“People often think of low-back pain as not that serious,” says Roger Chou, director of the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University. “Maybe it hurts, but it’s more of a nuisance than anything.”
But low-back pain has an enormous impact, he notes.
What causes back pain?
“That’s not a simple question to answer,” says Chou. “Some people have acute back pain maybe due to lifting something too heavy. But often, there’s no specific cause.”
Fortunately, “most people will be back to normal pretty quickly,” adds Chou. But for others, the pain persists.
“Some chronic back pain may be due to arthritis, or maybe the discs between the vertebrae have started to wear out,” says Chou.
But it’s not just what you see on an X-ray. “Mental health, job dissatisfaction, and how people cope with their pain are all linked to the severity and persistence of chronic low-back pain,” he notes.
Compounding the problem: pain can cause people to curtail their movement. “Some people are very afraid of their pain,” says Chou. “They think it means something serious, so they avoid physical activity.”
But movement may help.
“We don’t tell people to lie in bed for three to five days like we used to,” says Chou. “I urge people to try to do their regular activities, to the extent possible, even from the beginning.”
Pain medication is rarely the answer for chronic low-back pain. “Drugs are not going to reduce your pain by much more—or maybe any more—than exercise,” says Chou. “And medications, especially opioids, have side effects.”
What can best restore your lifestyle and help ease your pain? “Exercise,” says Chou. “And cognitive behavioral therapy, which helps people cope with pain.”
Are you better off with strength training, core stability, aerobic exercise, yoga, or something else?
No one type of exercise stands out.
“The average benefits are all in the same ballpark,” says Chou. “That tells me that simply moving is more important than exactly what you’re doing.”
“Many physical therapy programs incorporate a variety of types of exercise and cognitive behavioral principles,” he adds. “They get people to set goals and work through the fear and catastrophizing that may prevent them from getting better. That’s ideal.”
The bad news: exercise only leads to modest relief for chronic low-back pain.
“Chronic pain is really hard to treat,” notes Chou. “On average, we’re talking about an improvement of a point or so on a 10-point pain scale. Some people may improve by more, but it’s not a huge benefit for pain.”
On average, function also improves by only about that much.
“But we do see some people who have their function almost completely restored, even if they still have some underlying pain,” says Chou.
And just a point or two can make a difference. “We want to get people off the couch, moving, engaging with friends and family, and living their lives again.”
The Bottom Line: “If you have chronic low-back pain, find an exercise that you like,” says Chou. “It’s an opportunity to make some lifestyle changes that are not just good for your back but for all areas of your life.”
The information in this post first appeared in the September 2020 issue of Nutrition Action Healthletter.
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