Rehabilitation and Exercise for a Healthy Back

People who suffer from lower back pain are encouraged to help with their own recovery by exercising and getting physical therapy, but are seldom given the knowledge and tools needed to accomplish this. This discussion will provide a basic understanding of the causes of lower back pain, and discuss appropriate steps to exercise and rehabilitate a painful back.

Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Whether suffering from the first bout of low back pain or following extensive treatments or even surgery, the best way for patients to avoid or minimize the severity of recurrences is to rehabilitate the back through appropriate back exercises.

Exercise and Causes of Back Pain

There are several structures in the back that can cause and/or contribute to low back pain. These include:

Intervertebral Discs

Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber during everyday activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting, or other trauma), or due to ordinary wear and tear over time. And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.

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Making matters worse, the pain often interferes with a patient's ability to exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities and exercise cause the disc to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate.

Activity is also 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.

Spinal Muscles, Ligaments, and Tendons

The collective soft tissues around the spine - the muscles, ligaments and tendons - are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibers of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when soft tissues are injured, they can quickly repair themselves.

Since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain.

Spinal Nerves

When nerves are cut, pinched, or otherwise irritated, the muscles that the nerves control cannot work. For example, when a herniated or bulging disc presses on the L4-L5 nerve root, it may inhibit the nerve's ability to make the muscles it controls in the ankle and foot work properly, causing what is known as foot drop - the ability to raise the foot or stand on one's tiptoes.

Acute vs. Chronic Back Pain

It is important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but as the injured part heals the pain goes away.

Unlike acute pain, however, chronic pain does not correlate to an anatomical injury. It comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a "neural memory" after the initial source of irritation has resolved. The nervous system adapts to this chronic stimulation by creating an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas.

Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Active exercise also helps to create the physiological conditions that allow the injured structures to heal.

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Written by Vert Mooney, MD