What exercises work for lower back pain ?
Tokyo International Chiropractic Research update- The best exercises for chronic low back pain
So what exercises work ?
A very interesting article was recently published in the British Medical Jounal.
They examined the important question of which type of exercises work best for chronic lower back pain ?
Should we be doing yoga, pilates strength training or Mckenzie extension exercises to help our lower back pain. We don’t have time for everything so what works the best ?
Lower back pain that last more than 12 weeks ( Chronic lower back pain ) is a huge burden to society. Although chronic lower back pain only makes up 20% of cases that present to us practitioners it makes up over 80% of the costs for the direct costs of low back pain and if you have chronic lower pain you know you would be happy to try anything for meaningful result.
Each week there seems to be a new ” miracle cure ” or celebrity exercise program that is going to cure all and make all our flabby bits go way. Should we be doing kettle bells squats or swiss ball situps ? what is really going to help ?
And The Answer ?
Well according to authors the good news is that almost all exercise programs that you can choose from tend to make a significant improvement but not 1 thing seems to be so much better than anything else (1) .
So if you already drawn to pilates and yoga and enjoy the social aspect of these programs then pick one of those and stick to it.
Stretching by itself seemed to have very little improvement so if you are trying to treat your back pain just with stretches you watched from youtube you may have work cut out trying to get a good result.
The Mckenzie method which seemed to be darling child of rehab for few years got poo pooed in the study (1) My thoughts on this is that the Mckenzie method really seems to shine when you are dealing with a disc issue and much of non specific lower back does not really have a firm diagnosis so perhaps we may be making the sample size a little to general here. (1)
And The Winner ?
This study seemed to indicate that the pilates method seemed to yield the highest results but only by small margain against the others. The authors also sound significant improvements for mental health so if we can get off just looking at pain for a moment there are far higher reaching benefits to choosing an exercise activity that works for you.
Just my hunch but one reason I think the mat classes do so well is the social interaction and support you get from them. There is a big plus to exercising where you have friends waiting your attendance and have somebody to share a coffee with afterwards.
Even simple old arerobics seemed to get some positive results so even joining a fitness class or taking up light jogging my useful.
Us manual therapists also received a kick up the bum. It’s hard when research does not always agree with your clinical experience but if you are going to have some faith in the science then we are going to have to eat humble pie sometimes. As therapists we must try harder to incorporate exercise therapy into our treatments and also help hold the patients accountable for commitment to their chosen exercise program.
We must be a little cautious here. the beauty of the meta-analysis is that it allows a bit more power in finding what really works but the downside is that by throwing so many studies everything can get so generic that it can loose relevance to the actually condition.
This study only looked at ” non specific lower back “. If your therapist is confident of a structural diagnosis for your symptoms then some of the conclusions here may not be relevant for you. I’m thinking disc herniation or chronic SI ligament problems etc.
So the take home message for those in Niseko experiencing chronic lower back is that what is important is to pick an exercises intervention that works for you and stick to it.
In conjunction with a trial of manual therapy you will be well positioned to give yourself every chance of an active and enjoyable recovery.
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