Calcific Tendinitis of the Rotator Cuff (CTRC)
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Keep it simple? Can simple aerobic exercise assist in the management of lower back pain?

Apr 16, 2024

The World Health organisation (WHO) stated that in 2020, 619 million people were affected globally by lower back pain, with non specific lower back pain accounting for 90% of these cases, making it the single leading cause of disability worldwide (5).

Based on these figures it is of no surprise that here at Opus, and I am sure at many, if not all other MSK treatment centres, we see a large number of patient’s coming through the door looking for assistance with this matter. As with any injury we see, the case will vary from patient to patient and every individual will require a bespoke treatment plan, aimed at their particular presentation and tailored towards their overall goals. However, is it worth considering that something as simple as low intensity aerobic exercise could be of use to a high percentage of these patients at some point in their recovery?

Lower back pain is a pervasive issue, which can be impacted or triggered by a number of factors including: trauma, deconditioning, muscle imbalances, fatigue, obesity, sustained sedentary positioning and many more . Whilst there are several approaches to managing this issue, one possible tool could be the use of aerobic exercise. Aerobic exercise includes: walking, light jogging, cycling, use of a cross-trainer or aerobics in a swimming pool.

To harness the benefits of aerobic exercise for lower back pain relief, consistency is paramount. NHS guidelines (2), recommend engaging in aerobic activities for a minimum of 150 minutes per week, spread across several sessions. This equates to approximately 30 minutes of moderate-intensity exercise, 5 days a week. However, it’s essential to start sensibly and listen to your body, gradually increasing the duration and intensity as your fitness improves. In those individuals with lower back pain, the pain levels experienced during completion of their aerobic activity will also be an important factor in guiding the duration of their session and whether they need to include small rest breaks or alterations in the intensity of the exercise, to enable them to continue for the necessary time.

Aerobic exercise initiates a series of complex physiological responses within the body. Firstly, aerobic activities stimulate the cardiovascular system, increasing heart rate and promoting blood flow to various tissues, including the muscles of the trunk and lower back as per Sany, S.A., Mitsi, M., Tanjim, T. and Rahman, M. (2022) (3) This enhanced blood circulation delivers oxygen and nutrients essential for tissue repair and regeneration, while also aiding in the removal of metabolic waste products and reducing inflammation. It also triggers a chemical response through the release of endorphins, neurotransmitters produced by the central nervous system, often referred to as the body’s ‘natural painkillers’. Endorphins bind to opioid receptors in the brain, effectively reducing the perception of pain and promoting feelings of well-being and relaxation. This analgesic effect can significantly alleviate discomfort associated with lower back pain.

Research has demonstrated the efficacy of aerobic exercise in reducing the incidence and severity of lower back pain, as well as improving functional status and overall quality of life. The subsequent recurrence of back pain episodes can be reduced by 30% just through the use of aerobic exercise Shiri, R., Coggon, D. and Falah-Hassani, K. (2017) (4). Incorporating aerobic exercise is a cost effective and easily accessible way to attempt to alleviate lower back pain. By adhering to a consistent aerobic exercise regimen, individuals can mitigate discomfort, improve functional capacity, and promote overall well-being Gordon, R. and Bloxham, S. (2016) (1).

Now none of the above is to say that other types of exercise: strength training, pilates, yoga, mobility, aren’t of benefit or in fact more suited to some patients. What it does suggest though is that even when someone feels they are severely limited in what they can do, whether it be due to the lower back pain itself, or the time and resources available to them, something as simple as a walk, jog or bike ride can physiologically benefit them and reduce their pain levels.

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