So, you have developed some lower back pain, this is all too common, in fact in the year 2015 the global point prevalence of activity-limiting low back pain was 7.3%, this means that at any one time a whopping 540 million people were affected by debilitating back pain. Making low back the number one cause of disability globally! (Hartvigsen et al., 2018).

Often, if you’ve had low back pain for a while you’ve been recommended all kinds of management strategies and solutions. These can range from recommendations of pilates, yoga, strength training, dry needling, acupuncture, massage, manipulation, and many more invasive options. It can all become a bit confusing!

Let’s have a little dig into the available evidence to see if we can’t put you on track with a good solid recommendation for exercise when facing low back pain. But, before we do that let us take quick look at how we may be able to prevent low back pain, seems like a good place to begin!

“The only known effective interventions for secondary prevention being exercise combined with education, and exercise alone” (Foster et al., 2018). Ok, we get it… Exercise is good for low back pain, but what type of exercise?

Baring serious injury or pathology such as malignancy, vertebral fractures, or inflammatory disorders (eg, axial spondyloarthritis)which account for less than 1% of presentations (Henschke et al., 2009). Our clinical practice guidelines suggest that best management for acute low back pain consists of:

• Advice and education about the nature of low back pain.
• Reassurance that they do not have a serious disease and that symptoms will improve over time.
• And "encouragement to avoid bed rest, stay active, and continue with usual activities, including work.” (Forster et al.,2018).

What about types of exercise for persisting low back pain? Surely Pilates is the answer? What about Yoga? Strength training?

The Lancet low back pain series states that exercise for persisting low back pain should include a graded activity or exercise programme that targets improvements in function and prevention of worsening disability. Since evidence showing that one form of exercise is better than another is not available, the guidelines recommend exercise programmes that take individual needs, their preferences, and their capabilities into account in deciding what type of exercise to do.

Well, there you have it folks, the best type of exercise for your low back pain is the one that aligns with your goals and values, is enjoyable to you and most importantly the exercise that is most likely to get done! So find something that is fun and move as best as you can.

Be confident in knowing that once anything nasty has been ruled out by a trusted clinician, and that any exercise that do and is progressed in a graded manner is going to be a fantastic way to manage your low back pain and can even prevent it from arising in the future. If you would like some assistance in managing your low back pain and if you would like to know if you are safe to move we at The Biomechanics are always happy to help.

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References:

Hartvigsen, Jan, Hancock, Mark J, Kongsted, Alice, Louw,Quinette, Ferreira, Manuela L, Genevay, Stéphane, Hoy, Damian, Karppinen, Jaro, Pransky, Glenn, Sieper, Joachim, Smeets, Rob J, Underwood, Martin, Buchbinder,Rachelle, Hartvigsen, Jan, Cherkin, Dan, Foster, Nadine E, Maher, Chris G,Underwood, Martin, van Tulder, Maurits, … Woolf, Anthony. (2018). What low back pain is and why we need to pay attention. The Lancet (British Edition), 391(10137),2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X

Foster, Nadine E, Anema, Johannes R, Cherkin, Dan, Chou,Roger, Cohen, Steven P, Gross, Douglas P, Ferreira, Paulo H, Fritz, Julie M,Koes, Bart W, Peul, Wilco, Turner, Judith A, Maher, Chris G, Buchbinder,Rachelle, Hartvigsen, Jan, Cherkin, Dan, Foster, Nadine E, Maher, Chris G,Underwood, Martin, van Tulder, Maurits, … Woolf, Anthony. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet (British Edition), 391(10137),2368–2383. https://doi.org/10.1016/S0140-6736(18)30489-6

Henschke, Nicholas, Maher, Christopher G, Refshauge, KathrynM, Herbert, Robert D, Cumming, Robert G, Bleasel, Jane, York, John, Das,Anurina, & McAuley, James H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis and Rheumatism, 60(10),3072–3080. https://doi.org/10.1002/art.24853

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