Back Exercise for Pain Relief
One of the keys to recovering from an episode of back pain or surgery, and to help avoid future recurrences of back pain, is to pursue appropriate rehabilitation and exercise. A comprehensive exercise regimen should include a combination of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned
There are three types of muscles that support the spine:
Extensors (back and gluteal muscles), which are used to straighten the back (stand), lift and extend, and move the thighs out away from the body.
Flexors (abdominal and iliopsoas muscles), which are used to bend and support the spine from the front; they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.Article continues below
Obliques or Rotators (side muscles), which are used to stabilize the spine when upright; they rotate the spine and help maintain proper posture and spinal curvature.
While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.
For all forms of exercise, it is advisable to see a trained physical therapist. Depending on the specific diagnosis and level of pain, the exercise program will be very different, and these specialists are trained to develop an appropriate exercise program and provide instruction on correct form and technique.
Any form of inactivity, especially if an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain.
Stretching exercise should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back, so hamstring stretching is an important part of alleviating low back pain.
Specialized equipment is available that helps repetitions to be done in the same manner so that progress can be identified and the level of exercise regulated.
It is thought that future episodes of back pain are less likely to occur if back strengthening is accomplished than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercise to prevent a recurring cycle of pain and weakness.
There are two primary forms of exercise for strengthening and/or pain relief that tend to be used for specific conditions. When appropriate, the two forms of physical therapy may also be combined.
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- McKenzie exercise, in general focuses on extending the spine to reduce pain generated from a collapsed disc space (e.g. from degenerative disc disease). Theoretically, extension may also help reduce a herniated disc and reduce pressure on a nerve root. For patients who are suffering from leg pain due to a herniated disc (e.g. sciatica), extending the spine may help reduce the leg pain by "centralizing" the pain (moving the pain from the leg to the lower back). For most people, back pain is usually more tolerable than leg pain. Sometimes, based on the structured evaluation, flexion exercises are appropriate.
- Lumbar stabilization exercise focus on finding the patient's "neutral" spine, that is, the position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. Performed on an ongoing basis, these exercises can help keep the back strong and well-positioned. Special attention is paid to the extensor muscles of the lower back with resistance exercise.
Additionally, a strengthening program that involves progressive loading and unloading of the lumbar spine by means of flexion/extension exercise can reduce pain and increase the perception of improved back strength. This training, called facilitation, is best accomplished when the muscles to be facilitated are isolated in some way so that other muscles cannot take over the job. Often specific equipment is required to achieve that goal.
Low-Impact Aerobic Conditioning
Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.
Examples of low impact aerobic exercise that many people with back pain can tolerate include:
- Water therapy(also called pool therapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water counteracts gravity making many stretching movements easier and provides buoyancy as well as mild resistance.
- Walking. Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.
- Stationary biking. Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward.
Choosing the most appropriate form of exercise depends upon the nature of the injury and an individual’s exercise preferences. It may be helpful to discuss options with a physical therapist, or physician to identify which form of aerobic exercise is best to incorporate into an exercise routine.
Guidelines for Recovering from Low Back Pain
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In addition to stretching, strengthening and aerobic exercises, there are several lifestyle guidelines that can help in the healing and rehabilitation process.
Manage Anxiety About Low Back Pain
Controlling anxiety and fear of re-injury and low back pain is very important to regain normal muscle function. The basis for these psychological reactions to low back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically tells the muscles to improve their function can overcome this neurological barrier to normal muscle function.
Eat Properly to Help the Back Heal
The healing process can be aided with appropriate nutrition, which includes adequate calorie intake in a balanced manner. If all calories consumed are in the form of sugars (such as breads, pasta, and sweets), any calories not immediately needed for energy are converted into fat. Extra weight can slow the healing process. A balanced diet includes adequate protein as a source of the building blocks of soft tissue healing. Additionally, fresh fruit and vegetables supply the vitamins and trace elements necessary for effective healing. A vitamin supplement may also be helpful.
Stop Smoking to Improve Oxygen Flow to the Spine
Studies have shown that the development of low back pain was significantly associated with smoking. The underlying theory for this is that smoking deprives the spine structures of nutrients, particularly oxygen in the blood supply (because smokers’ lungs do not intake or distribute oxygen as effectively as non-smokers’) and thereby interferes with the spine’s attempts to repair itself. Stopping smoking can improve oxygen flow and improve rehabilitation outcomes.
Get Adequate Sleep to Support the Healing Process
One of the best ways to encourage sleep is to induce physical weariness through active exercise. Chronic inactivity does not create a need for the deep sleep that is so helpful for physical and emotional healing. Clearly, stimulants such as caffeine or nicotine should be avoided at bedtime. Smoking should also be avoided because it diminishes the available blood supply and makes the nervous system more sensitive.
Control Medication Use for Back Pain
While medications are often important for low back pain relief, one should also be careful about the use of medications. For example, use of narcotic medications and muscle relaxants over time may cause depression and should be used as little as possible. Also, while anti-inflammatory medications may provide low back pain relief, there is no evidence that they do anything to speed the process of healing. The use of heat therapy or cold therapy, or liniment or massage therapy, as mechanisms for pain control are very safe and positive alternatives for low back pain management.
Exercise Properly for Back Fitness
Exercising in a controlled, gradual, and progressive manner is the one signal the body responds to so that it knows to heal. Injections and medications can provide low back pain relief but cannot stimulate the healing process. If a pain problem has persisted for many weeks, the body is demonstrating that there are barriers to the healing process that need to be eliminated. The natural stimulus for the healing process is active exercise. Active exercise means using the nervous system to tell the muscles what to do, and includes dedication to an appropriate, comprehensive exercise and rehabilitation program.
Work With a Professional for Low Back Pain
Finally, seeking the assistance of an appropriately trained and licensed health professional for back rehabilitation and exercise is highly recommended. The back is a complicated structure, and specialists have a defined protocol to identify the cause of back pain. And it’s always important to see a physician if the lower back pain lasts for more than a few weeks or a month or if there are any symptoms that cause concern, as the continued pain and/or symptoms may signify a serious medical condition.
Ultimately, participating in developing and maintaining an active rehabilitation and exercise program for low back pain should help patients heal faster and have fewer recurrences of back pain.