By Michael Hall
What is the best treatment for Low Back Pain – Yoga, Stretching or a Self-Care Book?
Chronic low back pain (LBP) is a common problem that seems to have many different treatment solutions. But which one works best? A recent study (October 2011) set out to determine whether yoga, conventional stretching exercises or a self-care book is the most effective intervention for helping people with chronic low back pain.
In the study, a total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Questionnaires were used at the beginning, 6, 12, and 26 weeks by interviewers unaware of treatment group, to measure the outcomes.
The results indicated that Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms of chronic low back pain. These benefits were found to last for least several months. From this study, it can be concluded that movement or staying active assists in helping people with LBP.
Bodywise Health Comment
Low back pain (LBP) is a common and frustratingly difficult problem to cure. In fact, more than 70% of people report LBP during their lifetime. X-rays, CT scans and MRI scans often don’t correlate with the pain and symptoms reported and a definitive diagnosis is only made in 10-15% of cases. What’s more, the treatment approaches are many, with most often lacking proof. No wonder the public is confused.
There is no doubt the mechanisms behind low back pain (LBP) are complex. Research has shown that the brain anticipates movement and activates the deep core abdominal and back muscles to pre-stiffen the spine before the body moves (Hodges and Richardson 1996). These muscles hold the joints in ideal alignment and prevent potentially damaging movement. However, it has been shown that within 24 hours of a back injury, these muscles (i.e. transverses abdominus and multifidus) stop working effectively and even begin to waste away (Hides JA et al Spine 2001). Even the functioning of the brain changes in response to back pain (Schimdt-Wilcke et al 2006). Furthermore, it has been found that even if a person stays active (e.g. swims) and the pain does go away, the functioning of the brain and these muscles do not return to normal without specific training (Tsao et al 2009). With specific training however, there is evidence that the brain and deep core muscles begin to revert to normal within two weeks. And the protective effect of these exercises is lasting, with only 30% (compared with 84%) likely to suffer a recurrence within one year.
The connection between exercise and the treatment of LBP is not new. In fact, a review performed in July 2011 of 83 studies on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain concluded that only exercise therapy, multidisciplinary treatment and behavior modification are the only conservative treatments that should be used in daily practice in the treatment of chronic LBP. This is not to say that other interventions don’t work, but that they don’t have a proven, lasting effect when used in isolation. In reality, this never occurs as modalities and techniques are always used in combination to enhance the effect of each intervention. For example, modalities such as cold packs, heat, ultrasound and electrical stimulation often reduce pain and muscle spasm so that joint mobilisation and manipulation is made more effective at freeing up joints and relaxing the muscle. And joint mobilisation or manipulation can enhance the benefits of exercise therapy which aids in improving posture, movement habits and function and so on. Given that the evidence for treating LBP is conflicting, a physiotherapist may have to try different modalities and combinations of modalities to determine what works best for a particular patient. In reality, the best evidence that a particular management strategy is effective for a particular patient is whether or not the patient improves.
5 Top Tips for Dealing with Low Back Pain
1. Seek treatment early. Early intervention is the key to preventing pain from becoming chronic, costly and recurrent
2. Undergo a thorough assessment. This is critical to identify the stage of healing and the sources/causes of the back pain, as well as to understand perceptions, beliefs and coping mechanisms
3. Understand the nature of the problem and what the best strategy is for fixing it
4. Implement a strategic management approach that:
- a. addresses pain and the stage of healing;
- targets the structures at fault,
- specifically trains core muscles so that they regain their normal functioning;
- corrects posture and improves movement habits;
- addresses other concerns (e.g. home life, work life, work station set up etc); and
- progresses conditioning to above and beyond the stresses likely to be encountered in everyday life so a reserve capacity is created to protect against challenging, unexpected activities and unguarded movements
5. Incorporate these principals into the way that you live. In other words, live in a way that puts ideal stresses on to your body (i.e. sit correctly, stand correctly and move correctly), eat and exercise for optimal functioning and deal with physical and psychological insults quickly, comprehensively and completely so that healing can occur and the issues are fully resolved.
Karen J. Sherman, PhD, MPH; Daniel C. Cherkin, PhD; Robert D. Wellman, MS; Andrea J. Cook, PhD; Rene J. Hawkes, BS; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH Arch Intern Med. Published online October 24, 2011. doi:10.1001/archinternmed.2011.524
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