WHAT IS THE ROLE OF EXERCISE AND MOVEMENT IN LOW BACK PAIN?

Resuming Activity Levels after Acute Back Pain

Overexertion may be as unhelpful as prolonged bed rest during acute back pain. (In one study, recovery from acute back pain was slower for patients who immediately embarked on flexibility exercises than for those who gradually resumed normal activity.) Walking, stationary biking, swimming, and even light jogging, however, may begin within two weeks of symptoms. An incremental aerobic exercise program is less stressful than stretching or exercises strengthening the trunk muscles. Patients should never force themselves to exercise if, by doing so, pain increases.

Exercises to Avoid during Recovery

It should be strongly noted that incorrect movements or long-term high-impact exercise is a cause of back pain. People vulnerable to back pain should avoid activities that put undue stress on the lower back or require sudden twisting movements, such as football, golf, ballet, and weight lifting. Jogging is usually not recommended, at least not until the pain is gone and muscles are stronger. Exercises that put the lower back under pressure should be avoided until the back muscles are well toned. Such exercises include leg lifts done in a prone (face-down) position, straight leg sit-ups, and leg curls using exercise equipment.

Exercise for Chronic Back Pain

Exercise plays a very beneficial role in chronic back pain. In one study, for example, patients with back pain lasting for an average of 18 months were assigned eight one-hour exercise sessions over four weeks. They showed greater improvement in nearly every area, including reduced pain and increased capacity, compared to patients who did not exercise. Patients who choose a passive route (massage and heat therapy) experience slower recovery from pain than those who exercise (although after a year their conditions do not appear to differ much). Some studies suggest that the positive impact of exercise on low back pain does not depend on improving strength and flexibility but on changing the patients' attitudes toward their disability and pain. Some exercise programs used for prevention or for chronic low back pain include the following:

Low Impact Aerobic Exercises. Low-impact aerobic exercises, such as swimming, bicycling, and walking, can strengthen muscles in the abdomen and back without over-straining the back. Programs that use strengthening exercises while swimming may be a particularly beneficial approach for many patients with back pain.
Lumbar Extension Strength Training. Exercises called lumbar extension strength training are proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve lower back mobility, strength, and endurance, and enhance flexibility in the hip and hamstring muscles and tendons at the back of the thigh.
Yoga, Tai Chi, and Chi Kung. These exercises combine low-impact physical movements and meditation. They are based on principles of disciplining the mind to achieve a physical and mental balance and can be very helpful in preventing recurrences of lower back pain.
Flexibility Exercises. Whether flexibility exercises alone offer any significant benefit is uncertain. One study suggested that any benefits derived from flexibility exercises are lost unless the exercise regimens are sustained.
Retraining Deep Muscles. Of interest are studies that are finding a link between low back pain and impaired motor control of deep muscles of the back and trunk. According to these studies, contraction exercises specifically designed to retrain these muscles may be effective for patients with both acute and chronic pain.

It is important for any person who has low back pain to have an exercise program guided by professionals who understand the limitations and special needs of back pain and who can address individual health conditions. One study indicated that patients who planned their own exercise did worse than those in physical therapy or physician-directed programs.

Specific Exercises for Low Back Strength

Perform the following exercises at least three times a week:

Partial Sit-ups.

Partial sit-ups or crunches strengthen the abdominal muscles.

Keep the knees bent and the lower back flat on the floor while raising the shoulders up three to six inches.
Exhale on the way up and inhale on the way down.

Perform this exercise slowly eight to tens times with the arms across the chest.

Pelvic Tilt.

The pelvic tilt alleviates tight or fatigued lower back muscles.

Lie on the back with the knees bent and feet flat on the floor.
Tighten the buttocks and abdomen so that they tip up slightly.
Press the lower back to the floor, hold for one second and then relax.
Be sure to breathe evenly.

Over time increase this exercise until it is held for five seconds. Then, extend the legs a little more so that the feet are further away from the body and try it again.

Stretching Lower-Back Muscles.

The following are three exercises for stretching the lower back:

Lie on the back with knees bent and legs together. Keeping arms at the sides, slowly roll the knees over to one side until totally relaxed. Hold this position for about 20 seconds (while breathing evenly) and then repeat on the other side.
Lying on the back, hold one knee and push it gently toward the chest. Hold for 20 seconds. Repeat with other knee.
While supported on hands and knees, lift and straighten right hand and left leg at the same time. Hold for three seconds while tightening the abdominal muscles. The back should be straight. Alternate with the other arm and leg and repeat on each side eight to 20 times.

Note: No one with low back pain should perform exercises that require bending over right after getting up in the morning. At that time, the discs are more fluid-filled and more vulnerable to pressure from this movement.

& Tips for Daily Movement and Inactivity

The way a person moves, stands, or sleeps during the day plays a major role in back pain:

Maintaining good posture is very important. This means keeping the ears, shoulders, and hips in a straight line with the head up and stomach pulled in.
It is best not to stand for long periods of time. If it is necessary, walk as much as possible and wear shoes without heels, preferably with cushioned soles. Using a low stool, alternate resting each foot on it.
Sitting puts the most pressure on the back. Chairs should either have straight backs or low-back support. If possible, chairs should swivel to avoid twisting at the waist, have arm rests, and adjustable backs. While sitting, the knees should be a little higher than the hip, so a low stool or hassock is useful to put the feet on. A small pillow or rolled towel behind the lower back helps relieve pressure while either sitting or driving.
Riding and particularly driving for long periods in a vehicle increases stress. Move the seat as far forward as possible to avoid bending forward. The back of the seat should be reclined not more than 30¡ and, if possible, the seat bottom should be tilted slightly up in front. For long rides, one should stop and walk around about every hour and avoid lifting or carrying objects immediately after the ride.
Be sure to have a firm mattress. If the mattress is too soft, a 1/4-inch plywood board can be put between the mattress and box spring. On the other hand, some people have experienced morning backache from a mattress that is too hard. The back is the best guide.

Tips for Lifting and Bending

Anyone who engages in heavy lifting should take precautions when lifting and bending:
* If an object is too heavy or awkward, get help.
Spread your feet apart to give a wide base of support.
Stand as close as possible to the object being lifted.
Bend at the knees; tighten stomach muscles and tuck buttocks in so that the pelvis is rolled under and the small of the back is flexed slightly. Do not arch the back. (Even when not lifting an object, always try to use this posture when stooping down).
Hold objects close to the body to reduce the load on the back.
Lift using the leg muscles, not those in the back.
Stand up without bending forward from the waist.
Never twist from the waist while bending or lifting any heavy object. If you need to move an object to one side, point your toes in that direction and pivot toward it.
If an object can be moved without lifting, pull it, don't push.