Lower back pain and exercise

Low back pain is very common. So common, that most (80%) Australian adults will experience at least one episode of low back pain during their lifetime (1). Although often very painful, most low back pain is not caused by a serious problem and will resolve with some simple care. Physical activity is an important part of that care.

How do I manage my low back pain?
If you simply have low back pain without any other issues, then your pain is likely to be ‘uncomplicated low back pain’ that will resolve. Staying as active as possible can help you manage your low back pain (2).

How should I stay active?
You can choose from many options of exercise, with no specific type being the best. Just stay as active as you can, allowing for the restrictions in movement that may come with pain (2). People with low back pain usually do not compete, work for medals or train hard in these activities. They simply use these leisure activities for therapy, and just to experience the joy and pleasure of movement. Suggestions include:

• gardening, digging or pruning plants;
• walking and running;
• swimming;
• cycling; and
• dancing, yoga and tai chi.

What are the benefits of exercise?
Exercise is a powerful tool for moderating strong emotions, such as anxiety and depression. In fact, participating in enjoyable physical activities keeps you connected, happier and more focused on the
important things in life. Also, while you are in pain, staying active prevents loss of physical fitness, muscle  strength and cardiorespiratory function. Staying active therefore helps you ensure that other aspects of
your health do not decline too — being in pain is quite enough!

What happens as I start to recover?
When you had severe low back pain, you were using general exercise to stay active and to stop yourself from getting worse. Now you want to get better and stay that way. There is moderate evidence that doing exercise
at this post-back pain stage can help stop another episode of low back pain (3). You can increase your program of preferred exercise to include:

• Graduated training: To keep physically improving, your exercise program must become increasingly more difficult, e.g. if you stayed active by walking, to gain further health benefits you now need to walk further or
  faster, walk up hills, or carry extra weights. An accredited exercise physiologist can help you plan a suitable graduated training program in your preferred form of exercise.
• Increasing your range of motion: As your low back pain subsides, add some stretching and reaching exercises that increase the amount that you move your back. This is an ideal time to begin some tai chi, yoga,
  stretching or dancing if you have not done so already.
• Strengthening: Muscle strength, particularly in the small muscles that stabilise the lower back, does not return automatically when low back pain eases; therefore: to regain this strength, you may need to do some
  specific strengthening exercises, with graduated difficulty to progressively increase strength (4); and an accredited exercise physiologist can help you plan an exercise program to strengthen your low back.
  It is important you seek assistance with planning exercise if you have had multiple episodes of low back pain, because the back muscles can respond differently after repeated bouts of back pain (5).

References and further information
Exercise is Medicine Australia www.exerciseismedicine.org.au
Find an Accredited Exercise Physiologist www.essa.org.au
Exercise Right www.exerciseright.com.au
1. J Manipulative Physiol Ther. 2004; 27(4):238–44.
2. Australian Acute Musculoskeletal Pain Guidelines Group. 2003. Australian
Academic Press.
3. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555.
4. Spine. 2001; 26(11):E243–8.
5. Spine. 2010; 35(7):818–24.