Low back pain: Is there one better way to rehabilitate this?

It's well documented and understood that the best treatment for low back pain is movement and exercise. But is there any one specific exercise that is more beneficial than others? Not only is the rehabilitation for low back pain about movement and exercise, many people still have fears and mis-beliefs when it comes to their backs. A major role in the rehabilitation is reassurance against those beliefs. Reducing people's fears and giving them the assurances they need. If people don' understand their back's and how unlikely damage is to the lumbar spine then people are more likely to get on board with exercise and rehabilitation.

Magalhaes et al (2015) researched into this very topic. (Herein known as The Researchers). They decided to compare graded activity versus Physiotherapy exercise group. 1. Graded Activity

The Researchers classed graded activity as "Individual sessions of progressive and sub-maximal exercises aimed to improve physical fitness" This incorporated treadmill, leg and trunk strengthening exercises. In addition to an educational booklet regarding the aforementioned myths surrounding low back pain

2. Physiotherapy Exercise

This was classed as "Stretching of calves, hamstrings and the back, strengthening of the abdomen and balance work"

Over a six week period, the two groups were compared based on pain, ability, quality of life, perceived effect and return to work. There results showed no significant difference between the two groups. In other words, it made no difference over a period of 6 weeks what they performed.

However!... 1. This study had no control group. In other words, it is undetermined what the effects are if no intervention was offered at all. Would people have got better over the natural period of time? 2. This is not a longitudinal study. In other words, there is no evidence to establish whether there is any difference beyond the 6 week mark.

3. The researchers omitted all forms of hands on therapy from the Physiotherapy Exercise group. It was documented in the NICE guidelines in November 2016 that massage and joint mobilisation is still advocated in low back pain management. Therefore, I wonder why these researchers chose to omit this? And, would there have been a significant difference between the groups if this was included?

4. The graded Activity group were offered no Cognitive Behavioural Therapy (CBT) It is also well documented that there is an effect from those with mis-beliefs in low back pain to benefit from psychological services. 5. Finally, although the ages between the group were comparable, the inter-group range was diverse. I know from clinical experience, that age is a considerable factor when prescribing exercise and conversely advise. It is unknown from this study whether age within the groups had a significant difference.

But....

If the results were to be taken at face value, the one similarity that the two groups had was strengthening exercises. It stands to reason that people have low back pain because their back is over working because something is under-working. I have blogged on this before.

So, does it really matter what exercise you do, as long as you exercise? I would say yes! From my experience when people say "I've been doing some exercise" and you probe further, chances are they have been doing things likely to aggravate their pain. One thing is still for sure. Exercise will not do your back any harm. But for a programme that meets yours needs, I recommend an appointment with your local, friendly physiotherapist.

Article: Magalhaes et al (2015) "The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial. Manual Therapy. 20 pp: 603 - 609 is available on hard copy or pdf at request.