Back pain affects millions of people worldwide, and over 80% of adults will experience at least one episode of back pain in their lives. The causes are complex and varied, and there is a also a bewildering number of treatments on offer. This can make it hard know what is the best way to manage back pain, especially since something that is a “magic cure” for one person may be seem to be no help at all to another, or even make them feel worse. To help you make an informed choice on how to manage back pain, in this post we well review the evidence behind two of the major treatment options recommended for back pain: exercise and medication.
Exercise For Low Back Pain
Exercise is the most strongly supported and evidence-based treatment for low back pain. It is also among the most widely recommended. Extensive research confirms that exercise and movement, done at the appropriate level, should be included in first-line treatment for back pain. It can reduce your pain, increase your movement, and get you back doing the normal daily things you want and need to do. But what is more complex is knowing which exercise to do, and how much of it.
The Benefits of Exercise For Back Pain Include
– Improved muscle strength to support the spine and allow increased movement. Increasing spinal strength can also significantly reduce your risk of having future back pain episodes.
– Increased range of motion and enhanced movement patterns, which can relieve current pain and can help to prevent future injuries or recurrences of back pain.
– Exercise plays a significant role in effective weight management, and maintaining a healthy weight can reduce the level of stress on your spine
– Exercise has been shown to be very effective in improving mental health by reducing stress and anxiety. This is important because research shows that back pain, especially chronic (long term) back pain, is often affected by our mental health. Chronic back pain can lead to prolonged periods of anxiety and depression, and exercise is an extremely effective, non-medicinal way of combating this. For example, studies have shown that exercise can cut the effects of depression by up to 50% and be more effective than anti-depressants.
Exercise For Acute Back Pain
Acute back pain means pain that has only come on recently, for example in the last few days or weeks. It can range from mild through to moderate or severe. Exercise in this stage of back pain focuses on gently restoring movement and function within your comfort limits. Extensive research shows that keeping active within your pain limits helps you recover from back pain faster than if you rest too much. Exercise can help you stay active by encouraging movement and re-activating muscles while staying within your comfort limits and giving you confidence to get moving again. As your pain settles the exercise progresses to focus more on strengthening to get you fully back to your normal acitivites and to reduce your risk of future problems
Exercise For Chronic Low Back Pain
Chronic low back pain is pain that has been there for 3 months or more. Sometimes this means pain that has been there for years or even decades. It may be fairly constant, i.e. there is always some level of pain or discomfort present, or intermittent/episodic, i.e. where you may have weeks or months where you feel completely fine, but then have a pain episode that may last from days to weeks.
One of the strongest and most consistent findings in any area of low back pain research is that exercise is among the most effective ways to treat chronic back pain. For this reason, exercise should always be included in a management plan for chronic back pain sufferers. The exact type, intensity and frequency of exercise may vary for each person, and other treatments can often be helpful as well, but exercise should always be included for managing chronic or recurrent low back pain.
Despite the proven benefits of exercise, many chronic low back pain sufferers are reluctant to get moving and become active in the initial stages of their exercise journey. This is extremely common and completely understandable, as some movements or positions can be quite triggering for individual types of pain. An important thing to remember is that especially in the early stages, starting exercise may cause some discomfort and pain. Kept at an acceptable level this is completely normal and fine however, many people (understandably!) become fearful of aggravating their pain or “doing their back in again”. They are often unsure if they should continue to exercise through pain, so they stop exercising and reduce their activity even further. This leads to a downward spiral of weakness, activity reduction, and increasing fearfulness around doing any exercise again.
The Exercise “Sweet Spot” For Low Back Pain
For chronic back pain sufferers who feel they are caught in this downward spiral, getting guidance from an exercise professional who is experienced in this area can be extremely helpful. Knowing what is ok to feel and what is not, how much pain is “too much”, and having your form checked to make sure you’re doing things right, can really help your confidence in your ability to keep exercising.
Basically, there’s a “sweet spot” for exercise in low back pain. This is where you are exercising enough to gradually build strength and resilience, and working through an acceptable level of discomfort at times, but not pushing too hard so that your pain increases to unacceptable levels. Doing too little and completely avoiding pain probably means that you’re not using your body enough to build or even maintain your strength, so your ability to do normal activities steadily declines and your confidence reduces. But pushing too hard means your pain will increase to a level which will stop you doing activities (including exercise), your confidence will drop, and the belief that “I can’t do exercise any more” will be (incorrectly) re-enforced.
So, what’s an “acceptable” level of discomfort? Well, that’s a very personal thing – everyone is different, and even within one individual what they are happy to work through in one session may be different to the next session. This is where establishing an exercise routine with an exercise professional who is experienced in working with back pain clients can be really helpful. They can encourage and guide you to work through some discomfort, but know the signs to look for which indicate that you’ve done enough or need to pull back a little.
Which Type Of Exercise Is Best For Low Back Pain?
There is a mountain of research which looks at which type of exercise works best for low back pain. So far there is no clear indication that one form of exercise is consistently superior to another. What is being shown is that matching each person to the right type of exercise for them is the most important thing. This means that while Pilates might be fantastic for one person it may not work for someone else, or weight training might stir one person’s pain up but be really effective in relieving another’s. There are a multitude of factors and unknowns as to why this variability exists – easily enough for another blog post! – and we don’t have space to go into details here. But the important point to remember is that finding the right exercise for you is likely going to be one of the most effective treatment strategies you can find for beating low back pain.
Exercise Following Spinal Surgery
Similar to chronic low back pain, beginning to get moving again following spinal surgery can be a daunting prospect . Again, the research on this topic is clear: the sooner post-surgical clients begin to exercise and get themselves moving, the more favourable the long-term outcomes of the surgery are. The research is similarly as strong on using exercise as an alternative to many commonly prescribed post- surgery pain medications. The common stages of exercise following surgery are to regain good mobility, reactivate key muscles (core, glutes…), progress through graded strengthening exercises, and eventually to return you to your pre-surgical activities. It’s important to liaise with your surgeon throughout your rehabilitation process, and to work within their post-op protocols.
Medication for Low Back Pain
Medication definitely has a role to play in the management of low back pain. However, it should generally be viewed as a short-term measure as it can provide temporary relief but doesn’t address the root cause of your pain. Plus it can carry the risk of side-effects, especially in longer-term use.
For many mild-moderate cases of back pain, simple medications such as Panadol and Neurofen can be effective is dulling down the pain to acceptable levels. These should generally be your first option. For more significant pain, stronger medications like Voltaren or Celebrex can be effective. However, longer term use of these medications can have some side-effects, for example stomach irritation with Voltaren.
There are some more complex and stronger medications that are used for more severe types of back pain. However, these should only be prescribed when really needed, used for as little time as possible, and often carry more significant risks of side effects. These include drugs such as Endone, Valium, Lyrica, other opoids etc…
Exercise And Medication Combined Can Be Very Effective
In many cases, a combination of exercise and medication can be most effective. A short course of simple medication (e.g. Panadol/Neurofen, or Voltaren if required) initially can help you begin and progress with your exercise program more quickly. The short-term relief gained from the medication can allow your exercise program, which is the most important driver of your long-term recovery, to get you going more quickly. Then, as soon as possible, you can reduce and stop your medication, and your exercise program can progress to fully regain your strength and mobility.
Research supports the principle that combining exercise and medication yields better outcomes than using either approach alone for managing back pain. A systematic review by Steffens et al. (2016) involving over 30 randomized controlled trials found that combining exercise with NSAIDs resulted in greater reductions in pain and improved physical function compared to medication alone.
A simple way to think of it is that medication can bring you good short term relief, but doesn’t fix the underlying cause so often doesn’t deliver a long-term solution, especially for more chronic or recurrent pain. Exercise is more effective in bringing long-term relief, but if your pain levels are high initially it can be hard to establish an effective exercise program to begin with. So, combining a short course of simple medication with personalised exercise can bring both short-term and long-term relief.
Back Pain Exercise At Central Performance
Our exercise physiology team at Central Performance are experts in prescribing exercise programs for conditions including chronic back pain and back pain following spinal surgery. Our specialised Back Pain Program is designed to guide back pain clients from early rehab right through to rebuilding all-round health and fitness.
We know that going to a gym can be a new or intimidating experience for some people, especially if you’ve been in pain for a long time, haven’t exercised for quite a while, or you’re just not really a “gym person”. That’s why we always focus on providing a friendly, comfortable and welcoming environment for you, with coaches who really get to know you and care about your health. When you walk into Central Performance it doesn’t feel like a normal gym. It’s a small, personal and friendly environment where we know all of our clients & you’ll get to know our team in just a session or two.
Chris McCarthy, Head OF Exercise Physiology
I have a special interest in exercise-based management of low back pain. As Head of Exercise Physiology I developed and manage our Back Pain Program, which is specifically designed to help clients beat chronic back pain and recover from spinal surgery.
I love using a personalised approach with all of my clients, where each session is adjusted to perfectly match their ability and capacity on that particular day. By bringing a mix of mobility, stability and strength exercises into my programs I cover each aspect of movement that is needed to rebuild your spinal strength, flexibility and resilience.
Feel free to call me on 9280 2322 to speak to me and see if we can help you beat your back pain. You can also email an enquiry or book online.
