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Back Pain Exercises
Early in the evolution of back pain treatment, patients were encouraged to rest until the pain went away. While there may be controversies and much still to learn about low back pain, total rest is not the best option. In fact, clinical studies show that back pain exercises can reduce pain and improve function when done carefully and correctly. While nothing can substitute for the guidance of a trained physical therapist or a physician that specializes in physical medicine and rehabilitation, the first step in healing is to understand the basics of back pain exercises.
Isometric back pain exercises
Isometric exercises are those that keep the muscle at the same length during the exercise ("iso-" is same; "-metric" is length or distance). In order to perform isometrics, the muscle needs to be exerted against an immovable object. One example of isometric back pain exercises would be to sit with your back against a wall and press your shoulders backwards. The muscles in your back do not change length, but they do exert energy. Isometrics do not build strength within the muscle over a large range of motion, but these back pain exercises do help to relieve pain (or are at least a first step towards back pain relief).
Isotonic back pain exercises
In contrast to isometrics, isotonic exercises change the length of the muscle but by applying the same tone throughout the exercise. One way to think of isotonic exercises is the movement through space with a single resistance. For example, performing a concentrated biceps muscle curl would be an isotonic exercise. As far as isotonic back pain exercises are concerned, straightening to upright after being bent at the waist is an isotonic exercise for the back muscles.
Isokinetic back pain exercises
Isometrics and isotonics keep the muscle length or tone the same, respectively. In order to perform isokinetic exercises, the speed of the muscle movement must be kept constant regardless of length or level of exertion. This usually requires the use of specialized equipment to ensure a constant velocity. Some studies suggest that isokinetic back pain exercises are no more effective in general than standard care and are usually more expensive overall, making them useful in only specific situations or as part of a larger back pain exercise regimen.
Lumbar stabilization
Lumbar stabilization (sometimes called Dynamic lumbar stabilization) begins with the spine placed in a neutral position, that is, one that is without stress on the joints, muscle exertion, and causes as little pain as possible. The key to these back pain exercises that the patient maintains this neutral position while other muscles are used in increasing levels of exertion. The idea is to strengthen surrounding muscles while bracing and protecting the spinal muscles.
The McKenzie Method
The McKenzie Method is a comprehensive program that has been successful in relieving low back pain and improving function. It begins with an evaluation of low back pain both at rest and with the addition of resistance (loading). The patient's pain experiences (what makes things worse or better; what makes the pain centralize, etc.) are recorded. This information is known as the "directional preference" and used to formulate a treatment course. Treatment involves any number of exercises meant to relieve back pain but also includes patient education and empowerment. Patients are encouraged to be their own practitioners after they understand and can perform their own therapeutic maneuvers. Exercises are performed at home up to a dozen times a day rather than at office visits, which may only occur once daily or three times per week.
Which back pain exercises are the best?
It is has been shown that activity is better than dormancy in the treatment of low back pain. We also know that exercise regimens directed by a professional are helpful in reducing pain and improving function. What is not clear is which exercise work for what type of pain. The best that we have at this point is to follow the patient's directional preference. In other words, choose exercises that subjectively feel best for the patient. While not every exercise regimen will help every person with low back pain, omitting back pain exercises is not a reasonable option.
back pain exercises references
Busanich BM, Verscheure SD. Does McKenzie therapy improve outcomes for back pain? J Athl Train 2006;41:117-119.
Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 2005;142:776-785.
Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med 2005;142:765-775.
Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila Pa 1976 ) 2004;29:2593-2602.
Sertpoyraz F, Eyigor S, Karapolat H, Capaci K, Kirazli Yi. Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study. Clinical Rehabilitation 2009;23:238-247.
van MM, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 2010;24:193-204.
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