As a Remedial Massage Therapist and Personal Trainer in a clinical setting the most common reason people seek treatment at my clinic is due to lower back pain. The best outcomes I have found with clients is when they are exercising regularly. I was finding that manipulating the soft tissues can sometimes only give short term relief, but after a period of time symptoms can often return.
Lower back pain is the most common reason that people seek treatment and effects 60-80% of adults. “Low back pain (LBP) is defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain. Nonspecific (common) LBP is defined as LBP not attributed to recognizable, known specific pathology.”(1) If the pain has been ongoing for longer than 3 months, is outside tissue healing times, is non-specific (pain in different location to tissue damage or where possible injury has occurred), is considered lower back, hips, gluteals and going down into legs. Lower back pain is aggravated by lack of movement, high stress, fear and belief that there is a serious injury or issue, belief that certain movements are the cause of the pain, belief that their pain will not get better. Pain is a warning signal from the nervous system and is not necessarily indicative of injury or damage. When an injury takes place, we adapt the way we move to protect the area. Pain is useful here as it protects from further damage and gives the body a chance to heal from injury. When the pain continues after the area has healed it can be due to increasing sensitivity in the nervous system. This sensitivity increases and the capacity to move without pain decreases triggering pain signals with less and less movement needed. Exercise can assist with this sensitivity and pain cycle by retraining movement patterns. Part of this could be learning to switch off pain signals. As we strengthen and our cardiovascular fitness increases our belief around our body being vulnerable and damaged changes. We trust ourselves to move and eventually we experience pain free movement without even thinking about it. “Low back pain is understood to have a multifactorial aetiology with individual characteristics (age, physical fitness), psychosocial factors (stress, anxiety and depression) and occupational factors (heavy physical work, bend and twist motions and vibration) implicated in its development.Treatment of chronic low back pain is difficult and many of the established interventions have limited efficacy.”(1)
Evidence-Based Recommendations for Treatment
1. Psychosocial factors need to be addressed where possible as these are other factors that contribute to pain – sleep quality + quantity, stress management, mental health…
2. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is recommended
3. Aerobic exercise to increase the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain
4. Exercising in a supervised group program as it has better outcomes than non supervised exercise programs – reason for this may be that it is more enjoyable, assists with compliance, confidence that exercises are being done correctly assists with belief that exercise is of benefit
Application of Recommendations
Addressing psychosocial factors...
- What is causing your pain diary to identify triggers
- 8 hours sleep per night
- Meditation practice
- Referral to mental health professional
General exercise programme that combines muscular strength, flexibility and aerobic fitness...
- Include full body strength (all major muscle groups, sub 10 reps, +3 sets, leave 2 in the tank)
- Include dynamic stretching pre, during and post session to improve flexibility as muscles may be very tight due to constant contraction to protect painful area
- Include cardiovascular exercise (30 minutes moderate intensity 5x per week, recommend clients do this in addition to pilates session when they have initial assessment – walking, running, cycling or have reformer cardio classes on offer that clients can come along to as part of their weekly cardio training high reps, fast pace)
Stretch to improve the flexibility of the muscle-tendons and ligaments in the back as this increases the range of motion and assists with functional movement...
- Dynamic stretches as part of warm up pre session, during when changing positions on the reformer and end to finish eg. Standing roll downs, cat/cow, pike ups, feet in straps
Aerobic exercise to increase the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain...
- Have option of moderate intensity cardiovascular specific classes eg. reformer cardio sessions
- As part of initial assessment include 30 minute cardio sessions 5x per week that client carries out in their own time
Exercising in a supervised group program has better outcomes than non supervised exercise program...
- group, instructor run reformer, mat and clinical pilates classes and personal training
References
1. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials - Angela Searle, Martin Spink, Alan Ho, Vivienne Chuter, 2015 (sagepub.com)
2. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain (mdpi.com) Rebecca Gordon and Saul Bloxham, 2016
3. Effects of Pilates Exercise Programs in People With Chronic Low Back Pain (nih.gov) A Systematic Review, Sport and Exercise Sciences Research Unit (A Patti, AB, GM, MAM, MB, GB, AI, A Palma), University of Palermo; Posturalab (A Patti, GM), Italy; and Department of Biomedical Science (A Paoli), University of Padua, Padua, Italy, 2015
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