With back pain being so prevalent in our society, often recurrent, and potentially disabling, it is no wonder there are a lot of questions surrounding the role of exercise with back pain. Part of this comes from the vast unknown when it comes to cause of back pain. Often, patients don’t know what has happened, why it happened, and what to do. Studies looking at what patients believe is happening when they have back pain paint images of discs sliding out of the spine, or crumbling into nothing, bones grinding together, nerves being pinched or vertebra popping out of place. Terrifying images that often result in fear, stress, and avoidance of exercise
But the reality of back pain is that is only the 1-5% of back pain that is related to a serious problem like a fracture, inflammatory disease or malignancy. For the vast majority of back pain conditions, there can be no identifiable structure as being the cause. Now, this thought process goes against the common medical model of pain being that if there is an “issue with the tissues” then that would explain the pain. But more and more we are beginning to realise that changes in the body’s structure are not a good predictor of pain.
For example, in the lower back in a pain-free population, 90% of people will show signs of degeneration, 56% will show disc bulges, a further 30% will show signs of a disc prolapse, all without symptoms. And this isn’t exclusive to the back, shoulder scans revile the 90% of people over the age of 40 will have tears in the rotator cuff muscles with full function and no pain. In the knee, the severity of osteoarthritis is an extremely poor predictor of knee pain.
Now, this prompts health professions to ask the question “Why does it hurt then?”. When research tells us that the structures in the body are only a small part of the puzzle what are the things that make our bodies sore?
For lower back pain patients, some of the strongest predictors of pain are things like stress, anxiety, sleep, fear of injury and fear of movement. Also, thought processes like “I will never recover”, “Exercise is dangerous for me” and “If it hurts I’ll stop” all have links to prolonged recovery times.
The mechanism of all these psychosocial and cognitive aspects of pain is not entirely understood, but there is plenty of evidence to suggest that part of the process is the “sensitisation” of the nervous system. Imagine a knob that can be dialled up and down increasing the amplification effect of the nervous system resulting in an activity that didn’t hurt before, now being painful. It has less to do with the structures of the body being damaged or out of place, and more to do with how sensitive that body part is.
Which brings us back to the question, “Should I Exercise with Back Pain?”. The short answer is yes. In persistent back pain, the likely hood of it being because of a serious problem is very low, and the risk of causing more damage by exercising is virtually zero. But understanding the reasons why exercise is important for back pain is just as important as doing it.
Exercise is a great way of desensitising the nervous system in the body. When done in a gradual, progressive manner exercise will improve the resiliency of the spinal tissues to tolerate load, and in turn dial down the amplification effect of the nervous system. Exercise is linked to improved mood, better sleep, and lower stress. All of which are linked to a sensitive nervous system. And lastly, exercise can be fun!. Enjoyment levels of patients with back pain a considerably lower. So engaging in something that stimulates some good vibes, has a bit of laughter, and is an appropriate challenge can certainly bring more joy to our lives and in turn, decrease our pain.
But finding what is the right type of exercise is different for everybody. Some things will be more appropriate than others depending on your current fitness, exercise history, general health, and style of movement. Get in contact with a physiotherapist to learn what will work best for you.