Back Pain

Posted: 11 June 2020

1 in 6 Australians suffer from back pain in some stage of their life, making it the second leading cause of disease burden in 2015 (AIHW, 2019). Back pain is highly prevalent in our society, impacting almost 4 million Australians. The condition itself is as prevalent as it is complex. It presents with many signs, symptoms and causes, being managed with several treatment modalities. The most common form of back pain is located in the lower region - below the ribs and above the gluteal folds (Balagué et al., 2020)

Low back pain severity level can vary depending on each individuals case. The stages include acute (~6 weeks), subacute (6 to 12 weeks) and chronic (>12 weeks). Most acute back pain episodes will resolve regardless of treatment (Arbor, 2010). However, several studies suggest that exercise interventions focused on a balance of trunk stabilisation, endurance, strength and power can play a major role in the management of chronic low back pain (Bronfort et al., 2011; Searle et al., 2015; Wang et al., 2012).

In addition to physical health, it is also important to consider in importance of social and psychological health when managing low back pain – this is otherwise known as the biopsychosocial model approach (Gatchel et al., 2007). An individual’s emotional, behavioural and socio-economic circumstances all contribute to their ability to cope and manage low back pain.

The definitive cause of back pain remains largely unclear, however certain physical characteristics such as posture, movement quality and ability to load have been shown to be key predictors of low back pain.

The evidence clearly shows that exercise has been associated with positive outcomes for individuals with low back pain. It can be quite a complex condition thus there are no specific exercise guidelines in the management of low back pain. Nevertheless, regular physical activity including a combination of aerobic, resistance and flexibility training should be implemented to not only address the physical but psychological and sociological health of the individual.

I have low back pain, where and how do I start exercising?! That is a common question that we hear in clinic. Listed below are some of my general tips that may help you in the management of low back pain. To give yourself the best chance of success it recommended that you get in contact with our exercise physiologist for further guidance.

  • Adopt biopsychosocial approach

Implement proper sleep hygiene, regulate stress, maintain healthy diet

  • Find and eliminate your back pain triggers

Common triggers: bending, prolonged sitting

  • Replace movement strategies

E.g. hinge rather than bending

  • Stabilize the trunk via an exercise program

Include regular walking to increase/maintain physical activity levels

  • Learn efficient movement patterns, perform them consistently and resiliently

E.g. push, pull, lift, carry, lunge, squat



References

Australian Institute of Health and Welfare 2019. Back problems. Cat. no. PHE 231. Canberra: AIHW. Viewed 22 April 2020,

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2020;379(9814):482-91

Bronfort, G., Maiers, M., Evans, R., Schulz, C., Bracha, Y., Svendsen, K., Grimm, R., Owens, E., Garvey, T. and Transfeldt, E., 2011. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. The Spine Journal, 11(7), pp.585-598.

Gatchel, Robert J., Peng, Yuan Bo, Peters, Madelon, L.; Fuchs, Perry, N.; Turk, Dennis C. 2007 The biopsychosocial approach to chronic pain: Scientific advances and future directionsfckLR Psychological Bulletin, Vol 133(4), 581-624

Searle, A., Spink, M., Ho, A. and Chuter, V., 2015. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation, 29(12), pp.1155-1167.

Wang, X., Zheng, J., Yu, Z., Bi, X., Lou, S., Liu, J., Cai, B., Hua, Y., Wu, M., Wei, M., Shen, H., Chen, Y., Pan, Y., Xu, G. and Chen, P., 2012. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain. PLoS ONE, 7(12).

University of Michigian Health System. Acute Low Back Pain. Ann Arbor (MI): University of Michigian Health System; 2010. p.16.

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