By David Borenstein, MD
Executive Editor, theSpineCommunity.com
Lower back pain is second only to the cold as the most common affliction of mankind. Each year in the United States, up to 20 percent of the population will have an episode. Back pain is a common cause of work absence and disability.
Historically, for episodes of low back pain that lasted six to eight weeks or less, bed rest was suggested as the best therapy. Beginning in the 1980s, research began to reveal that, in fact, for many, the most effective remedy was found to be the exact opposite: staying active as tolerated was associated with a better outcome than bed rest.
However, while remaining active was found to be helpful for most, some sufferers did not find relief through this approach: about 10 percent experienced persistent pain lasting for extended periods of time; and, others experienced recurrent episodes of low back pain that never resolved. Questions remained about the potential to find lasting solutions or prevent these episodes.
Given that movement was associated with improved outcomes in acute low back pain, researchers began to consider the role exercise could play in preventing and treating chronic low back pain. Research related to the potential for exercise to prevent and treat low back pain, seeking to find answers to questions like: “When should patients start exercise?” and, “Which exercises or type of exercise are most appropriate to prevent or treat chronic low back pain?
Recently, The Cochrane Collaboration, a global, independent network of health professionals and patients that review the quality of health-related information used to make clinical decisions, provided insight into these questions in a review of research that described the benefit of motor control exercise compared to other exercise regimens.
Motor control exercises, or spinal stabilization exercises, are exercises that re-establish the co-ordination of deep trunk spinal muscles. Motor control therapy restores coordinated and efficient use of deep trunk spinal muscles with a progression of increasingly more strenuous tasks. For example, initial exercises are completed while lying on a solid surface. With improvement, exercises are advanced to standing postures. Other exercises may be performed using gravity alone. Advancement allows exercises to be done against additional outside forces.
The Cochrane Review included 2431 participants with low back who participated in 29 clinical trials. Most individuals were middle-aged and were in treatment programs from 20 days to twelve weeks. The trials evaluated pain intensity and disability in relation to motor control exercise, manual therapy modalities, home exercise, and minimal intervention. Motor control exercises were consistently shown to have benefits. Other forms of intervention, like manual therapy, also showed improvements. Minimal intervention had the poorest outcome.
The take home message of the review: Exercise, including motor control exercise, is associated with improvement in pain and disability for patients with chronic low back pain; and, there is never a bad time to start exercising if you are living with low back pain. The final decision in regard to the choice of exercise should be a joint decision between the preferences of the patient, therapist, availability, and cost.
Deyo RA, Diehl AK, Rosenthal: How many days of bed rest for acute low back pain? N Engl J Med315:1064-1070, 1986
Saragiotto BT, Maher CG, YamatoTP et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Systemic Reviews 2016 Issue 1 Art. No.: CD012004. DOI: 10.1002/14651858. CD012004