Can exercise really prevent back pain?

April 5, 2014

 

Can exercise really prevent back pain?

This is an article that I read some time ago on the different types of exercises that may improve back pain. It is an interesting article and I hope to post more in the future but the The bottom line is it doesn’t matter what you do to exercise as long as you move!

At A Spinal health and Movement Center we are fortunate to have a Gyrotonic studio in our Movement Center are that is owned and operated by Rich O’Connor of GyrotonicAlbq. that is very helpful in rehabilitation but the important point is that the body needs to move and exercise.

How Exercise “Really” Prevents Low Back Pain (Probably)
Posted on May 29, 2012 by Tony Ingram • 15 Comments
It probably won’t surprise you that research generally supports the idea that exercising and being fit can help prevent lower back problems.

But what might surprise you are the reasons why it seems to help.

It’s not what you think!

Yes, exercise prevents back problems.

In 2009, an article was published in The Spine Journal that reviewed research on the prevention of back problems 1. After a comprehensive review, only 20 out of 185 articles fulfilled their criteria as relevant, high-quality research. So what did they find?

The only thing that consistently prevented low back problems was exercise.
– Effect sizes huh? were moderate, which is actually pretty good.
What wasn’t effective? Some very popular ideas:
– Education alone.
– Lumbar (back) supports.
– Shoe orthoses (inserts).
– Reduce lifting loads.
Pretty interesting!

Of course, there are limitations to this research. For instance: what do they mean by education? We’ve seen before that learning how pain works can actually prevent and reduce low back pain in some people. Typically, education for preventing back pain involves “how to avoid hurting your back” videos and classes – but not pain science education. Maybe it’s all about what type of education people receive!

Types might be important? Then what about exercise?

That actually brings to the most important point:

Does it matter what type of exercise people do to prevent back problems?

Apparently not – the research studies on exercise used very different protocols. Some included everything from strengthening + endurance + flexibility + education, while one study simply consisted of “passive extension”. No matter what type of exercise was performed, it generally helped prevent back problems.

The authors of the 2009 review conclude in the final line of their abstract:

“The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals.”

That’s a powerful statement. The “physiologic goals” of exercise (to improve strength, endurance, flexibility, and even coordination) are probably not the same reasons it has an effect on pain – it’s probably due to other benefits!

Exercise isn’t good for preventing or reducing pain because it “strengthens / conditions your core”, or “improves spinal mobility / flexibility / stability”, or even “improves motor control”.

Core stability experts – don’t get mad at me – check the research: when these highly specialized approaches are formally studied, they are never shown to be any better than “general exercise”. 2, 3, 4, 5

These “physiologic goals” might be important for health, physical function, and athletic performance, but they do not ‘prevent’ or ‘treat’ pain.

Then why does exercise help with pain?

You might be asking yourself: so why does exercise help with pain?

Science to the rescue!

A 2012 article has been published in the journal Pain that reviewed pain perception in athletes 6. They looked at how athletes differ from normally active people when it comes to their pain threshold and pain tolerance. So what did they find?

Athletes tend to have higher pain tolerance than normally active people.
However, their pain threshold didn’t appear to be any better.
So it wasn’t that athletes feel less pain – it’s just that they deal with it better. And this was true for a variety of different types of exercise.

It should be noted that we’re not talking about improved pain tolerance during or immediately after exercise (often attributed to increases in adrenaline, endorphins, or endocannabinoids). We’re talking about pain tolerance in general.

So why do athletes tolerate pain better?

There are a lot of potential reasons – and the authors of the study mention the fact that pain tolerance is strongly influenced by “psycho-social factors”. For example, pain acceptance and coping may be improved through exercise. Exercise may also reduce ‘kinesiophobia’ – a fear of movement, perhaps through graded exposure, and teaching people that it’s okay to move when they have pain.

Of course, it’s probably quite a bit more complicated than that, and there are likely many reasons why exercise is good for pain besides just improved tolerance.

Either way, it seems clear that exercise is good for pain because of its complex effects on biochemistry, neurophysiology, and psychology.

Not because it puts you back together like humpty dumpty.

CONCLUSIONS:

Exercise of any sort probably has its effect on pain through psychology, neurophysiology and biochemistry – but not strength, flexibility, alignment, or stability.

Those things may still be important. But pain is complex. It’s not ’caused’ by damage, and it must be treated with many factors in mind. See the ‘Pain Education‘ section of this site.

This is important to understand so that we keep asking the right questions, keep doing good research, and ultimately help people with their pain.

www.albuquerque-chiropractor.com

 

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