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Keep it simple? Can simple aerobic exercise assist in the management of lower back pain?

Keep it simple? Can simple aerobic exercise assist in the management of lower back pain?

16 April 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.

Reference List

 

Man stretching at a standing desk beside a window at home

Lower Back Pain and Pelvic Floor Dysfunction

Lower Back Pain and Pelvic Floor Dysfunction

3 April 2024

Lower back pain (LBP) is the most prevalent musculoskeletal injury, as approximately 80% of the population will experience LBP in their lifetime (Arab et. al 2010). Transverse abdominus activation is often prescribed for LBP however pelvic floor muscle (PFM) is not always incorporated into treatment. PFM aids in supporting the abdominopelvic organs and there is an abundance of research on the role of the PFM in urinary and fecal incontinence. Nevertheless, it is important to remember the PFM role in lumbar and pelvic stability and intra-abdominal pressure (Mohseni-Bandepi et. al 2011). Research illustrates that the combination of pelvic floor exercise alongside routine treatment can provide significant pain relief in LBP compared to routine treatment alone (Bi et. al, 2013), demonstrating the importance of PFM exercises.

The link between LBP and PFM helps to provide insight into the correlation between LBP and pelvic floor dysfunction (PFD). PFD is an umbrella term to describe weakness, poor endurance and hypertonicity of the PFM which can impact incontinence, prolapses and pelvic pain. Dufour et al. found that 95% of women with LBP had PFD, ‘71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse’(Dufour et. al 2018), further highlighting the importance of incorporating PFM in treatment. Arab et al. also examined PFD in women with and without LBP. The results show PFD in participants with LBP compared to those without. This is valuable for health care participants when assessment and treating LBP (Arab et. al 2010). It is also important to recognize PFD in pregnancy-related lower back pain (PLBP). Pool-Goudzwaard et. al discovered ‘52% of PLBP, significantly more than in the healthy control group’ (Pool-Goudzwaard et. al,2005) and promote addressing both LBP and PFD during pregnancy.

There are a variety of methods to help activate, strengthen and relax the pelvic floor in order to aid recovery in PFD.  Kegels or reverse Kegels are often prescribed to promote awareness and strengthen PFM (Torgenu et. Al 2021). Transverse abdominus contraction has also been shown to help activate and strengthen PFM. Sapsford et al. found ‘that abdominals contract in response to a pelvic floor contraction command and that the pelvic floor contracts in response to both a “hollowing” and “bracing” abdominal command’(Mohseni-Bandepi et. al 2011), therefore proving the PFM can be activated by engaging the abdominals. Hypopressive exercises (HE) have also shown to aid recovery from PFD. HEs lowers the intra-abdominal pressure which enables an involuntary contraction of the PFM and transverse abdominus. Navarro-Brazález et. al suggests the combination of HEs and pelvic floor muscle training improves PFM strength and quality of life for patients with PFD (Navarro-Brazález et. al 2020).

Reference List

 

  • Arab, A.M., Behbahani, R.B., Lorestani, L. and Azari, A. (2010). Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Manual Therapy, 15(3), pp.235–239. doi:https://doi.org/10.1016/j.math.2009.12.005.

  • Bi, X., Zhao, J., Zhao, L., Liu, Z., Zhang, J., Sun, D., Song, L. and Xia, Y. (2013). Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research, 41(1), pp.146–152. doi:https://doi.org/10.1177/0300060513475383.

  • Dufour, S., Vandyken, B., Forget, M.-J. and Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, pp.47–53. doi:https://doi.org/10.1016/j.msksp.2017.12.001.

  • Mohseni-Bandpei, M.A., Rahmani, N., Behtash, H. and Karimloo, M. (2011). The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork and Movement Therapies, 15(1), pp.75–81. doi:https://doi.org/10.1016/j.jbmt.2009.12.001.

  • Navarro-Brazález, B., Prieto-Gómez, V., Prieto-Merino, D., Sánchez-Sánchez, B., McLean, L. and Torres-Lacomba, M. (2020). Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. Journal of Clinical Medicine, 9(4), p.1149. doi:https://doi.org/10.3390/jcm9041149.

  • Pool-Goudzwaard, A.L., Slieker ten Hove, M.C.P.H., Vierhout, M.E., Mulder, Paul.H., Pool, J.J.M., Snijders, C.J. and Stoeckart, R. (2005). Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. International Urogynecology Journal, [online] 16(6), pp.468–474. doi:https://doi.org/10.1007/s00192-005-1292-7.

  • Torgbenu, E.L., Aimakhu, C.O. and Morhe, E.K.S. (2020). Effect of Kegel Exercises on Pelvic Floor Muscle Disorders in Prenatal and Postnatal Women – A Literature Review. Current Women’s Health Reviews, 16. doi:https://doi.org/10.2174/1573404816999200930161059.

Woman performing a single-leg balance exercise indoors

Can regenerative medicine help with back pain?

Can regenerative medicine help with back pain?

4 March 2024

Golfer in a red top holding their lower back with gloved hands
Photo by Gordon Cowie on Unsplash

Back pain is a silent problem amongst the general population, with figures suggesting that approximately 1 in 6 people are experiencing back pain at any given time in England. What’s more, back pain is deemed the largest single cause of disability across the UK. But why is this? And why are the numerous treatments available not bringing these numbers down?

Most cases of back pain are caused by muscle and ligament strains and, in the vast majority of cases, cannot be avoided. However, there are several other causes of back pain, including sciatica, a slipped disc, and ankylosing spondylitis, that can often occur spontaneously and without trauma. Then, we move to treatments. For the most part, treatments of back pain focus on rehabilitation and pain management, which, although great in getting you back on your feet, does not always treat the underlying cause and prevent further injury. Sports medicine is a great option to educate you on preventative measures; however, regenerative medicine offers more long-term symptom relief.

The role of regenerative medicine

Let’s first consider platelet rich plasma (PRP) injections. For those experiencing repetitive and debilitating back pain, surgery is usually the last option you want to take; however, PRP offers an effective alternative that could treat the pain of your injury as well as prevent further strains. Depending on the root of your back pain, PRP can be injected into the discs, facet joints, and paraspinal muscle, with previous patients seeing an improvement in their symptoms within six weeks of their first treatment. In clinical studies, PRP injections have been used to treat patients with degenerative disc disease, join-related pain, and pain or functional decline caused by facet joint arthropathy.

Mesenchymal stem cell therapy, on the other hand, has shown great success in patients with chronic discogenic low back pain. This type of pain is caused by chemically or mechanically damaged discs in the back and is often caused by trauma. However, this pain also arises due to deterioration as a result of ageing. Stem cell therapy is deemed a valid alternative treatment for back pain caused by disc disease, with one study demonstrating treatment success in over 90% of patients. This success is down to the regenerative impact of stem cells and their ability to differentiate into cartilage at the site of injury.

The key distinction between Opus and other private clinics in the UK is that we are the only institution that offers a regulated and licenced mesenchymal stem cell treatment. Get in touch with our team to discuss how we can support you in your treatment journey using either our world renowned sports medicine specialists or regenerative medicine.

Related reading

Lower back pain in Golf

Lower back pain in Golf

23 November 2023

Lower back pain (LBP) is the most common injury for golfers as 34.5 % of all golfing injuries involve the lumbar spine. It is important to understand the golf swing in order to identify the cause of injury and provide optimum treatment. Most injuries occur due to the impact of the golf club and the follow-through phase. Follow-through phase promotes lumber extension and eccentric contraction of abdominals in order to generate force and rotation; this places increased pressure on the spine and intervertebral discs (Finn et. Al 2013). Hosea et. al found that the compressive load during a golf swing was considerably higher in professionals than amateur golfers, with a difference of 7584 N versus 6100 N. The compressive load in a professional golf swing is equivalent to 8 times body weight (Dale and Brumitt, 2015). It is important to compare this to cadaveric studies which have shown disc prolapses to occur at 5,500 N; this highlights that the golf swing (in both amateur and professional golfers) is able to generate enough force to injure the lumbar spine (Lindsay and Vandervoot,2014).

The golf swing is repetitive, asymmetric in nature and dependent on the dominant hand; this can determine the location and severity of LBP. For example, in a right-handed golfer, the right- sided external obliques, paraspinal muscles and abdominals take the most impact and therefore the right lumbar region is most commonly injured. Also, the end position of the golf swing is called reverse C position which promotes lumbar extension and increases the risk of facet irritation. In more severe cases, spondylosis and discogenic back pain can occur from poor technique and severe muscle imbalances. (Finn et. Al 2013)

It is important to focus on muscle imbalances, thoracic and lumbar mobility and technique to prevent and recover from LBP. From analysing the swing mechanics, core stability exercises are essential in LBP rehabilitation (Evans and Oldreive,2013). Horton et al. found a delay in muscle activation in abdominal muscle for golfers with LBP, especially the lead external oblique during back swings; this further highlights the importance of core strength and endurance in protecting lumbar spine. (Horton et. Al 2001). Hip stabilisation and mobility is equally important to aid trunk rotation and lumbar stability. Vad et. al demonstrated that reduced lead hip rotation (internal and external) and lumbar spinae extension were found in golfers with LBP; this may be due to decreased hip rotation in the leading lower limb causing more force to be directed into the spine (Vad et. al 2004). Therefore, ensuring glute strengthening exercises in rehabilitation are key to provide a base of support for trunk rotation. (Finn et. Al 2013)

Reference List

 

  • Dale, R.B. and Brumitt, J. (2016). Spine biomechanics associated with the shortened, modern one-plane golf swing. Sports Biomechanics, 15(2), pp.198–206. doi:https://doi.org/10.1080/14763141.2016.1159723.

  • Evans, C. and Oldreive, W. (2000). A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance of Transversus Abdominis. Journal of Manual & Manipulative Therapy, 8(4), pp.162–174. doi:https://doi.org/10.1179/jmt.2000.8.4.162.

  • Finn, C. (2013). Rehabilitation of Low Back Pain in Golfers. Sports Health: A Multidisciplinary Approach, 5(4), pp.313–319. doi:https://doi.org/10.1177/1941738113479893.

  • HORTON, J.F., LINDSAY, D.M. and MACINTOSH, B.R. (2001). Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise, 33(10), pp.1647–1654. doi:https://doi.org/10.1097/00005768-200110000-00006.

  • Lindsay, D. and A. Vandervoort, A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine, 5(4). doi:https://doi.org/10.5812/asjsm.24289.

  • Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D. and Andrews, J.R. (2004). Low Back Pain in Professional Golfers. The American Journal of Sports Medicine, 32(2), pp.494–497. doi:https://doi.org/10.1177/0363546503261729.

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