This is right up there amongst the questions I get asked most frequently – and rightly so! Low back pain is one of the most common reasons people seek the help and advice of an Osteopath and lower back pain remains the single leading cause of disability since it was first measured in 1990 - 2017 according to the Global Burden of Disease Study (GBD). To give an idea of the financial impact this has, treating all the types of back pain combined costs the NHS more than £1000 million per year and Arthritis UK (now ‘Verses Arthritis’) estimate the cost of back pain to the UK economy could be as high as £20 billion per year!
Physical exercise in its various forms been shown time and time again to be one of our most powerful tools in pain management, rehabilitation from injury, mental health and emotional wellbeing and in generally improving the capacity of our body. There is a truly gigantic amount of research available on exercise for low back pain, some of which is concerned primarily with evaluating the various different forms of exercise in an effort to identify which is ‘best’ or perhaps most effective in our ongoing fight against low back pain.
The Big Question…
What then, is the best type of exercise for your sore back?
Well firstly, it is important to identify (as far as possible) the cause of your back pain. Low back pain is a much more complex beast than many people perhaps appreciate and can be due to a cocktail of physical, environmental, emotional and psychological factors – all of which need to be considered when deciding on an appropriate plan for providing relief.
Having consulted with an appropriately trained healthcare professional, specific and targeted exercises may be employed in the short to mid-term to begin to improve your symptoms. If there are specific positions, movements or activities that really aggravate your back pain then you may be given advice to temporarily avoid or alter them – sometimes you may even be advised to work gently towards them! Every single case is different so advice can differ accordingly.
A study published this year in the British Journal of Sports Medicine (BJSM) by Owen et al. (2019) examined the effectiveness of specific modes of exercise training for adults with chronic (lasting longer than 6 weeks) non-specific low back pain. This paper looked at 89 previously published studies and found some low-quality evidence that the following forms of exercise are able to improve pain, physical function and mental health:
· Aerobic exercise (running/cycling etc. commonly referred to as ‘cardio’)
· Resistance training (often known as ‘weight training’)
· Stabilisation/motor control exercises
Now I know what you’re thinking… ‘Isn’t that more or less all the types of exercise, James?’
Basically, yes! So, we have some evidence to say that taking part in any or all of these types of exercise is likely to play a role in improving your low back pain. However, it’s important to remember that managing low back pain isn’t always as straight forward as picking an exercise and doing it. Exercise may form just part of a mixture of techniques and management strategies that should be chosen for you according to:
· the pain you are experiencing
· how long that complaint has been going on
· the things that most aggravate and relieve your symptoms
· your medical history and any other health issues you may have
· what type of activities or exercise you usually enjoy
· what your goals are – maybe that’s just to get out of pain so you can walk to the shops again or maybe it’s to get back to climbing mountains.
The ‘take-home message’…
When managing a person’s low back pain, my advice is that there are usually a number types of exercise that may be beneficial. Most likely, this is due to the fact that exercise has a multitude of positive effects on your body and brain including building strength and capacity, modulating the pain you’re feeling and improving your mental and emotional wellbeing. Any specific exercises or drills that you are given should, ideally, be a temporary measure that helps to facilitate you towards whatever type of exercise/sport/activities you enjoy.
Ultimately, there can’t truly be a ‘best’ exercise for low back pain because everyone’s low back pain is a different experience and has a different person attached to it. Once safe and sensible steps have been taken to begin to reduce your pain and improve the way you are able to function in day to day life, then the ‘best’ and most effective exercise is usually the one you enjoy doing!
Always seek the advice of an appropriately trained healthcare professional if you have suffered a traumatic injury to your back or if you experience any of the following symptoms (either in isolation, or in combination with low back pain):
· Any numbness/weakness/tingling or ‘pins and needles’ into your arms/hands/legs/feet
· Any sharp, stabbing, shooting or ‘electric shock’ like pain down either/both legs
· Any changes to your ability to urinate (wee) or defecate (poo)
· Any change to the sensation in your saddle area/groin e.g. numbness
· Any abdominal pain
· Any blood in the toilet bowl when you go to the loo
· Any pain that wakes you during the night (particularly in a sweat)
· Pain/stiffness in your spine first thing in the morning that takes longer than 30mins to improve with movement.
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Yours in health,