Is Exercise Best for Low Back Pain?

Non-muscular lower back pain needs rest and regular exercise

(RxWiki News) Chronic degenerative-related low back pain can be challenging to manage. A recent study highlights an alternative approach to the commonly prescribed exercise therapy.

Patients with non-muscular lower back pain that is thought to be caused by mechanical stress typically experience difficulty finding the right treatment.

Often this category of low back pain is prescribed exercise therapy and active lifestyle, but a study published this past February in BMC Medicine suggest that daily rest and lumbar support can be an equally successful treatment.

"Discuss different approaches to pain management with your doctor"

One theory is that exercise can inhibit microfracture healing through vigorous weight-bearing exercise. If microfractures are present in the vertebral bone, time and rest for healing can improve a patient’s condition without aggravating it.

The study was based at the Spine Centre of Southern Denmark from August 2007 to December 2008. One hundred patients were put through a regimen of either rest or exercise. The treatment lasted ten weeks through an outpatient clinic with follow up after one year.

Those instructed to rest did so for one hour two times a day with the option of using a lumbar support for up to four hours a day to help reduce the load on the spine.

The rest cohort met in café-like settings in groups of no more than ten every second week for 45 minutes to discuss their condition with a physiotherapist. Those instructed to rest were also instructed to avoid hard physical activity until the initial ten weeks were completed.

Those assigned to physical activity completed exercises for the stabilizing of muscles in the lower back and abdomen, matched with dynamic exercises for postural instability and light physical fitness training.

The exercise was conducted in groups of no more than ten for one hour guided by a physiotherapist. The exercise took place once a week in conjunction with active living. Participants were encouraged to repeat the exercises at home three times a week on their own.

After the initial ten weeks, participants were encouraged to continue their exercise at home.

Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome.

Pain, general disability, general health, depression, improvement and incidents of sick leave were all recorded for this study. The two groups showed no significant differences in outcome.

After ten weeks, 18 percent of the rest group and 26 percent of the exercise group sought additional treatment for back pain. At one year, 64 percent of the rest group and 50 percent of the exercise group had sought additional treatment. Researchers did not feel this difference was statistically significant.

"Chronic low back pain can be very difficult to resolve, but frequently pain can be alleviated if a customized treatment plan is used and personalized to the individual," says Diane Shiao, PT, MSPT, DPT of Revive Physical Therapy and Wellness in Edison, New Jersey.

"One patient may respond quite well to stretching exercises whereas another patient may improve faster focusing on core stabilization and strengthening."

The study was led by Rikke K. Jensen and the team reported no competing interest. The project was funded by the Velux Foundation, a Danish non-profit foundation.

Review Date: 
June 8, 2012