Back Pain and Sciatica

Description

Alternative Names

Exercise and Physical Therapy

Exercise is not helpful for acute back pain. In fact, overexertion may be as unhelpful as prolonged bed rest during recovery. In one study, for example, recovery was slower for patients who immediately embarked on flexibility exercises than for those who gradually resumed normal activity. An incremental aerobic exercise program (e.g., walking, stationary biking, swimming), however, may begin within two weeks of symptoms. Jogging is usually not recommended, at least not until the pain is gone and muscles are stronger.

Patients should avoid exercises that put the lower back under pressure 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.

It should be stressed that incorrect movements or long-term high-impact exercise is often a cause of back pain in the first place. 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.

In all cases, patients should never force themselves to exercise if, by doing so, pain increases.

The Role of Physical Therapy

Physical therapy with a trained professional may be useful if pain has not improved within the first three weeks. It is, in fact, important for any person who has chronic 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.

Physical therapy typically includes the following:

• The first stage involves patient education and training the patient in correct movement. Sometimes heat or electro-therapies (such as therapeutic ultrasound or low-energy lasers) are employed, although their benefits are unproven.
• If back pain persists beyond five weeks, physical therapy is used for rehabilitation. It employs exercises to help the patient keep the spine in neutral positions during all daily activities.

Exercise for Chronic Back Pain

Exercise plays a very beneficial role in chronic back pain. In fact, starting intensive exercise four to six weeks after a first back surgery is very helpful for speeding up recovery. Repetition is the key to increasing flexibility, building endurance, and strengthening the specific muscles needed to support and neutralize the spine. Exercise should be considered as part of a broader program to return to normal home, work, and social activities. In this way, the positive benefits of exercise not only affect strength and flexibility but they also alter and improve the patients' attitudes toward their disability and pain.

Unfortunately, there is insufficient evidence to determine which specific exercises will best help the patient. Some exercise programs that have studies with some success for prevention or treatment of 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. In one study, for example, pregnant women who engaged in a water gymnastics program had less back pain and were able to continue working longer.
• 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, Chi Kung. Practices originating in Asia that combine low-impact physical movements and meditation may be very helpful. They are designed to achieve a physical and mental balance and can be very helpful in preventing recurrences of low back pain. Pilates, an exercise practice that uses yoga principles, may be specifically helpful and deserves further research.
• 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.