Exercise That Works for Low Back Pain

Across Australia, the cost of low back pain is on the rise, but outcomes are not improving.

With most expenses being related to recurrence and chronicity, low back pain (LBP) ranks as one of the most common and costly musculoskeletal disorders.2,3 Fortunately, a persuasive body of research has laid out a path toward better using exercise therapy to quell low back pain. Taking that evidence-based path starts with overcoming some long-standing misconceptions about low back pain.

Low Back Pain Misconceptions

Rest does not fix low back pain: Low back pain most commonly stems from degenerative changes and deconditioning. That’s why rest does not fix low back pain.4     

Not benign or self-limiting: Chronic low back pain is a long-lasting condition with a variable course of flare-ups.4 It is not a series of unrelated episodes. Because the symptom of low back pain come and go, people may be lulled into believing the causes of their low back pain have healed. Unfortunately, the underlying problems usually persist, lurking until the next time they cause a disabling bout of pain.5 

Not all physiotherapy is alike: Despite being the most trained in the approved exercise therapy programs, research suggests physiotherapists demonstrate high use of disproven treatments such as lumbar traction and electrical modalities.6,7

What Works for Low Back Pain?

Exercise therapy and other physiotherapy treatment for low back pain will be based on individual assessment. However, research shows some common elements to the most effective low back pain plans.

Immediate: Earlier physio is associated with better long-term outcomes. Earlier physio also reduces one and two-year healthcare utilisation including opioid use, injections, imaging, and surgery. This results in direct costs lowered by $1,000 to $2,700 over one to two years.8

Active: At one-year follow-ups, people who managed back pain passively proved more than twice as likely to experience recurrence than people who managed back pain with exercise (84% vs 30%).9,10

Supervised: When back pain is bad enough that a person will visit the doctor, it’s time to pull out all the stops and receive a full course of physiotherapy. You deserve it. When doctors refer patients to physiotherapy, patients show higher satisfaction than when doctors try to skip physiotherapy.12 Various treatment guidelines continue to recommend advice for back pain despite that fact that research has shown for decades that advice is not effective.11 Most importantly, you can give a patient a professional assessment, personal training, and printed instructions. People expected to do those exercises at home on their own achieve lesser outcomes than people who do those same exercises with the ongoing help of a physiotherapist.12,13 Compared to patients expected to complete therapeutic exercises on their own, at ten weeks, patients receiving physiotherapy proved almost twice as likely to demonstrate clinically significant improvement in back pain ratings.

References

  1. Australian Institute of Health and Welfare 2016. Impacts of chronic back problems. Bulletin 137. Cat. no. AUS 204. Canberra: AIHW.
  2. Maher C, Williams C. Managing low back pain in primary care. Aust Prescr. 2011; 34: 128-32.
  3. Dagenais S, Tricco A, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010; 10: 514-29.
  4. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ. What low back pain is and why we need to pay attention. The Lancet. 2018 Jun 9;391(10137):2356-67.
  5. Hides J, Richardson C, Gwendolen J. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine. 1996; 21 (23): 2763-2769.
  6. Workin LL, Smeets R. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018 Jun 9;391(10137):2368-83.
  7. Keating JL, McKenzie JE, O'Connor DA, French S, Walker BF, Charity M, Page MJ, Green SE. Providing services for acute low-back pain: A survey of Australian physiotherapists. Manual Therapy. 2016 Apr 1;22:145-52.
  8. Arnold E, La Barrie J, DaSilva L, Patti M, Goode A, Clewley D. The impact of timing of physical therapy for acute low back pain on health services utilization: a systematic review. Archives of Physical Medicine and Rehabilitation. 2019.
  9. Hides J, Gwendolen A, Richardson C. Long-term effects of specific stabilizing exercises for first episode low back pain. Spine. 2001; 26 (11): pp e243-248
  10. Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research. 2015 Jun;15(1):150.
  11. Oliveira V, Ferreira P, Maher C, et al. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care & Research. 2012; 64 (11): 1739-1748.
  12. Ford J, Hahne A, Surkitt L, et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. 2016; 50: 237-245.
  13. Ammar T. A randomized comparison of supervised clinical exercise versus a home exercise program in patients with chronic low back pain. Physical Therapy and Rehabilitation. 2017 Aug; 4( 1): 7.

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