Exercise and Education as a Tool for Improving Lower Back Pain

Lower back pain is the leading cause of disability in the world and is expected to affect 60-70% of people within their lifetime. As we know, lower back pain can negatively impact several aspects of daily life and is reported as the leading cause of activity limitation and work absence in the world. Non-specific lower back pain is estimated to cost Australia at least $10 billion annually through treatment costs, effects on productivity, loss of people from the workforce, and early retirement.

So, what is ‘non-specific lower back pain‘?

Explanations such as ‘non-specific’ lower back pain, ‘age-related changes’, or ‘wear and tear’ are often used in diagnosing lower back symptoms and can be a source of frustration for those suffering these symptoms as they do not provide any understanding as to why the pain has arisen. Non-specific lower back pain accounts for approximately 95% of lower back pain diagnoses and refers to pain that is not caused by ‘red flag’ pathology such as nerve root compression, fracture, tumor, inflammatory disease, or infection. Non-specific lower back pain is typically characterised by the presentation of pain symptoms and is often colloquially referred to as a ‘sprain’ or a ‘strain’.

Those suffering from non-specific lower back pain are often left wondering what may have caused their pain initially. Unfortunately, the physical injury model alone is unable to explain pain of this variety and it is necessary to consider other factors including personal situation and psychosocial elements. A recent study has suggested that patients suffering from non-specific lower back pain do not necessarily care for the classical referral pathway of being sent for diagnostic imaging and eventually being presented with a vague diagnosis. This suggests that the average person suffering from lower back pain desires useful knowledge to explain their condition and how to improve their symptoms.

What can we do to help?

Exercise has been shown to be an effective method for addressing chronic lower back pain, improving pain and function when delivered with supervision. The mode of exercise should be tailored to the individual, incorporating mobility and strengthening, while also employing strategies to improve adherence and progression.

Understandably, exercising while in pain may be a little daunting for the average person, and it is important to employ strategies to assist with improving adherence. We know that a person’s self-appraisal of their lower back pain is a predictor of outcomes and that an improvement of this self-appraisal will likely result in an improvement of self-efficacy and ultimately their pain and function. A recent study has suggested that in isolation, a program delivered by an exercise professional, yoga instructor, or even self-education through a booklet resulted in a comparable improvement in self-efficacy over a period of one year. In addition, we know that fear avoidance of activity is positively influenced by pain education. This is indicative of the importance of understanding the contributors to pain and approaching activity with the understanding and confidence that you will be safe to do so.

Through this understanding and education, anyone can improve their self-efficacy – and increase the likelihood that they will improve their pain and function too. A useful tool for anyone who feels stuck would be to check out the ‘Pain Management Guidebook’ as a starting point.

References

Hayden, J., van Tulder, M., & Tomlinson, G. (2005). Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. Annals Of Internal Medicine142(9), 776. doi: 10.7326/0003-4819-142-9-200505030-00014

Marshall A, Joyce C, Tseng B, Gerlovin H, Yeh G, Sherman K, Saper R, Roseen R (2021) Changes in Pain Self-Efficacy, Coping Skills and Fear Avoidance Beliefs in a Randomized Controlled Trial of Yoga, Physical Therapy, and Education for Chronic Low Back Pain, Pain Medicine.

Smuck M, Barrette K, Martinez-Ith A, Sultana G & Zheng P (2021) What does the Patient with Back Pain Want? A Comparison of Patient Preferences and Physician Assumptions. The Spine Journal.

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