Exercise and Back Pain
A typical response to experiencing back pain [4] is to take it easy - either staying in bed or at least stopping any activity that is at all strenuous. While this approach is understandable and may even be recommended in the short term, when done for more than a day or two it can actually undermine healing. Instead, active forms of exercise [5] are almost always necessary to rehabilitate the spine and help alleviate back pain.
When done in a controlled, gradual, and progressive manner, active exercise distributes nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments and joints healthy. Consequently, a regular exercise routine helps patients avoid stiffness and weakness, minimize recurrences of low back pain, and reduce the severity and duration of possible future episodes of low back pain.
Depending upon the patient’s specific diagnosis and level of pain, the back pain exercise and rehabilitation program [6] will be very different, so it is important for patients to see a spine specialist trained to develop an individualized back exercise program and to provide instruction on using the correct form and technique.
For most back conditions, active exercise and stretching - not rest - is typically necessary to help reduce pain and encourage healing.
To be effective, a patient’s back pain exercise program should be comprehensive, working the whole body even if it targets the back. A balanced workout should include a combination of stretching, strengthening, and low impact aerobic conditioning.
Stretching as part of a back pain exercise routine
Almost everyone can benefit from stretching the soft tissues - the muscles, ligaments and tendons - in the back and around the spine. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and reduced motion can accentuate back pain. Stretching different muscles and ligaments is essential for gaining and maintaining mobility and flexibility. Patients with chronic back pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that meaningful and sustained relief of low back pain typically follows the increase in motion.
The most important muscles to target are:
- Hamstrings, in the back of the leg, to aid correct posture while sitting and standing, and support the gluteus muscles in the buttocks and the hip flexors and minimize stress on the low back
- Piriformis, which run from the back of the femur (thigh bone) to the sacrum (the base of the spine). When tight, this muscle can cause sciatica-like pain, and has been linked to sacroiliac joint dysfunction
- Psoas Major which is attached to the front portion of the lower spine and can greatly limit low back mobility if tight, making it hard to stand for extended periods or kneel on both knees.
- Gluteus muscles of the buttocks which support hip flexibility as well as the pelvis
Stretching should be done daily, perhaps several times a day, to ensure flexibility. See also Stretching for back pain relief [7].