Low back pain affects millions of Americans each year and costs consumers billions of dollars trying to find the perfect solution to an agonizing condition. It causes people to miss out on work, social events, prevents them from participating in activities they love, and can even lead to depression. So what are low back pain sufferers supposed to do?
Low Back Pain Treatment
When it comes to treating chronic back pain, in the past, doctors recommended bed rest, to help with recovery. However, as we learned more about the condition, the guidelines for treatment changed and we now know that keeping moving is one of the most important things that you can do to help with your recovery. Movement is key. Current international guidelines all agree that exercise should be used as a first line treatment for low back pain. So that brings about the question of how do we know what sort of exercise we should be doing? Which ones are safe for those who suffer from chronic low back pain?
Exercise therapy is one of the most widely recommended treatments for low back pain. When it comes to managing chronic low back pain, experts agree that exercise is one of the best ways to reduce pain, and to restore flexibility and strength (key components for managing the condition). There is a wealth of scientific data that supports the use of exercise therapy for first line treatment of LBP so it is no wonder that the guidelines all unanimously agree on it.
Why Exercise for Low Back Pain?
There are some types of exercise that are specifically beneficial to strengthening the muscles that surround and support the spine. Not all exercises will do this. Some may even be jarring and harmful to your spine. Strengthening the muscles that support your spine is important because stronger muscles means less pressure on the surrounding discs and joints. When your spine is properly supported it is more mobile and flexible, so there is less pain and stiffness.
A healthy spine also means healthy discs. “Discs” is the term used to describe the intervertebral discs that separate the bones of your spine - your vertebrae. Your discs are like spongy cushions that act like shock absorbers. They help reduce impact on your vertebrae and help to keep the spine stable and mobile. Keeping your discs hydrated is important because healthy discs absorb water from your body throughout the day (see our blog on dehydration and low back pain), but the water also leaks out of the discs as the day goes on. When we engage in physical activities, the discs are able to exchange fluids and thereby get nutrition to help keep them healthy. This fluid exchange also helps to reduce swelling that is sometimes found in the soft tissues that surround injured discs. When we don’t engage in fitness activities, swelling can increase and the discs end up degenerating through lack of nutrients.
Circulation is another benefit of exercise for low back pain. Exercising increases our circulation and good circulation is key for distributing nutrients throughout the body, including to our spinal discs. Improved circulation also means improved blood flow which helps to relax the muscles in our body (like those surrounding our spine), reducing stiffness and increasing flexibility.
One of the best things about exercising is the release of endorphins. Endorphins are known as the “feel good” chemicals in our bodies. They are the body’s natural pain relievers and are produced by our central nervous system when we are stressed or in pain. Endorphins act on the opiate receptors in our brains, similar to how actual opioids work, reducing pain and increasing our sense of pleasure.
Endorphins are released by your body when you do things like exercising, dancing, making music, or even just having a good laugh. Endorphins can help reduce anxiety, depression, and even pain. The really good news is that the more you exercise, the more your body makes endorphins, which makes working out more and more rewarding, both mentally, and physically.
What Type Of Exercise Is Best For Low Back Pain
So now that we know how and why exercise benefits our low backs, the question arises, what sort of exercise should we be engaging in? If we don’t want to risk making our low back pain worse, what is the best type of exercise for people with low back pain? How do we know what will help, or what could cause us even more pain?
When we look at the data behind different types of exercise, fortunately it seems that there are many different types of exercises that can be good for low back pain. When we go through our list of top workouts, hopefully there will be something that jumps out at you, that you might enjoy doing. Generally speaking, when it comes to low back pain, it seems that almost any type of low impact aerobic exercise is a good choice. Exercise programs that involve strengthening, or endurance, have been proven to reduce low back pain and disability in chronic low back pain patients. Exercises that target your core for strengthening purposes are also highly recommended.
It seems as if the experts don’t really want to pick any one particular thing, either. The World Health Organization recommends activities such as walking Tai Chi and Yoga, as does the American Academy of Family Physicians. The European back pain guidelines don’t really specify what type of activities to try, and the US VA recommends Pilates as an option for low back exercises. We will talk about some of these types of workouts in more detail, but probably the most important thing to remember is that not all exercises are beneficial for chronic low back pain. When you start to exercise you might find yourself a little sore and stiff in the beginning, which is completely natural. If, however, you start feeling pain that is stronger, and lasts for more than 15 minutes during your workout, you should definitely stop exercising and contact your healthcare provider.
Walking is one of the easiest exercises that you can do for low back pain. You can do it pretty much anywhere, any time, and best of all, it is free! Walking is a wonderful way to socialize, exercise your pet, see your city (or neighborhood), or simply get outdoors. Walking is great for strengthening the low back muscles that help to support your entire body. When you walk, there is improved blood flow to your muscles, which means that your muscles can get more of the oxygen and nutrients that it requires for optimal health and functioning. Walking also helps to flush out the toxins that can cause pain and stiffness. Just a quick walk around the block to start. Perhaps a 30 minute walk with a friend to catch up? There is nothing preventing you from starting right away.
Swimming is one of the best exercises that you can do for low back pain. Swimming provides supported low impact aerobic conditioning for your body. When you swim, the water helps to support your body’s weight, reducing the stress that is typically placed on your joints and spine. Unlike other types of aerobic exercise that can often be jarring and tough on your body (like running or jogging) swimming helps you achieve a cardiovascular workout in a more gentle and pain free way.
If you are thinking of swimming for your low back pain, experts recommend freestyle or backstroke over butterfly or breaststroke, which can arch your low back, putting more strain on it. Not everyone has a pool, which makes it a little more challenging to pursue than walking, but many neighborhoods have local pools, or rec centers with indoor pools. With summer just around the corner, this exercise could be a great addition to your vacation plans!
Tai Chi is a form of exercise that is based on the principles and movements behind an ancient Chinese martial art, called Tai Chi Quan. The martial art of Tai Chi Quan emphasizes slow, soft movements, requiring those who practice it to have a calm and focused mind. Tai Chi takes these principles and applies them to healing, rather than combat. Movements in Tai Chi are slow, controlled, and deliberate, and flow from one position to another.
When it comes to low back pain, research has shown that slow flow of Tai Chi movements, along with the deep breathing that accompanies it, helps to ease back pain. The focused movements help to strengthen the abdominal muscles that support the low back, while the balance portion of Tai Chi also helps with flexibility and stability. If you are looking to take up Tai Chi, check out local community fitness centers or neighborhood groups.
Yoga is a mind and body practice that is based on ancient Indian philosophy. Yoga combines different postures and positions with mindfulness, meditation, and breath work. Many people use yoga just for meditation and relaxation, but research has shown that yoga is a great way to help reduce low back pain. Yoga poses help to build strength in your low back muscles, as well as improving your flexibility over time. Yoga also has significant mental health benefits due to its relaxation focus.
Yoga is a great exercise for low back pain because it can be done at home, or in a group setting, and is generally fairly inexpensive to practice. It can be done almost anywhere. All you need is a little space to put down your mat and you are all set. While there are lots of yoga studios (even hot yoga studios and Goga studios - that’s another topic entirely!) yoga can be done in your living room or even in a park or your garden.
Many people think of yoga as relaxing and low impact. While this is true for a lot of yoga practices, it is important to note, however, that like with many types of exercise, yoga is not completely without risk of injury for low back sufferers. Some research has actually shown a 10 -15% increased incidence of low back pain in people who practice yoga. It is important to work with a trained yoga instructor and to let them know if you have any physical injuries or concerns before starting the class. That way they can recommend certain modification for poses that will not place unnecessary strain on your low back.
With proper supervision and knowledge of back injuries, fortunately the risk of injury is typically very low. The practice of yoga allows for many modifications for those who have specific health conditions. There are yoga classes for children, pregnant women, and even chair yoga for seniors with health challenges. Overall, the benefits associated with regular yoga practice far outweigh the risks when it comes to helping patients with low back pain.
Pilates is a form of low-impact exercise that strengthens your muscles, while improving your posture and flexibility. Based on the movement founded by Joseph Pilates, Pilates targets your whole body using slow, precise movements, along with breath control. Pilates can be done on a mat or on machines; with no equipment, or with special machines called “reformers”. If you are doing mat exercises with no (or limited) equipment, Pilates can be another very flexible and inexpensive way to workout with low back pain. If you are taking classes, especially on the reformer, then it starts to get a little more expensive.
Whichever option you choose, your workout will focus on controlling small, specific movements, rather than lots of endless repetition or very heavy weights. In Pilates, your body will work to lift against gravity (or the reformer’s springs and bands), targeting specific isolated muscles. When it comes to low back pain, research has shown that just 8 weeks of Pilates classes caused improvements in abdominal endurance, balance, and flexibility. With its focus on breathwork, Pilates also has significant benefits for mental health and relaxation, which has been shown to help with reducing pain sensations.
No matter what type of space, budget, or time you may have, it certainly seems as if there is an exercise to suit anyone who struggles with low back pain. Some people may have one particular exercise that they prefer, while others may prefer to combine different activities to keep things interesting. The important thing to keep in mind, is to stay consistent and always know that even the best programs in the world probably will not be able to “cure” your low back pain forever. Staying active on a regular basis is key and it has so many benefits for our bodies beyond just preventing low back pain. Movement is paramount for endorphin release (and the happy feelings that go with them), happiness, for getting outdoors, for keeping us connected with the world, and for helping with weight maintenance and prevention of chronic diseases such as heart disease and diabetes. So, knowing some of the top types of exercise for low back pain, what are you going to try today? It's as easy as putting on your shoes and stepping out the door!