Back Pain and Exercise

   

Barely a week goes by without a health campaign or awareness day, and this week is no exception. 8th-12th October is Back Care Awareness Week. And, given that an estimated 84% of us experience back pain in our lives, I felt it was one worth writing about.

Back pain can range from a twinge in the lower back brought on by lifting something awkwardly, to chronic upper back pain from sitting at a computer all day, to excruciating disc damage, and everything in between. It has many possible causes, but one thing's for certain - exercise almost always does more help than harm.

A healthy back

Your back has a pretty tough job to do day-to-day. Even if you’re sitting at a desk, your spine and its surrounding bones and muscles have to work hard to keep you upright! Muscle strength (particularly in the ‘core’ muscles around your abdomen), good posture and flexibility are all important for preventing injury and pain.

When something goes wrong

In 2011, musculoskeletal problems such as back pain accounted for 35 million lost working days in the UK, and it’s thought that at any one time 11.9% of women are experiencing back pain. As there are so many different structures (ligaments, bones and muscles) in your back, it’s always best to see your doctor or a physiotherapist if you hurt your back. This will help you address the root cause as quickly as possible and help avoid the risk of longer-term problems.

When you’re in pain, work might not be the best place for you (especially if heavy lifting or computer work take up the bulk of your day), but that doesn’t mean that sitting with your feet up is the best plan. It’s a good idea to keep active as this may help ease muscle spasms.

According to Backcare UK:

People who are physically active and participate in regular sport or exercise not only experience better overall health but also better back health.

What types of exercise help keep your back healthy?

The UK’s National Institute for Health and Clinical Excellence recommends that people with low back pain carry on with normal activities and stay active.  They encourage doctors to recommend a structured exercise programme which may include aerobic activity, muscle strengthening, postural control and stretching as part of treatment. 

The following advice is general, but should help if you’re experiencing niggling pains, stiffness and tension in your back. Essentially, it’s important to strengthen the supporting muscles around your back at the same time as loosening tight muscles that may be pulling your back out of alignment. This could include:

Aerobic activity
Walking is a great way to stay fit, but focus on maintaining a good posture. It’s natural to feel scared about doing something that might hurt your back, so work within the limits of your pain, and build up gradually. 

Muscle strengthening
Rather than going for the fixed weights machines in the gym, where your body is fully supported (and your back doesn’t have to do much work), concentrate on multi-joint movements where you are actually using your core muscles to support your body. A gym instructor will be able to explain how to do this safely. 

An example could include working out with Kettlebells - one study found that a supervised full-body kettlebell workout, three times a week, reduced pain in the neck, shoulders and lower back within eight weeks. This is because kettlebell exercises work the posterior muscle chain - the back, bum and hamstrings - which tends to be weak in desk workers.  But if your back pain is severe, it may be better to stick with static exercises such as wall squats first of all. 

Postural control
Exercises like the bridge, back extensions and pelvic tilts help build strength in those all-important core muscles.  Check out WebMD for an explanation of how to do these and which exercises are better avoided.  One recent research study suggests that one weekly session focused on lower back training is enough to benefit strength and reduce pain in people with chronic pain. An alternative is to go to a pilates class run by an experienced instructor - ask them in advance if they can help with your back pain. 

Stretching
The final element that will help ease your back and shoulders is to incorporate some gentle stretching. Again, this can be done in a class-based setting, such as yoga, but it’s important to check that the instructor will be able to help you adapt the workout to avoid aggravating any injuries.  Often, back pain is a result of tight muscles in the hips and hamstrings, so ensure you stretch these out after a workout.

Where to get advice
If you’re looking for a personal trainer or fitness instructor, visit REPS for a list of registered exercise instructors with a Level 4 qualification in exercise for the management of lower back pain.  Your doctor may also be able to refer you to an exercise programme run by the NHS.

If you haven’t been exercising regularly for a while, don’t worry if you experience short-term discomfort after a workout. A little pain is normal and just shows that you’ve worked hard! But if the pain doesn’t go away within a couple of days, speak to a fitness instructor or your physiotherapist about how to adapt the exercises to suit you better. Above all, set a goal, start small, and build on your successes week-to-week.

REFERENCES:

— Balague, F. et al. (2012) Non-specific low back pain. The Lancet. 379(9814); 482-491. Bruce-Low, S. et al (2012) One lumbar extension training session per week is sufficient for strength gains and reductions in pain in patients with chronic low back pain ergonomics. Ergonomics. 55(4):500-7. Hoy, D. et al. (2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum. 64(6):2028-37. Jay, K. et al. (2011) Kettlebell training for musculoskeletal and cardiovascular health: a randomized controlled trial. Scandinavian Journal of Work and Environmental Health. 37(3):196-203. National Institute for Health & Clinical Excellence (2009) Early Management of Persistent Non-Specific Back Pain. [online] Available from: http://www.nice.org.uk/CG88 Office for National Statistics (2012) Sickness Absence in the Labour Market - 2012. [online] Available from: http://www.ons.gov.uk/ons/dcp171776_265016.pdf