Exercise for low back pain
It’s all about the core
When a person has acute low back pain, exercise is not high on the list of things to do. The bed is so much more enticing. But health professionals warn against bed rest for acute LBP. One day perhaps, two at most. Bed rest weakens muscles, which actually can aggravate the situation.
While many bouts of LBP can be resolved with over-the-counter painkillers, cold compresses or heat, some cases just stubbornly persevere. According to Mayo Clinic, if the pain persists for about a week or gets worse, professional help is needed.
Most often that help comes in the form of physical therapy … and exercise.
The challenge is figuring out the source of the pain, according to Dr. Clare E. Safran-Norton, a clinical supervisor and physical therapist in the Department of Rehabilitation Services at Brigham and Women’s Hospital. “Is the pain originating from the back, hip or sacroiliac joint (point where the base of the spine connects to the pelvis)?” she asks. If the person has sciatica, it may be associated with a disc that is bulging or ruptured. If the culprit is spinal stenosis, a narrowing of the space that houses the spinal cord, the person may feel more pain when walking.
The source of the pain is key, as it dictates the treatment. For instance, a herniated disc benefits from exercises that extend the spine backwards, according to Safran-Norton, while exercises that bend the spine forward help relieve the pain of spinal stenosis.
Although exercise for LBP is not cookie-cutter, the goal is the same. “We want to ultimately restore the level of function,” she said. “We hope to reduce pain and restore strength, range of motion and basic activities of daily living.” The treatment is comprehensive, and can include manipulation of the spine, soft tissue mobilization and exercise. Education on proper posture and good body mechanics is pivotal to prevent a recurrence. A typical treatment plan is one to two sessions per week for about six weeks.
While the majority of cases of LBP can be relieved by physical therapy, some require another level of care. There are telltale signs, such as a functional loss of strength that can result in a foot drop or severe pain or loss of urine when a person sneezes or coughs. In these cases, surgery may be indicated and the patient should consult his or her doctor right away. Physical therapy and exercises can resume following the surgery.
Physical therapy is one of the most effective treatments to improve LBP. In a recent Gallup study, one in four adults had sought care for significant neck or back pain in the past 12 months. Forty-one percent of the respondents indicated that physical therapy was very effective in relieving the symptoms of LBP in comparison to only 15 percent who received surgery.
Work out before your back goes out
LBP should not be the only reason to start an exercise program. Actually, if you exercise regularly using good form, you might be able to ward off an episode of LBP altogether.
It’s all about the core. That’s more than just the abdominals, or “abs” for short. Of course abs, which bend the spine forward, are principal players of the core, but they often don’t act alone. Rather, the core is a group of muscles that surround your torso like a sheath. The muscles actually prefer to work in a group instead of singly. They contract together to help stabilize the spine. They keep you upright.
Most people engage in aerobic activities to improve the cardiovascular system. Activities like walking and bicycling get the heart pumping, but are working the core as well. With every step the core keeps you standing and moving.
Although sit-ups and crunches to increase core strength are the mainstay in many fitness centers, Safran-Norton is not a big fan of either. She is not alone. These exercises have fallen out of favor, according to HEALTHbeat from the Harvard Medical School. Sit-ups are hard on the back and work the hip flexors as well as the abs, which really might have the opposite impact than intended. Tight or overly strong hip flexors pull on the lower spine and increase its normal curvature, which can result in LBP.
“They can be harmful if you have a herniated disc,” Safran-Norton explained. Contrary to common belief, it is possible to have a herniated disc without pain. Pain ensues if there is pressure on the sciatic nerve. Crunches, especially if done incorrectly, just might give the nudge to painful sciatica.
Instead she is a fan of planks, and side planks at that. In exercise you prefer a simple movement that provides the greatest benefit. That’s a good description of planks. In these exercises you hold your trunk off the floor in a straight line. There are many variations of the plank. In a forearm plank the forearms remain on the ground while holding your core off the ground in a straight line from head to feet. In the straight-arm variation, the weight is on the hands similar to the position for a push-up. You can also perform planks on your knees if being on your toes is too difficult at first try.
While all planks strengthen the core, side planks tend to bring in the muscles on the side of the torso that might not get as strong a workout in other plank positions.
There are several benefits of planks. They don’t require equipment or much space. They actually provide a full body workout, since they work your shoulders and hips as well as your core. They can also improve balance and posture. Generally, you hold a plank for 20 to 30 seconds, and repeat three to five times. Increase the hold time and reps as you improve, up to two minutes.
Although exercise is critical for core strength, it goes hand-in-hand with a healthy diet, weight control and not smoking for overall good health.