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Exercise to Improve Back Pain

November 26th, 2013

By Gina Mattes, PharmD Student Cedarville University

Today almost 80% of  Americans have back pain, but often the treatments used are ineffective and costly. 1 However, there is another way that people can relieve back pain that is relatively cheap or free and you can do it right at home! Exercise is being proven to be more beneficial for your heart, but it’s also better for pain.1 In an article posted in The New York Times a study was cited that showed even going for a walk every day can help reduce back pain.1 This conclusion was made because there was no statistical difference between the exercise group and the walking group with significant improvement in walking distance from the beginning to the end in both groups.2 The six minute walk test was the main outcome for the study.  Both groups participated in a six-week program that was twice a week. Both groups started with 20 minutes during each session and increased by 5 minutes every week. The walking group spent time on a treadmill starting at a low intensity, increasing intensity, then had a cool down with low intensity at each session. The exercise group focused on active movement and strengthening exercises, beginning with a five minute warm up, low loaded exercise increasing the number of exercise repetitions over the course of the 6 weeks, and a five minute cool-down.2

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Another way to reduce chronic pain The New York Times article proposes is doing yoga. One study showed that yoga for short-term effectiveness helped tremendously, but only moderate outcomes for long-term effectiveness.3 The reason exercise has been helping rather than hurting is because you are strengthening the muscles in your back and abdomen, in doing this you are able to regain function of your back without pain because of the endurance your body has built up.2 In the study presented by the Clinical Journal of Pain Cramer and colleagues looked at 10 randomized clinical studies that collectively had 967 chronic back pain patients that showed strong evidence for short term relief and moderate evidence for long-term relief.3 There is no simple solution or usually a reason for back pain to be occurring, but even if there is no reason for the pain people don’t have to be in pain instead they can go for a walk and build up those muscles. I agree with this article. It’s easier and way cheaper to go outside and walk around the block a few times, going to the gym, or looking up youtube yoga videos to do some yoga and help yourself than taking medications that probably won’t help in the long run.

Studies have show that the standard of care for lower back pain such as steroid shots, has often  been ineffective for chronic pain. 3, 4 Additional evidence shows that people doing yoga to relieve chronic back pain is much more helpful.1,2,3  In a study done by Saper he came up with a 12 week hatha yoga program.5 The study included a 12 week yoga program with each session lasting about 75 minutes, led by a 2 year yoga expert.5 The program was broken up into four, three week segments with each week containing a different theme.5 The participants were strongly encouraged to practice yoga for 30 minutes each day, the participants were given all material needed to practice at home.5 Improvement was evaluated by questionnaires that participants filled out at 6 and 12 weeks of intervention.5 At the end the study showed that participants’ pain decreased resulting in the decrease of using pain medications and muscle relaxants.5 However, the study did have a high number of drop out rates and a low number of follow up at 26 weeks.5 Even with the issues of the study it still shows a significant difference in people who did a yoga program versus the people who did not.5

The increase in studies that exercise in some form helps chronic pain patients long-term are overwhelming. Even a short day trip in a study done in Japan where people went to an amusement park for the day had pain relief, but the relief quickly faded after that day.2,3 This study included several age groups and measured back pain at different times (10 minutes, 1 hour,and 3 hours after arriving), but had a low number of participants in the study making it more questionable.3 In light of this new evidence I would highly recommend to my patients to try and build those lower back and abdomen muscles by going for a walk or maybe even looking up a few easy exercises online instead of jumping to steroid shots. In the end walking around the block would likely be more beneficial to health holistically than medication therapy.

So which would you rather have, going for a walk every day or sitting in the doctor’s office waiting for a shot that may not have long term effectiveness?

References:

1. Reynolds, G. Alternatives for back pain relief. The New York Times. July 18, 2013:MM18. October 21, 2013 http://well.blogs.nytimes.com/2013/07/18/looking-for-alternatives-for-back-pain-relief/?_r=0

2.   Shnayderman I, Katz-Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation [serial online]. March 2013;27(3):207-214.

3.   Centre for Reviews and D. A systematic review and meta‐analysis of yoga for low back pain (Provisional abstract). Clinical Journal Of Pain [serial online]. 2013;:450-460.

4.   Staal J, Nelemans P, de Bie R. Spinal injection therapy for low back pain. JAMA: The Journal Of The American Medical Association [serial online]. June 19, 2013;309(23):2439-2440.

5.   Saper R. Yoga for Chronic Low Back Pain in a Predominantly Minority Population: A Pilot Randomized Controlled Trial. Alternative Therapies In Health & Medicine [serial online]. November 2009;15(6):18-27.

6.   Sakakibara T, Wang Z, Kasai Y. Does going to an amusement park alleviate low back pain? A preliminary study. Journal Of Pain Research [serial online]. January 1, 2012;5:409-413.

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5 Responses to “Exercise to Improve Back Pain”

  1. Cara Toms Says:

    I found your article very interesting. My dad suffers from chronic back pain for many years now and has tried every shot, surgery, and medication there is. He has mentioned to me that after his physical therapy he feels the best. My mom and him going walking a lot and he does say that helps too. I would think walking and increasing your daily physical activity could benefit a person more than just relieve pain. Walking everyday could allow a patient to lose weight, help relieve pain, and feel all around healthier. I would recommend this to my future patients to help with back pain!

  2. Aaron Le Poire Says:

    I think the idea of exercise to help with chronic back pain is a great one, especially with the evidence provided. There are obviously benefits not only for back pain with exercise such as weight loss and lowering the risk of other health issues. For someone who has chronic back pain, exercise, even just walking a few times a week, could definitely improve their life. However, I think more studies need to be done to determine what method is best for long term treatment of chronic back pain. I would like to see some more studies looking at the long term effectiveness of exercise on back pain compared to other more traditional approaches. Back pain can be a very debilitating condition, so I feel like a study that looks at the effects of both traditional methods such as cortisone shots in addition to exercise could be beneficial. I also think more research could be done in the area of finding out what can cause back pain, so it can either be better prevented or treated more effectively through different treatment regimes. I definitely think people should be informed on how exercise can help with their back pain, but I also think they should be informed as to how they can further injure themselves through exercise and need to be taught proper form if they are going to do exercises besides walking.

  3. Caleb Lyman Says:

    This solution is definitely news to me. I don’t know much about back pain but I would not have thought that exercising would have the effect of pain relief. I would like to know if the improved endurance of the back muscles actually reduces the pain or merely masks it. If the pain has an underlying cause then masking it could be dangerous. If, however, that cause cannot be taken care of, then this would be great for the pain management. Concerning the yoga experiment, I would be very interested to see what the participant questionnaire looked like. The study seems a little weak, but I suppose a problem like this would be rather complicated to study with much specificity.

  4. Chelsae Ward Says:

    Reading through your post was very interesting and insightful for me. I struggle with mild back pain due to issues with my spine and therefore, I can really take the information provided here to practice. I have been through physical therapy before and they mentioned many of the same things to me that you said here in your blog post.
    A lot of back pain comes from weakened muscles. In saying that though, I like Caleb’s point in that simply assuming your back pain is due to this reason could be dangerous. For me personally, my pain comes from weakened muscles due to formation issues with my spine. I agree that encouraging people to exercise is a great way to help with the pain, but I think it is also important to make the point in telling our patients that they should get any unexpected prolonged back pain examined.
    I will certainly be thinking more about taking a short walk everyday over taking a pain reliever!

  5. Heather E. Says:

    After reading this article, I am encouraged to exercise regularly. Although I do not experience any back pain, I would definitely do what I can to opt-out of the hassle of getting a shot.
    Did you find any research articles on whether the effects of exercise would change because it was for short term or long term treatment?

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