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Best Exercises For Back Pain

“I suffer from back pain should I exercise? Which exercises are best”?

These are very important questions to be answered when helping patients with back pain. As with so many complex problems there isn’t a simple answer that is appropriate for every individual. So when I get asked by a patient with back pain “should I exercise” (assuming they are medically well) I say YES; however that is quickly followed by me saying ”but it has to be the appropriate exercise for you at the appropriate time”. The benefits of exercise to our overall health are irrefutable, but doing the wrong exercises or doing an inappropriate amount of exercise can make things worse. So let’s explore which might be be some of the best exercises for back pain.

Whilst I cannot give individualised advice in a short article, we can use a recently published paper to shine a bit of light into the murky waters of treating back pain.

The Science

Forgive me for getting a little scientific just for a moment; to better understand the questions in the title we need certain key bits of information. The study I am going to refer to, which was published in the British Journal of Sports Medicine is what’s known as a network meta-analysis. This type of study gives scientists the opportunity to pool data sets from previous trials together, this enables greater confidence in the conclusions, but it also allows the scientists to compare 3 or more different types of treatment and rank them in terms of effectiveness. This is very useful to us in this situation as there are many different types of exercise.
The trials that get pooled together are known as randomised controlled trials (RCT’s). RCT’s allow us to see whether or not a specific treatment is the reason for a difference developing between a control group who receive no treatment (or standard treatment) and the group receiving the treatment we are wanting to investigate. Patients are put into the groups at random so the treatment and control groups should be very similar at the start of the study to make it a fair comparison at the end. In other words we can observe whether or not the treatment we are testing is better than doing nothing or better than the usual treatment, thus establishing a cause and effect relationship.
Back pain is a very complicated condition and humans (thankfully) don’t live in laboratories, therefore being confident that one type of exercise is better than another can be tricky. This is especially so given that you can’t give placebo exercise. RCT’s were originally designed to test medications, so you could just compare a group given a sugar pill with a group given a real medication and compare the outcomes. You can’t do that with exercise and that’s partly why we need these big network meta-analysis studies.
So back to our question: which exercises are best for back pain? Well for people with longstanding back pain (who are medically well and do not have leg pain):

Study Conclusions

1) Pilates helped best for pain
2) Resistance training (light weights and bands) and stabilization and movement control exercises improved general physical function the most effectively
3) Resistance training (using light weights and bands) and aerobic training (running, cycling, cross training etc) helped best for mental health. This is relevant because looking after our mental health is especially important when we are dealing with pain.
So whilst there is no single exercise that’s a magic bullet for all back pain this does help offer some more clues to this clinical conundrum of which exercises are best for back pain.
Let’s step away from the science and be pragmatic, I said appropriate exercise at the appropriate time. It is very important to slowly introduce exercise and build up gradually over several weeks and if someone is in a lot of pain or if their pain flares up easily this is especially important. It’s also sensible to consider the following:

Additional Recommendations

  1. Avoid prolonged periods bending forwards (e.g. gardening) so take regular breaks to straighten up and walk around.
  2. Do not sit for more than 30 minutes at a time and use a good supportive chair. The posture you adopt at the computer or when you are reading will have a significant impact on your pain levels and your capacity to exercise. So sit properly and take regular short breaks (1 minute or so) to stand and move.
  3. Avoid heavy or awkward lifting tasks, or if you must lift warm up by doing a few exercises in the morning (which you should have done anyway) AND BEND FROM YOUR HIPS AND YOUR KNEES. This allows the strong buttock and leg muscles to do much of the lifting; they are the strongest muscles in the body so use them correctly.
  4. Avoid “Boom and Bust” cycles a lot of people do very little exercise then decide to change and suddenly do an enormous amount of strenuous exercise. This can also lead to problems.
  5. You need to continue doing regular exercise even after the pain has gone or has calmed down to reduce the likelihood of future problems.

Finally it’s very important to get the advice of a healthcare professional who is experienced in treating back pain and prescribing exercises that are most appropriate to you given your symptoms and circumstances.
Right, it’s time for me to take another break and do my exercises!

For those interested the paper described in this article is:
http://dx.doi.org/10.1136/bjsports-2019-100886 

Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis
Authors:
Owen PJ, Miller CT, Mundell NL et al.

A similar blog that may also be of interest can be found below:
https://byfleetchiropractic.co.uk/blog/ 

Stuart Seating

Please remember, a chair is just one of the elements of good office ergonomics. To read more see the link below from the Chartered Institute of Ergonomics and Human Factors.

https://www.ergonomics.org.uk/Public/Resources/Sectors/Office_Ergonomics.aspx

If you would like to read more of about pains or problems that may be related to office ergonomics please see the links below:

https://www.stuartseating.com/spinekind-blog/

https://byfleetchiropractic.co.uk/blog/