Exercising with Low Back Pain – is it safe?

It is now well accepted that exercise is an effective tool in the management of low back pain. It can be undertaken in a range of different settings, from walking or yoga, to a home exercise program, swimming, or a tailored pilates regime. Whilst there is an enormous variety of exercise programs available, there is no 'ideal' exercise intervention. Many different forms of exercise have shown similar benefits for low back pain. Exercise programs are probably best chosen according to factors such as patient and clinician preferences, accessibility and costs. 

Everyone should find a way to move that works with their body. It is important to be cleared for exercise by your GP or specialist for any relevant general medical conditions (eg. heart conditions). There are also some back conditions where exercise is contraindicated unless there is medical clearance

  • fracture

  • cancer

  • infection

  • cauda equina syndrome

“...do it slowly enough that it doesn’t freak out your system. We say always do more today than you did yesterday, but not much more” and “movement is medicine and motion is lotion”.
— Professor Lorimer Moseley, Australian Pain Specialist, discussing exercise for chronic low back pain.
WHEN_Lowe_Back_Pain

Exercise tolerance often changes in the setting of low back pain. You may notice:

  • finding many activities a lot harder than before

  • changes in your symptoms

  • a fearful state of mind

  • general muscle weakness (which can be due to certain muscles switching off in the presence of pain, or be as a result of being more sedentary throughout your injury)

  • a change in your pain tolerance to certain stimuli, as your brain and body sensors are often more alert following past injury

  • spasm of your back and hip muscles which can cause further pain

  • a change in your energy levels as you adjust to a return to exercise following back injury

  • general changes in your body

◦      You may have put on weight or lost muscle tone during your back injury, and your body will need time to adapt to new pressure dynamics

  • mental and emotional stress

◦      this commonly occurs with, or is increased in, back injury and back pain and can also affect the level of pain you experience.

It is not uncommon for people with back pain to experience changes in their symptoms whilst exercising. These sensations are often normal and safe. However, if you believe you may be making your back pain worse, or perhaps are experiencing symptoms moving down the legs, it would be advisable to have a doctor or physiotherapist review your situation. If you experience progressive leg symptoms, back pain and/or any saddle region (crotch) numbness, tingling or loss of control, it is advisable to seek a more urgent review to ensure your nerves are able to access all parts of your body freely.


REFERENCES

  1. Almeida M, Saragiotto B, Richards B, Maher CG. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. MJA. 2018; 208(6):272-275. doi: 10.5694/mja17.01152

  2. Foster, Nadine & Anema, Johannes & Cherkin, Dan & Chou, Roger & P Cohen, Steven & Gross, Douglas & Ferreira, Paulo & M Fritz, Julie & Koes, Bart & A Turner, Judith & Maher, Chris & Buchbinder, Rachelle & Hartvigsen, Jan & Underwood, Martin & Tulder, Maurits & P Cohen, Stephen & Menezes Costa, Lucíola & Croft, Peter & Woolf, Anthony. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 391. 10.1016/S0140-6736(18)30489-6.

  3. Exercise for chronic low back pain. Handbook for non-drug interventions. RACGP. https://www.racgp.org.au/clinical-resources/clinical-guidelines/handbook-of-non-drug-interventions-(handi)/musculoskeletal/exercise-for-chronic-low-back-pain

  4. Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017;15:413–421. https://doi.org/10.1002/msc.1191

  5. Dahm K, Brurberg K, Jamtvedt G, Hagen K. Advice to rest in bed versus advice to stay active for acute low back pain and sciatica. Cochrane Database of Systematic Reviews. 2010;(6): CD007612. DOI: 10.1002/14651858.CD007612.pub2

  6. Maher, CG, Williams C, Lin C, Latimer, J. Managing low back pain in primary care. Aust Prescr 2011;34:128-32. DOI: 10.18773/austprescr.2011.069 https://www.nps.org.au/australian-prescriber/articles/managing-low-back-pain-in-primary-care

Authors:

Millie Shield & Dr. Rhea Psereckis

Marco van der Heide