One of the keys to recovering from an episode of back pain or surgery, and to help avoid future recurrences of back pain, is to pursue appropriate rehabilitation and exercise. A comprehensive exercise regimen should include a combination of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned.
MUSCLES SUPPORTING THE SPINE
While some of the three muscle groups are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.
Commonly disregarded spinal muscle groups include:
- Extensors (back and gluteal muscles), which are used to straighten the back (stand), lift and extend, and move the thighs out away from the body.
- Flexors (abdominal and iliopsoas muscles), which are used to bend and support the spine from the front; they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.
- Obliques or Rotators (side muscles), which are used to stabilize the spine when upright; they rotate the spine and help maintain proper posture and spinal curvature.
For all forms of exercise, it is advisable to see a trained and licensed physical therapist, occupational therapist, chiropractic physician or physical medicine and rehabilitation physician (also called a physiatrist). Depending on the specific diagnosis and level of pain, the exercise program will be very different, and these specialists are trained to develop an appropriate exercise program and provide instruction on correct form and technique.
Any form of inactivity, especially if an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). 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.
Stretching exercise should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back, so hamstring stretching is an important part of alleviating low back pain.
Specialized equipment is available that helps repetitions to be done in the same manner so that progress can be identified and the level of exercise regulated.
It is thought that future episodes of back pain are less likely to occur if back strengthening is accomplished than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercise to prevent a recurring cycle of pain and weakness.
There are two primary forms of exercise for strengthening and/or pain relief that tend to be used for specific conditions. When appropriate, the two forms of physical therapy may also be combined.
McKenzie exercise, in general focuses on extending the spine to reduce pain generated from a collapsed disc space (e.g. from degenerative disc disease). Theoretically, extension may also help reduce a herniated disc and reduce pressure on a nerve root. For patients who are suffering from leg pain due to a herniated disc (e.g. sciatica), extending the spine may help reduce the leg pain by “centralizing” the pain (moving the pain from the leg to the lower back). For most people, back pain is usually more tolerable than leg pain. Sometimes, based on the structured evaluation, flexion exercises are appropriate.
Lumbar stabilization exercise focus on finding the patient’s “neutral” spine, that is, the position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. Performed on an ongoing basis, these exercises can help keep the back strong and well-positioned. Special attention is paid to the extensor muscles of the lower back with resistance exercise.
Additionally, a strengthening program that involves progressive loading and unloading of the lumbar spine by means of flexion/extension exercise can reduce pain and increase the perception of improved back strength.
This training, called facilitation, is best accomplished when the muscles to be facilitated are isolated in some way so that other muscles cannot take over the job. Often specific equipment is required to achieve that goal.
LOW-IMPACT AEROBIC CONDITIONING
Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. 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 gradually lose their ability to perform everyday activities.
Examples of low impact aerobic exercise that many people with back pain can tolerate include:
- Water therapy (also called pool therapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water counteracts gravity making many stretching movements easier and provides buoyancy as well as mild resistance.
- Walking. Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.
- Stationary biking. Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward.
Choosing the most appropriate form of exercise depends upon the nature of the injury and an individual’s exercise preferences. It may be helpful to discuss options with a physical therapist, or physician to identify which form of aerobic exercise is best to incorporate into an exercise routine.
UTILIZE PROFESSIONAL HELP
To help relieve your back pain, you may have to go to physical therapy. There, a physical therapist will work with you to restore movement and help your body heal. The therapist may also teach you about ways to minimize pain in the future.
Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They’re called passive because you don’t have to actively participate. Your physical therapy program may start with passive treatments as your body heals, but the goal is to get into active treatments. These are therapeutic exercises that strengthen your body and help prevent a recurrence of your back pain.
Your physical therapist may give you passive treatments such as:
- Deep Tissue Massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).
- Hot and Cold Therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.
- Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.
- TENS (transcutaneous electrical nerve stimulation): A TENS machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body’s production of endorphins, your natural pain killers. The TENS equipment your physical therapist uses is relatively large. However, a smaller machine for at “at home” use is also available. Whether large or small, a TENS unit can be a helpful therapy.
- Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.
In the active part of physical therapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with back pain, especially since your pain might not even be caused by the same condition.
If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This is all part of the “self-care” or “self-treatment” aspect of physical therapy: through physical therapy, you learn good habits and principles that enable you to take better care of your body.
Your physical therapist may also suggest a personalized exercise program for you. This can help reduce the likelihood of your back pain recurring and can also improve your overall health.
We have close working relationship with Proactive Physical Therapy, Body Central, & Athlon Physical Therapy. Please contract their respective offices for more information on how to get started on your low back program.
Adopted in part from Vert Mooney, MD November 20, 2006, Source: http://orthopedics.about.com