Low Back Pain

exercise May 25, 2022

Low back pain is complex and multi-factorial. Let’s explore the science…

Low back pain is one of the most prevalent medical complaints, 7.5% of the global population suffers from it at any given time. Experiencing back discomfort can impact one’s quality of life, interfering with favourite recreational activities, daily routines, and ability to work productively.

Low back pain is defined as pain, muscle tension, or stiffness localized below the rib margin and above the inferior gluteal folds (bottom of butt cheeks), with or without leg pain.

Picture obtained from Breathe Education Clinical Pilates Diploma lectures, 2022.

For prognosis and outcome purposes, LBP is described as either:
*Acute, where the pain has been around for less than 6 weeks
*Subacute where the pain has been consistent for 6-12 weeks
*Chronic where pain lasts longer than 12 weeks

For acute pain, there are two events that cause it:
1. Trauma - where you had a severe accident that caused damage to the tissue
2. Too much too soon - where you loaded your muscle without progressively overloading it, like moving day where a person who doesn’t normally exercise moves heavy boxes for 12 hours straight and has overloaded the muscle. We can prevent this with consistent strength training 2-3 times weekly, slowly adding challenges in load and duration. And have lots of people helping you move :)

The good news with trauma and too much too soon injuries is that most bodies heal within normal tissue healing times. Muscles heal within 3-6 weeks, bones heal within 6-8 weeks, and joints within 12-18 months. You can lightly load healing tissue around the 7 day mark, but most likely you can begin simple movements within a couple days (like the exercises pictured below).

Chronic LBP is a little different.

There are three causes of chronic LBP:
1. LBP associated with another specific spinal cause (cancer, fracture, infection, ankspondylititis
2. LSP caused by radiculopathy (nerve pain) or spinal stenosis
3. Non-specific LBP

The first two are rare, meaning 90% of all chronic back pain is non-specific LBP, making it is the leading cause of back pain. Non-specific LBP is caused by many factors: lack of sleep, worry, low physical activity, tissue status, poor nutrition, increased stress, lack of social support.

The Cup of Resilience is the perfect metaphor to describe long term pain issues. Your body can only handle so much for so long until it becomes overloaded. Using the imagery of an overflowing cup, we then can become over sensitized to pain - feeling pain all over or in a specific area.

Photo from Dr. Greg Lehman's website, a pain specialist, link in resources

The good news many studies show there is a way out of chronic LBP. If we can find a balance of stress, physical activity, and healthy eating habits our cup will not over flow and/or we build a bigger cup. My favourite way to reduce chronic pain is through nutritious eating and feel-good movement, where relief from stress is a by-product :)

For movement, luckily we have very thorough exercise testing and prescription guidelines. Here in Canada and America we use the American College of Sport Medicine’s (ACSM) guidelines. Each area of the world have very similar guidelines. The guidelines have been formed using over 1000s of peer reviewed scientific studies and are updated when new research is discovered.  

ACSM’s Guidelines for Low Back Pain

✓Pilates and other muscle strengthening activities promoting coordination, endurance, core strength, and overall total body strength have been extensively shown to be highly effective interventions for LBP
✓Move your body within your pain tolerance, and limit certain exercises that seem to make symptoms worse. If you perform a movement and it hurts don’t do it. If you perform a movement and it doesn’t hurt continue with it. This is very individual and may need to be explored and changed often with your skilled trainer
✓Progressive low grade to moderate aerobic exercise helps relieve symptoms, eventually high intensity is allowed once symptoms lessen within pain tolerance. Caution with walking downhill as it seems to aggravate LBP in older adults. Walking on incline is beneficial
✓Flexibility exercises are encouraged (with hip and low limb emphasis)
✓Repeated movements have been shown to help with pain - called Directional Preference. This means if you find forward folds reduce symptoms, it is beneficial to consistently do forward folds every day 3 times per day. It’s not really about a certain exercise per say, its more individual to each person. Directional Preference is connected with your neural pathways, similar to the effects of self-massage via balls and foam rolling.

Types of movements shown to relieve LBP, especially sciatica:

Picture obtained from Breathe Education Clinical Pilates Diploma lectures, 2022.

This post is jam-packed with information. I tried to keep the science simple, but truthfully this topic can fill several books! If you have any questions or concerns, I’d love to help!

*Roy, Brad A. Ph.D., FACSM, FACHE; Vanichkachorn, Greg M.D. Low Back Pain, ACSM’s Health & Fitness Journal: March/April 2013 - Volume 17 - Issue 2 - p 5 doi: 10.1249/FIT.0b013e3182829609


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