Rehabilitation Exercises

Regular exercise is an essential part of having a healthy back. In the treatment of back pain, almost every healthcare provider agrees that exercise plays an important role in recovery. Every day we make demands on our bodies that can stress our backs. It's a well known fact that the more fit you are, and the stronger your back is, the more easily your body can deal with the stress and strain of every day activity.

Unfortunately, when most people start to experience back pain, they become less active. As a result, the muscles that support the spinal column become weaker and have less endurance. If your back loses enough muscle tone, the muscles can shrink, contract and tighten. Your back may feel tight much of the time, tire easily, and start to feel uncomfortable even when you are sitting in a chair. The feelings associated with chronic back pain and spinal fatigue make most people feel drained, tired and depressed. It becomes harder and harder to break the cycle of pain causing inactivity, which causes more pain, which then causes more inactivity. Eventually, this scenario can lead to other health problems that are the direct result of inactivity, such as heart attacks, strokes and obesity.

Therefore, exercise is an important part of the "use it or lose it" theory of overall spine health. Patients with chronic low back pain are particularly susceptible to suffering from the ill effects of too little exercise. If it hurts when you move your back, and is less uncomfortable when you don't, then you have the perfect incentive to become less active with time. Although this may seem like a logical reaction to pain, it is almost certain that avoiding physical activity will make the pain become even worse over time. This knowledge comes from the unhappy experience that doctors have had in the past with prescribing prolonged bed rest and inactivity for back pain, which over time, only aggravated the situation and made it more difficult to treat in the long run. We now know that if you want to relieve the physical pain of many types of back pain while also making yourself stronger both mentally and physically, you need to get moving.

A commitment to a physical conditioning program that is approved by your physician is important to everyone, but it is especially important to those with chronic back pain. Exercise has many benefits, and has even been called a healthy "non-chemical tranquilizer," because the process of stretching and strengthening the muscles of the back produces a feeling of relaxation and well being similar to that produced by many muscle relaxants and pain relievers. Low back pain is often described as a "psychobiological" problem, meaning that it includes both physical and psychological components. Exercise can help treat both parts of this problem, by providing you with a healthy means of relieving some of the frustration and sense of helplessness associated with low back pain, in addition to treating the problem at its very heart.

Exercise can be the key to your recovery, as well as a good prevention against future pain. Our physicians have developed an exercise routine with easy explanations and diagrams to help you follow them properly. The purpose of these exercises is to promote flexibility and strengthen the spinal musculature

What Types of Exercise?

What types of exercise help back pain patients?  A group of scientists called the "Cochrane Group" reviewed 43 randomized controlled trials of chronic back pain sufferers (symptoms lasting longer than 12 weeks). (1)   They recommended that a successful chronic back program should contain the following elements:

1) Individually designed and supervised programs
2) Stretching
3) Strengthening
4) Improvement in pain and function
 

A key component of the report is the strong recommendation for exercise and its implications. A supervised exercise program is recommended because it is safe and does not increase the risk for injury. Exercise is a tool to increase endurance, flexibility and strength, and also improves pain, mental status and behavior.
In a review of the literature, Rainville, et.al., (2)  reported that exercise therapy in rehabilitation accomplished three important goals:

1) Elimination of impairment by increasing patient function
2) Reduction of pain intensity
3) Reduction of pain related disability

Rainville's review showed these three goals could be accomplished without increasing the risk for future episodes of back pain.

Strengthening Exercise

Apart from general exercise, strengthening exercise is important to rehabilitation success. The most successful rehabilitation programs focus on strength related to movement and function.  Such rehab programs make strength training central in their overall treatment plans. Patients who perform strengthening exercise in a supervised clinical setting gain confidence to increase their daily activities when away from the treatment facility.

Strengthening exercises using resistance machines during rehabilitation are helpful because activity levels can be accurately measured. Therapeutic exercise can be likened to a medication, and patients should be given a 'prescribed' dose to accomplish the most in their personal rehab programs. The therapeutic 'dose' of prescribed exercise is best measured in an objective clinical setting. The dose can thus be safely increased with increasing strength.

Preventing Episodic Back Pain

What about preventing back pain? Strength training is important to build and preserve functional capacity while reducing the risk for future injury. Although the value of aerobic exercise cannot be discounted, strength is the fitness element critical to maintain function throughout life. Regular strength training should be considered a priority to anyone working toward optimal functional capacity.

Healthy Backs

If you experience episodic back and neck pain, you may not be able to avoid back pain.  With spine strengthening exercise strategies, however, you may be able to develop a stronger and healthier back.

References

1. Hayden JA, VanTulder, et al. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 142(9): 776-85, 2005.

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