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Lower Back Pain & Exercise

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According to the AIHW (2020), About 4.1 million, or 16% of Australians have a self-reported lower back pain (LBP). Individuals with LBP often experience limitations on their day to day functions. In addition, LBP is associated with increased absence from work, medical expenditure, and a poorer quality of life.

What Are The Different Types Of Lower Back Pain?

LBP is often grouped into 3 categories:

  1. Specific Spinal Pathology

  2. Radicular (Nerve Root) Pain

  3. Non-Specific Lower Back Pain (NSLBP)

Acute Low Back Pain

Serious Spinal Pathology

Cancer

  • Age > 50 years

  • History of cancer

  • Unexplained weight loss

  • Failure to improve with conservative surgery

Vertebral Fracture

  • Age > 50 years

  • Female

  • Major trauma

  • Pain & tenderness

  • Distracting painful injury

Nerve Root Pain

Pain in the leg (+/- pins and needles or numbness) in a dermatomal distribution

Leg pain worse than back pain

Neurological exam reveals sensory, motor, and reflex changes of the same spinal level

Non-Specific Low Back Pain

Pain in the lumbosacral area

Pain may radiate diffusely into buttock or thigh, but not below knee crease

Patient is generally well

Age 20-55 years

Pain is mechanical in nature

Diagnostic triage (Hush & Nicholas, 2011)

Most LBP fits into the 3rd category, being non-specific low back pain. It has been said that up to 85% of all LBP cases have an unknown cause (Gordon et al, 2021). There is a wide range of evidence for exercise therapy in the treatment of LBP. Its us is to address impairments that are thought to be contributing factors.

Exercise & Low Back Pain

Exercise is thought to reduce the severity of pain compared to no treatment (Hayden et al, 2021). One possible reason might be due to the fact that exercise promotes blood flow to the tissues around the back, which is an important process in healing (Benjamin, 2014). The Dutch Physiotherapy Guidlines (2002) recommend that patients with non-specific low back pain engage in general exercise, as remaining inactive for long periods can negatively impact recovery. This is due to the difficulty in localising a specific source of injury, making the prescription of specific exercises hard. As a result, physiotherapists treat impairments identified in assessments that are known to be predictors of LBP. This can range from poor muscle recruitment, muscle weaknesses or biomechanic strategies.

One popular method for treating low back pain is the Pilates method. Pilates encourages the activation of stability muscles during movement. Cueing relating to the Multifidus, Transverse Abdominus, Diaphragm & Pelvic Floor are common features of the Pilates method. Pilates equipment such as a Reformer, Wanda Chair, and Trapeze have been demonstrated to improve the development of Transverse Abdominus compared to mate-based pilates work (Eliks et al, 2019).

The Summary

  • Low Back Pain is a prevalent condition that has been documented and studied across the globe for decades. it leads to losses in productivity, decreases in functional ability, and reduced work performance.

  • While there are many known causes of LBP, most fall into the non-specific category.

  • Exercises such as clinical Pilates can lead to improved outcomes by improving blood flow, promoting healing, and strengthening muscles in the affected areas.