Back pain has many faces and to many people it can be distressing, disabling or even frightening. Whether back pain comes from a strain, degenerative disc disease, a herniated disc, spinal stenosis, spondylolisthesis, a complex deformity or even a fracture, there are many options that can help you live an active lifestyle. One important option for long term relief and protection is exercise.
However, knowing the steps to successful recovery and long term comfort requires a good understanding as to how and why exercise is considered in specific diagnoses of the spine. The use of physical therapy and exercise can reduce pain, the need for medication, and can prevent or delay the need for more invasive or surgical procedures.
Effects of Immobility
Exercise is typically the last thing considered by someone in pain. In fact, often times people resort to bed rest as a means of preventing pain. However, research clearly has shown that immobility can be detrimental to recovery by prolonging and even increasing pain. Immobility results in a cycle of activity avoidance. Loss of strength and endurance actually contribute to increasing pain. To make matters worse, muscle inactivity causes more than simply increased pain. It also contributes to osteoporosis, degenerative joint disease, obesity, and muscle atrophy. These problems can be prevented and, in some cases, reversed through specific and regular exercise. In fact, research shows dramatic improvement of low back pain in individuals who become physically fit.
Your body's responses to degenerative processes or traumatic injury are unique. Pain can cause a gradual loss of range of motion, tightened muscles, changes in posture, a decrease in activity levels and ultimately a decrease in functional abilities that until now are often taken for granted. Restoring your posture and creating improved balance between your muscles allows your body to work more efficiently while decreasing tension and pain.
Principles for Pain-Relief Exercise
The basic principle for pain-relief exercise is that the person should feel better after he/she completes the exercise. It is best that a patient participate in enjoyable exercises that can be incorporated into their daily routine. A carefully structured and supervised exercise program focusing on flexibility, core stability, strength, and aerobic conditioning plays a major role in pain management.
Muscles, bones, joints and ligaments are designed to move but not all exercise is created equal. As we grow older, we tend to focus more on general exercise and activity rather than specific goal-oriented movements that include endurance, stretching and strengthening. The benefit of exercise for the low back depends on three key principles: 1) Obtain satisfactory aerobic fitness (endurance), 2) focus on specific muscle groups that support your back, and 3) avoid exercises that place excessive stresses on your back.
Types of Exercise
Flexibility exercises. Limiting movement can prolong or increase pain. Flexibility exercises targeting specific muscle groups enable joints to move through their full range of motion, which minimizes stiffness. Stretches should be held for at least 30 seconds and performed in a pain free range. Flexibility exercises decrease the risk of further injury to the back.
Strengthening exercises. Strength or resistance training can serve to decrease and prevent pain while improving function. Benefits include increased bone density, cardiovascular fitness, muscle function, increased metabolism, and improved joint stability. Strong muscles act as shock absorbers for joints in the spine and body. The stronger stabilizing muscles become, the more force that is unloaded from bones and cartilage. Specifically, core strengthening is necessary to provide better low back stability and also improves weight distribution and posture. Adding strength to abdominal, back and leg muscles provides extra support to your spine, reducing pressure on your spinal discs. Strength can help in preventing disc injury. Resistance training can lead to improved coordination and balance, decreasing the risk of falls and further injury.
Endurance exercises. Exercises such as walking, swimming or walking in waist-deep water can help maintain a healthy back. This type of exercise helps your heart and other muscles use oxygen more efficiently which aids in pain reduction. Endurance exercise also rebuilds stamina and energy lost from inactivity and can reduce inflammation and improve mobility in joints. Endurance training can result in weight loss reducing the impact and stress on joints which contribute to pain and more damage.
Properly performed exercises can increase the release of hormones in the brain such as endorphins and serotonin. These hormones are naturally produced in the body to fight pain, or block the bodyâ€™s perception of pain. These hormones also help to lessen anxiety and depression.
Regular exercise can increase energy levels and metabolism resulting in improved mood and quality of sleep. The benefits of exercise range from pain reduction to overall improved quality of life and functionality. Why wouldn'â€™t you want to exercise for life?
An Accurate Diagnosis Leads the Way
How do you determine what exercises are most effective for your lower back pain? Obtaining an accurate diagnosis is important before engaging in a physical therapy program. Often times, exercises should focus on posture such as bringing your head and shoulders back while straightening the spine and strengthening muscles in your core. Certain lower back injuries are rehabilitated through specific strengthening and stretching exercises. You may have heard of people performing "extension exercises" when rehabilitating from a low back injury. Though this is often the case, it is not a rule in dealing with back pain. Some pain can be made worse with extension exercises but would benefit from a flexion based exercise program.
Proper exercise programs are started slowly, increased gradually, and are easily modified depending on current pain levels. Common exercise recommendations for exercise include 20 to 30 minutes of aerobic conditioning combined with 10 minutes of flexibility training daily. Strengthening exercises should be performed on an every-other-day basis.
Physicians and physical therapists recommend specific exercises to treat particularly painful joints. The amount and type of exercise recommended for each individual depends on the joint(s) involved, the degree of inflammation, the joint'â€™s stability, one's general health and past medical history. Your therapist can also help you to understand body mechanics, posture, and proper lifting techniques. Improper exercise techniques can lead to muscle tears, inflammation, and increased pain and loss of mobility.
A correctly designed exercise program can decrease pain. However pain relief will not happen overnight. It is only through consistency and patience that reducing pain and increasing functionality can be achieved. Do not follow the old adage, "no pain, no gain." Remember, pain is your body's way of telling you that an exercise or activity may be causing further inflammation or damage. Exercise is a powerful tool in recovering from any injury and essential in recovering from a back or neck injury. The wrong type of exercise, improper technique or too much resistance can prolong an injury and even make it worse. During your evaluation, your physical therapist will determine which exercises are best for your rehabilitation.