Chronic low back pain: exercise, walking, or both?
The great dread that is low back pain (LBP) will affect 80% of Americans at some point in their life. Especially since the coronavirus lockdown, The LAB has seen a sharp rise in LBP cases due to more people working on their laptops from home.
The study:
A randomized controlled trial by Suh et al looks at the impact of different exercise protocols on individuals with chronic low back pain (>3 months).
Group 1: Flexibility exercise (FE)
Group 2: Walking exercise (WE)
Group 3: Lumbar stabilization exercise (SE)**
Group 4: Lumbar stabilization combined with walking exercise (SWE)**
**SE exercises targeted the transverse abdominis, rectus abdominis, erector spinae, multifidus, internal obliques and quadratus lumborum.
All groups underwent their designated exercise program for 30-60 minutes, 5-6 times a week, for a period of 6 weeks. These exercises were performed on their own at home. All participants were also educated on optimal posture and the abdominal bracing method, which was encouraged to be used throughout exercise.
The main outcome measures were subjective pain (VAS) during rest and physical activity, while the secondary outcome measures included the Oswestry disability index questionnaire, Beck depression inventory, frequency of medicine use, strength of lumbar extensors and endurance of postural positions. These measures were taken just before the first session, 2 weeks after last session, and 6 weeks after last session.
The results:
All groups experienced significantly less pain during physical activity, improved scores in the Oswestry disability index and Beck depression inventory, after the 6-week program.
The FE and SE groups experienced significant less pain during rest after the 6-week program.
The WE and SWE groups had significant increase in postural endurance for prone, supine and sidelying positions.
What it means:
Limitations behind the study include the absence of a control group, lack of long-term follow-up, and a small sample size (n=48).
All groups, despite their differences in exercise programs, experienced positive outcomes with respect to low back pain and tolerance to everyday physical activities. While this reiterates the benefits of general exercise for the low back, the author believes the study’s positive findings may also be attributed to the education that all participants received on optimal posture with ideal pelvic alignment for lumbar lordosis and activation of erector spinae, as well as the abdominal bracing method to maintain activation of the transverse abdominis and internal oblique musculature.
See below for examples of low back pain exercises.
REFERENCES:
Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2019 Jun;98(26):e16173. doi: 10.1097/MD.0000000000016173. PMID: 31261549; PMCID: PMC6616307.