Exercise - Conservative Measures: Back Pain

Content provided by the Faculty of the Harvard Medical School

Exercise

One aspect of treatment that has come to be better appreciated is the value of exercise as an integral part of any treatment plan. Today exercise therapy is routinely used to help prevent episodes of acute low back pain and to improve function in chronic low back pain. Those who are sidelined by spasms and strains of the torso muscles have the most to gain from a routine exercise program because strong, flexible muscles are less prone to injury.

One golden rule about your exercise program is to stop if it becomes painful. Exercise is meant to help, not hurt.

Any exercise program should be customized to meet your individual needs and introduced gradually a couple of weeks after the onset of symptoms or when you are feeling reasonably comfortable. If you are suffering from acute back pain, the goal is to enable you to resume normal activities as soon as possible and to remain symptom-free following recovery from the acute attack. If you have chronic back pain, work with your physician to define the desired functional goal — whether it involves being able to take a tour of European museums, play with your grandchildren, or simply sit in the backyard reading a good novel.

Building muscles

Many experts believe that weak back muscles — due to idleness or age — cause or exacerbate many cases of low back pain. That's why strengthening your back muscles is important not only for treating low back pain, but also for helping to prevent a recurrence, which happens in 4 out of 10 cases.

Exercise strengthens and stretches the muscles that support the spine. (For some suggested exercises, see Figure 12.) Strong abdominal or flexor muscles, for example, help people maintain an upright posture, as do strong extensor muscles, which run the full length of the back and maintain alignment of the vertebrae. Meanwhile, two iliopsoas muscles — which run from the lumbar vertebrae to the hips — and the buttock muscles help support the back during walking, standing, and sitting.

Figure 12: Back strengthening exercises Lie on the floor on your back. Bend your knees and keep your feet flat on the floor. Squeeze your buttocks and pull your abdomen in toward your back. Your lower back should be pressed flat on the floor. Now raise your buttocks about an inch off the floor. Your lower back will lift slightly off the floor while your upper back remains flat. Hold for a few seconds before relaxing. Repeat 10 times. While lying on the floor on your back, with your head and neck supported, grasp your leg just below your knee. Pull your leg gently toward your chest. Hold for 20 seconds. Repeat on other side. Repeat 10 times. Stand with your feet slightly apart and your hands on the top of your buttocks. While looking up, push your hips forward slightly and gently bend backwards. Keep your knees straight. Hold for 10 seconds. Relax. Repeat 10 times. Lie on your back and bend your knees. With your arms crossed in front of your chest, slowly lift your shoulders off the floor as you pull your abdomen in and tighten your buttocks. Repeat 8–20 times.

Low-impact activities such as walking, swimming, and gentle stretching exercises often help people with sciatica. However, because disk injury and other problems, such as osteoarthritis, can cause sciatica, people with this condition should see their doctor before undertaking a strenuous exercise regimen.

Stretching

Stretching is a valuable component of any treatment plan for a person plagued by back problems. Most experts believe that supple, well-stretched muscles are less prone to injury. Indeed, shorter, less flexible muscle and connective tissues restrict joint mobility, which increases the likelihood of sprains and strains.

Stretch regularly but gently, without bouncing, as this can cause tissue injury. Beginners should start by holding the stretch for a short time and gradually build up to roughly 30-second stretches over time. Back strengthening exercises, such as partial sit-ups, are also beneficial when done regularly.

A stretching and strengthening regimen should target the back, abdominal, and buttock muscles. In addition, the muscles of the upper legs should be flexible and strong because they're connected to the iliopsoas and buttock muscles and, if weak and tight, can strain the supporting structures of the back.

Working in aerobic exercise

In addition to doing exercises that increase the strength and flexibility of the lower back, people should also engage in regular aerobic exercise. Aerobic exercise not only improves cardiovascular fitness, but also helps people shed excess pounds that can place an additional burden on the back. Most guidelines advise people to engage in aerobic activity for 20–30 minutes a day.

Certain aerobic activities are safer for your back than others. Experts recommend walking and swimming for people with chronic low back pain because high-impact activities — such as running, tennis, and aerobic dance — jar the back.

Last updated:	January 23, 2007