Exercising with Lower Back Pain If Rest does not help

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 CuídatePlus, “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.