Exercise Guidelines for Clients with Lower Back Pain
By Jennifer Green, MS
|Jennifer Green, NCHPAD Visiting Information Specialist|
One of the key influences on your clients' approach to exercise will be their individual beliefs about lower back pain. Some people with LBP deem this to be minor and inconvenient. They will often choose to ignore it and go about performing their usual program. On the other hand, others will stop their daily activities and seek professional advice. If pain is aggravated by certain exercise activities, it is highly likely that some persons may avoid the activities that they anticipate will cause pain. Therefore, the capacity to exercise may be significantly compromised by the degree to which people react to lower back pain.
Most occurrences of LBP do not require treatment, and at most, minor modifications of a heavy physical activity program will be needed for a couple of days. For significant acute pain (less than three months in duration), in which pain and injury are somewhat related, it is logical to modify activity temporarily, potentially treat the pain, and be "guided by pain intensity and duration as normal exercise is resumed." An early return to normal exercise activities should be encouraged, and any guidance to rest should be accompanied by advice about precise time for exercise resumption. For chronic or recurrent LBP (more than three months in duration), pain frequently persists, but is not indicative of ongoing tissue injury, and therefore cannot be used as a guide to adjust exercise management. Health professionals should address misconceptions or fears about exercise or activity as a source of further pain. It is appropriate to motivate and guide the individual to resume activity. For chronic, nonspecific pain, exercise and activity are strongly recommended.
Numerous studies have shown that exercise is significantly more effective than rest for lower back pain. There is also strong evidence that no single, specific exercise regimen is superior. Therefore, exercise guidelines for individuals with lower back pain are similar to the guidelines established by the American College of Sports Medicine (ACSM) for apparently healthy populations with proper adjustments.
The goals of an exercise program for individuals suffering from lower back pain should be to improve health and well-being, increase exercise tolerance, and prevent debilitation caused by inactivity. Exercise modalities that minimize stress to the lower back should be started during the first two weeks of acute LBP. During the acute stage of severe LBP, movements specifically for hip and back muscles can be delayed for at least two weeks. The intensity should be low, with gradual increases in intensity and duration. For those with chronic LBP, exercise intensity and duration should also be progressed gradually over time rather than pain-contingent. This is particularly important in individuals who are fearful of re-injury. Finally, given that adherence to any exercise or activity regimen is crucial, if benefits are to ensue, it is vital that exercise or activity prescriptions consider client preference.
Strength training should focus on core and trunk stability. It is suggested that clients under the age of 50 perform 10-15 reps/day and those over age 50 perform 8-12 repetitions/day ≥ 2 days per week. Flexibility can include stretching exercises that do not increase lower back pain. Clients should focus on stretching each muscle for 2 minutes/muscle group. Clients should hold the position for 3 repetitions for 10 seconds each. Finally, aerobic training should be modified to your individual clients' abilities while lower back pain is troublesome. The cardiovascular portion of the exercise prescription should at least consist of a brisk walk 3-5 days/week and a 1-minute chair sit-to-stand exercise 2-3 days/week.
Pengal, L. H. M., Ph.D., et. al. (2007). Physiotherapist-directed exercise, advice, or both for subacute low back pain. Annals of Internal Medicine, 146(11), 787.
Simmonds, M. J., Ph.D., PT., MCSP., & Derghazarian, T. P. (2009). Lower back pain syndrome. In J. L. e. a. Durstine (Ed.), ACSM's exercise management for persons with chronic diseases and disabilities(3rd ed., p. 266). Human Kinetics.
Thompson, W. R., Ph.D., FACSM, Gordon, N. F., MD, Ph.D., MPH, FACSM, & Pescatello, L. S., Ph.D., FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
Van Middelkoop, M., Ph.D., et al. (2010). Exercise therapy for chronic nonspecific low-back pain. Best Practice & Research Clinical Rheumatology, 24(2), 193.
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