Back rehab a lifelong commitment – expert

In the fifth part of The Independent on Saturday’s series on lower back pain, Lynette Savides explores exercise further

IN LAST week’s article, we discussed the beneficial role that exercise can play for those individuals who suffer with chronic back pain. With that background, the important questions to ask now are, what to do, when to do it and how to do it.

Diving headlong into an exercise programme without any specific guidance regarding the choice and intensity of exercise can not only be ineffective but could also worsen your back pain. It is important that you seek guidance from an exercise professional such as a biokineticist.

Any decent exercise programme designed at improving chronic lower back pain should include an educational component. This education should be aimed at teaching correct posture, improved movement of the spine in activities of daily living and simple “home techniques” to reduce symptoms.

When starting an exercise programme, you should be aware of what the expected outcome is. For example, the diagnosis of your specific back pain might mean that your exercise programme will only relieve certain symptoms, while other symptoms will not be expected to improve.

Most importantly, it is vital that you understand the significance of a lifelong commitment to a back treatment programme. This does not mean that you will spend a lifetime doing supervised exercise.

Rather, it means that you should spend a lifetime caring for your back’s well-being. The number one risk factor for back pain is previous back pain. So once you have been a victim of back pain, you are unfortunately already at an increased risk of a recurrence. The solution is to keep on exercising.

Stretching is an important aspect of managing lower back pain, but should not be confused with joint mobility. Flexibility refers to the muscle structures. Hamstring tightness, for example, can limit movement in your pelvis and place it in a position that increases stress on the lower back.

Therefore hamstring stretching is highly beneficial in managing lower back pain. However, this stretch must be done with care, so as not to aggravate any of the surrounding structures.

Joint mobility, on the other hand, refers to the specific movements around a joint. For example, the limited movement in a facet joint of your lower spine, perhaps the result of a previous injury, can result in a dysfunctional posture and consequent abnormal loading.

Once your joints and muscles are moving in the correct ranges, the strengthening of your trunk stabilisers will be a lot more effective.

Doing hundreds of sit-ups each day to supposedly fix your back is not only misguided, but can in fact make your back problem worse. Rather, there are a number of deep abdominal stabiliser muscles, just in front of the spine, that should be strengthened so that the spine is better supported.

These muscles are the “core” that biokineticists refer to. So, unfortunately, a back rehabilitation programme will not necessarily give you “washboard abs”, but then that’s not the aim.

The role of your deep abdominal stabilisers is to act like a corset and create a stable framework for your spine to move around. Equally important are your pelvic stabilisers, which support pelvic and hip movement. Your pelvis acts as a base for your spine, so it is vital that your pelvis is just as stable as your spine.

So now you know why a good back rehabilitation programme must include strengthening muscles such as the “glutes” (buttock muscles).

It is also important that your back rehab programme include a certain element of upper and lower body strengthening. It would be of no use to have strong trunk and pelvic stabilisers with no leg or arm strength to match.

An often repeated rule of back care is “always bend your knees when lifting a heavy object”. This would not be helpful if you did not have the leg strength to squat yourself up and down to lift the heavy object. The same holds true for your upper body strength. If you do not have the strength to pick up and carry a heavy object, you will simply end up increasing the load on your spine.

Weight loss is a vital part of reducing the load on the spine in the overweight. Reducing the load on the spine will rapidly improve the symptoms of lower back pain, so weight loss strategies must be included in back rehabilitation programmes.

Lastly, it is really important that a back rehabilitation programme addresses the specific needs of each individual patient. A golfer needs a strengthening programme that will allow him to load and rotate his spine, while a person who works at a desk requires specific education and exercises to reinforce correct posture.

And remember, “be good to your spine; you only get one”.