Cardiovascular and strengthening exercises combined with chiropractic care are important in the management of low back pain.1

If a patient has a history of heart problems, it is important for the patient to consult with not only the doctor of chiropractic but their primary care physician to be certain that they can tolerate cardiovascular fitness-promoting activities. Specific instructions are given by the chiropractor with respect to proper exercise for the patient's condition before beginning any exercise program.

In general, a reasonable amount of exercise that is performed daily and utilizes activities that are enjoyed is recommended for patients undergoing chiropractic treatment.

Exercise Benefits

Many studies have reported the importance of exercises in managing acute and chronic low back pain2-5, strengthening the low back6, preventing and keeping back patients working7-9, and to improve quality of life8. The strength of the abdominal muscles was also found to be able to differentiate between those with vs. without chronic LBP10.

Overall and when combined with chiropractic care, aerobic exercise helps promote proper digestion, keeps the muscles in proper tone and promotes better circulation. Walking briskly around the block at least once or twice is a convenient and popular activity.

Also, many forms of work and/or household tasks can function as an exercise program. The important point is to exercise!

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Types of Exercises

There are many applicable |back exercises that are available for patients also undergoing chiropractic care for lower back pain. One can classify the chiropractic patient into a flexion or extension biased category to determine the variety that is best for that patient.

For example:

  • If a patient feels best when bending over (flexion biased), exercises that promote low back flexion such as pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position and others are usually helpful.
  • If a patient is least symptomatic in extension, especially if leg pain centralizes or diminishes (extension biased), prone press-up type exercises usually yield the best results.

Other exercises that can help reduce lower back pain include:

  • Strengthening of the pelvic stabilizing muscles (trunk muscles)
  • Stretching of the hamstrings, adductors, and other overly short or tight postural muscles
  • Proprioceptive or balance promoting.
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Reported Efficacy of Exercise in Chiropractic Care

According to the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP):

  • Strong evidence supports exercise as being at least as effective as other non-surgical treatments for chronic low back pain
  • Moderate evidence supports use of a graded-activity exercise program in occupational settings for subacute lower back pain
  • Some evidence shows that exercises are no more effective than other nonsurgical treatments for acute lower back pain.11

As with any chiropractic treatment, it is important for chiropractors to perform a focused reevaluation of an exercise program following its initial therapeutic trial to determine its effectiveness. Using spinal range of motion as a measurement of the effectiveness of exercise is just one way in which chiropractors can make such determinations.

References

  • 1.Bigos S, Bowyer O, Braen G, et al., "Acute low back problems in adults. Clinical practice guideline No. 14. AHCPR Publication No. 95-0642," Rockville, MD; Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services (1994).
  • 2.Chiropractic & Osteopathy, 2010, 18:3
  • 3.Chou R, MD, Qaseem A, MD, PhD, MHA, et al., "Diagnosis & Treatment of LBP: A Joint Clinical Practice Guideline from the American College of Physicians & the American Pain Society," Annals of Internal Med, 2007;147:478-91. (3)
  • 4.Mayer J, DC,PhD. Mooney V, MD, Dagenais S, DC PhD, "Evidence-informed management of CLBP with lumbar extensor strengthening exercises," T Spine J, 2008;8:96-113. (3)
  • 5.Keller, MD, et al., "Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With CLBP Randomized to Lumbar Fusion or Cognitive Intervention and Exercises," Spine, 2004 29(1): 3-8 (3)
  • 6.Bigos S, MD, Holland J, MD, MPH, Holland C P, et al., "High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults," T Spine J, 2009;9:147-68. (4)
  • 7.Sculco AD, Paup DC, Fernhall B, Sculco MJ, "Effects of aerobic exercise on low back pain patients in treatment," Spine J, 1(2):95-101 (2001).
  • 8.Staal JB, Hlobil H. Twisk JWR, Smid T. Koke AJA, van Mechelen W, "Graded activity for low back pain in occupational health care: A randomized, controlled tial," (2004).
  • 9.Whittaker JL, Warner MB, Stokes M, "Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain," jospt, 43(1):11-19 (2013).
  • 10.McKenzie, RA, "The Lumbar Spine: Mechanical Diagnosis and Therapy," Spinal Publications/Printed by Wright & Carman, LTD, Upper Hutt, New Zealand, 1989 reprinted.
  • 11.Globe G, Morris C, Whalen W, et al., "Chiropractic Management of Low Back Disorders: Report from a Consensus Process," Journal of Manipulative and Physiological Therapeutics November/December 2008: 651-658.
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