Exercise and Physical Therapy

Exercise and Physical Therapy

Exercise is not helpful for acute back pain. In fact, overexertion may be as unhelpful as prolonged bed rest during recovery. In one study, patients who immediately embarked on flexibility exercises recovered slower than those who gradually resumed normal activity.

An incremental aerobic exercise program (such as walking, stationary biking, swimming) may begin within 2 weeks of symptoms. Jogging is usually not recommended, at least not until the pain is gone and muscles are stronger.

Patients should avoid exercises that put the lower back under pressure until the back muscles are well toned. Such exercises include leg lifts done in a face-down position, straight leg sit-ups, and leg curls using exercise equipment.

It should be stressed that incorrect movements or long-term high-impact exercise is often a cause of back pain in the first place. People vulnerable to back pain should avoid activities that put undue stress on the lower back or require sudden twisting movements, such as football, golf, ballet, and weight lifting.

In all cases, patients should never force themselves to exercise if, by doing so, the pain increases.

The Role of Physical Therapy

Physical therapy with a trained professional may be useful if pain has not improved within the first three weeks. It is, in fact, important for any person who has chronic low back pain to have an exercise program guided by professionals who understand the limitations and special needs of back pain and who can address individual health conditions. One study indicated that patients who planned their own exercise did worse than those in physical therapy or doctor-directed programs.

Physical therapy typically includes the following:

• The first stage involves patient education and training the patient in correct movement. Sometimes heat or electro-therapies (such as therapeutic ultrasound or low-energy lasers) are used, although their benefits are unproven.
• If back pain persists beyond 5 weeks, physical therapy is used for rehabilitation. It uses exercises to help the patient keep the spine in neutral positions during all daily activities.