
Until a few years ago, when a patient had muscle pain or injury, absolute or relative rest was recommended as part of the treatment. Now this has changed in exercising with lower back pain since absolute rest can become counterproductive and cause the damaged or injured area to atrophy, making it difficult or lengthening the recovery of the patient.
Lower Back Pain
Precisely along these lines, a study has
been published in which it is evidenced that exercising with lower back pain not only helps but is key to
improving the recovery of patients with low back pain,
which is one of the most frequent among Spaniards.
This study, published in the British
Journal of Sports Medicine, has had the participation of
Spanish researchers and concludes that in patients with low back pain,
exercising leads by itself to a reduction of more than 20% in pain intensity, a
23% improvement in the degree of disability and 380%
more chances of feeling recovered overall.
As Francisco Kovacs, from the Kovacs
Back Unit of the HLA-Moncloa University Hospital, in
Madrid, director of the Spanish Network of Researchers in Back Ailments and one
of the authors, informs CuÃdatePlus, “this is a very broad study in
which We will have analyzed data from 3,514
patients. "
Specifically, as the author summarizes,
“The risk that the episode of low back pain lasts longer is higher among
those who have deficient muscles and tend to rest in case
of pain instead of maintaining a higher degree of physical activity than pain
It allows".
This is why staying active with or without
injury is so important. What's more, “2 days of complete bed
rest is enough for muscle pain to be lost, which tends to prolong the episode of low
back pain and increase the risk of its recurrence, " he warns.
But not only does the study show this, but
it also concludes that "with equal intensity of pain, the degree of
disability is also higher among those with deficient muscles."
Is it good for any low back pain?
Although there are several types of low
back pain, the most frequent is still called "nonspecific". This
is characterized by being the one that originates in the soft tissues, such as
muscles, tendons and ligaments and that is produced by the malfunction of the
musculature.
According to the study data, it is in this
type of pain where exercise is most effective,
although “it has also been shown to be effective in recovery after surgery (in
the few cases where it is indicated) and in pain due to structural
alterations of the spinal column, essentially in which it
is produced by nerve compression due to herniated disc ”, clarifies the expert.
As for chronic low back pain,
according to the expert, the exercise would not only be necessary but should be
mandatory. In these cases, “if the lower
back pain is intense, it is chances that in the start it will be necessary
to apply some additional treatment to be able to do the exercise without pain,
but exercise
is essential in the medium and long term, even to help
the improvement to be maintained. ”, Determines Kovacs. In addition, he
adds, "it is the only chance that shown to have positive effects for this
type of injury."
However, it is important to note that,
unfortunately, "exercise would have no effect on pain related to systemic
diseases, that is, in pain associated with those pathologies that do not
originate in the spine itself but that occur there, such as those caused by an
infection, cancer, fibromyalgia,
metabolic, rheumatic inflammatory conditions with an autoimmune or genetic
component or referred pain caused by visceral affections ”, he lists.
The essential thing is to do
something, no matter what
Just as there are different types of pain,
there are also different
types of exercises or physical activity that can be performed in each case,
however, according to Kovacs, any of them have positive effects if they are
maintained over time.
"All the studies show that you need
to exercise for a certain amount of time to have the desired effect." Therefore,
taking into account that no differences have been detected between the different
types of exercise but there have been differences in
their maintenance, it is advisable to choose the one that
fits the personal preferences of each patient. In summary: " The essential thing is to do some exercise, whatever it is and
what you like to maintain it over time," emphasizes the expert.
Once this doubt is cleared, it only
remains to know which training pattern would be the best in each case. According
to Kovacs, it is best to choose "supervised exercises" since these
have been the ones that have shown the best results compared to those that are
practiced without supervision.
Likewise, it is important to note that:
·
Less than a weekly session has no or minimal effect. "The effect begins to be relevant and
cumulative after two weekly sessions and, once the muscles are sufficiently
trained, three weekly sessions are usually optimal."
·
Especially when the muscle is required to
exert an effort intense enough to exhaust it, "it is
necessary to let it rest for at least 24-36 hours before demanding it again ." For
this reason, although cardiovascular training sessions or not particularly
intense can be done every day, "intense training sessions have to be
separated by at least one rest day." This does not mean that you
cannot do intense exercise every day, but in that case, according to Kovacs,
"it would be convenient to train different muscle groups on alternate days
and keep one day a week off."
·
The duration of each training session will
depend on the specific type of exercise that is done as
well as the muscular and cardiovascular state of the patient.
What if it hurts?
The study data show that exercise improves
the evolution of low back pain, but what happens when the area hurts so much
that it is impossible to practice any exercise? According to Kovacs, "it
doesn't have to hurt ." In fact, "it is
convenient to interrupt and modify all those exercises that trigger the pain or
increase its intensity".
The problem of implementing these tips
appears in people who have never exercised since
in these cases "the feeling of muscle exhaustion or the next day's
stiffness can be confused with pain".
Here it must be taken into account that
the stiffness,
conceptually, " does not force to change anything
in the training pattern, except in cases of clinically
relevant aggravation of pain where it would be advisable to change the training
pattern or the muscle groups in that is focused, ”says the expert.
Sports practice is only contraindicated
" in those cases in which pain is systematically
triggered or aggravated and especially if it is pain radiating to the leg ." In
these cases, "it is necessary to first apply the necessary medical
treatments to cure the patient and then initiate appropriate exercise aimed at
reducing the risk of future painful episodes."
Nor would it be indicated in patients
suffering from other diseases that prevent them from doing any exercise such as
"serious cardiac or oncological pathologies under treatment in the phases
in which exhaustion induced by chemotherapy prevents it", concludes the
expert.
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