave up exercising. The research is clear in that exercise is not something to be feared but instead a potent and scientifically validated tool for decreasing back pain.


A couple more interesting derivations from current research.

1: You need accountability.

2: Moderate-high intensity exercise is not the enemy.


One particular study found that individuals that participated in a multidisciplinary team approach had less pain at 3 and 6 months than those who exercised alone. Long term outcomes (>2 years) were similar, however individuals with a team around them had a quicker reduction in pain. Accountability matters and patients with low back pain need to find their support team. This could include healthcare providers, coaches, trainers, friends, family, or anyone willing to support you in your pursuit of fitness. Another takeaway is that moderate-high intensity exercise has its place for those with LBP. HIIT training can be a good tool for those with chronic LBP, while lower intensity endurance exercise may be more beneficial for those with chronic generalized pain (multiple sites). The idea that high intensity exercise or endurance training is “bad for you back” is scientifically unfounded. It’s ok to get your heart rate up and get after it!


The conclusion is simple. If you have chronic low back pain, the worst thing you can do is nothing. Exercise of various intensities and types have been tied to decreasing pain and improving outcomes. Find an activity or exercise type that you enjoy and stick with it. Build a team of friends/coaches/healthcare providers to encourage you and help you along the way. You’ll thank yourself when you get there.


Stay kinetic friends.



 


References:


Stevens, G.Z, Fritz, J., Silfies S., et el. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy (2021). Published Online:October 31, 2021Volume51Issue11PagesCPG1-CPG60.



 

Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.


If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.






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