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Exercise for low back pain

It’s all about the core

Karen Miller | 1/19/2017, 9:26 a.m.
If low back pain does not go away within a week or so, often physical therapy and exercise are recommended. ...
Photo by Yawu Miller

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.

Clare E. Safran-Norton, P.T., Ph.D, OCS
Clinical Supervisor
Rehabilitation Services
Brigham and Women’s Hospital

Clare E. Safran-Norton, P.T., Ph.D, OCS Clinical Supervisor Rehabilitation Services Brigham and Women’s Hospital

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.