As you probably already know, many aspects of diagnosing and treating back pain are controversial in the medical community. However, one area that the medical community does generally agree on is the role of rehabilitation (physical therapy and back exercise) in helping recover from back pain and prevent or minimize future recurrences of back pain.
Basically, if a pain problem has persisted for many weeks the body is signaling that there are barriers to the healing process that need to be eliminated. In back pain, exercise and rehabilitation are critical in stimulating the healing process.
Lack of Activity and Exercise Actually Makes the Pain Worse
Pain often prevents us from getting enough exercise and lack of exercise can worsen the pain by leading to stiffness, weakness and deconditioning. Movement is necessary to keep the discs, muscles, ligaments and joints all healthy. For example, physical activity allows diffusion of nutrients into the disc space and helps it stay healthy. Significant inactivity deprives the injured disc of the nutrition it needs and this can lead to further degeneration and pain. Additionally, activity and exercise are needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material, which is highly inflammatory. See Back Exercise and Fitness for Back Pain Relief and The Importance of Abdominal Exercise and Back Exercise.
Rehabilitation and Exercise Stimulate Healing
Exercise in a controlled, gradual and progressive manner is the only way we can tell our body to heal. Injections, medications and other passive therapies can be important in providing pain relief, but they cannot stimulate the healing process. The natural stimulus for the healing process is active exercise. Active exercise means we use our nervous system to tell the muscles what to do, and it requires dedication to an appropriate, comprehensive exercise and rehabilitation program. See Rehabilitation and Exercise for a Healthy Back.
Stretching, Strengthening and Aerobic Conditioning Exercises are Each Important
A comprehensive rehabilitation program should consist of stretching, strengthening and aerobic conditioning of the back and body. All three of these activities are important in your recovery.
- Stretching exercises are important because any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. 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. For more information, see Stretching for Back Pain Relief.
- Strengthening exercises are important in order to help prevent future recurrences of back pain. Especially if an episode of low back pain has lasted two weeks or more, a strengthening program (such as McKenzie exercises, Lumbar stabilization training and/or facilitation exercises) is critical to long-term recovery. See Strengthening and Back Pain Relief Exercises.
- Aerobic conditioning exercises are important as aerobically fit patients have fewer episodes of low back pain, and experience less pain when an episode does occur. 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 lose their ability to perform daily activities over time. See Low-Impact Aerobic Exercise.
Try to Manage Your Anxiety about Exercising
While it is natural to feel anxious about exercising, it's important to manage your anxiety and fear of re-injury in order to regain normal muscle function. The basis for feeling anxiety about lower 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 compels the muscles to improve their function can overcome this neurological barrier to normal muscle function.
See an Appropriately Trained Health Professional for Rehabilitation
For all forms of exercise, it is advisable to see an appropriately trained and licensed spine specialist -- such as a physical therapist, occupational therapist, physical medicine and rehabilitation physician (also called a physiatrist) or doctor of chiropractic. Depending on your specific diagnosis and level of pain, the rehabilitation and exercise program will be very different, and spine specialists are trained to develop an appropriate rehabilitation program and provide instruction on correct form and technique. See How a Physical Therapist can Help with Exercise and Back Exercise and Physical Therapy for Back Pain.