Posts in Back Injuries
Impact Of Walking On Chronic Low Back Pain
walking-exercise-chronic-pain-low back pain

Low back pain remains the most common musculoskeletal diagnosis seen by primary care providers including Physical Therapists. While the majority of cases of low back pain are not serious in nature symptoms tend to be recurrent and can become chronic (> 3 months) if left untreated. As low back pain progresses from acute to chronic in nature changes in the both the peripheral and central nervous systems can occur leading to increased symptoms and loss of function. Patients with signs and symptoms consistent with nervous system changes are often prescribed pain science education and graded exercise to improve their symptoms and most importantly participation in life, work, and recreational activities. A recent review of the research examines the impact of walking vs. general exercise on patients with chronic low back pain.

Vanti and colleagues reviewed the available research on the effects of walking alone compared to exercise, as well as, the impact of the addition of walking to other forms of exercise (Disabil Rehabil. 2019). They reviewed 5 randomized controlled trials on the topic and make recommendations based off this evidence. In general, most forms of exercise including walking, showed a positive effect on a patient’s low back pain, fear of activity, and disability. Authors noted walking was not superior to other forms of exercise, but may be more easily implemented because of its’ ease of implementation compared to other forms of exercise. This study confirms prior research advocating for increasing the activity levels of patients with chronic back pain.

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High Percentage of Positive MRI Findings Among High Performing Olympians

In the absence of rare spine pathology the only abnormal low back MRI is a normal MRI.  After age 30 many of our spines will age and positive findings will become more common in patients with and without back pain.  MRIs have tremendous sensitivity and can find even the smallest amount of pathology, but their specificity is lacking in patients with low back pain.  Multiple studies have shown high rates of spinal pathology among asymptomatic groups of individuals.  A recent study highlighted the presence of spinal pathology among an elite group of athletes.  

Wasserman and colleagues retrospectively analyzed spinal MRIs of Olympic athletes from the 2016 Rio Summer Games (BMJ. 2018).  The authors reported 100 olympic athletes underwent a spinal MRI during the games and half of these high performing athletes were diagnosed with moderate to severe spinal disease.  Consistent with previous MRI studies, athletes over 30 years old had the highest rates of spinal disease on MRI.  The majority of athletes likely had positive findings on MRI before they had back pain and will have the same findings when their back pain is resolved.  Patients are encouraged to have their MRI findings read in light of their subjective and clinical examination to determine which spinal changes are due to age and which may be causing their current symptoms.

Physical Therapy Shown To Be Deterrent of Future LBP Flare Ups
low back pain-prevention-treatment

Death, taxes, and low back pain are three of the certainties of life with over 90% of individuals reporting low back pain at some point in their lives.  Our previous posts have described the ability of Physical Therapy to both accelerate a patient's recovery from low back pain and reduce its' risk of recurrence.  A recent study examined the factors that are correlated with a "flare up" or exacerbation of symptoms in patients with acute LBP.  

Authors studied 48 patients with low back pain (<3 months duration) and assessed for periods of either baseline symptoms or flare ups described as a period of increased pain lasting at least 2 hours (Suri, P et al. Spine. 2018).  Prolonged sitting, > 6 hours, was the only activity significantly associated with a flare up.  Patients who sat greater than 6 hours were 4 times more likely to have a flare up.  Mental health, including stress or depression, was also associated with a low back pain flare up.  The authors showed patients undergoing Physical Therapy treatments reported significantly less flare ups.

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How Does Low Back Pain Lead to Disability?

Physical Therapy is an excellent choice for low back pain with numerous research articles supporting its' ability to rapidly reduce pain and disability.  Many interventions utilized in our Boulder Physical Therapy practice, including manipulation and exercise, are designed to prevent low back pain symptoms from being chronic or recurrent.  An interesting article was published identifying factors which play a role in the transition of low back pain to lost work and activity time.

Lee and colleagues conducted a review of the available literature on back and neck pain to determine the mechanisms behind the common life experience of low back pain and the less common outcome of disability (Pain 2015).  The authors reviewed 12 studies of close to 3000 patients with neck or back pain and found self efficacy levels, psychological distress, and fear explained the relationship between pain and disability.  Interestingly, other variables such as age, MRI findings, and function did not influence this relationship.  This study highlights the importance of how we frame, understand, and view our back pain symptoms.  Viewing our symptoms as a common, manageable occurrence may help reduce the transition from low back pain to lost work and play.

Repetitive Spinal Flexion Athletes Are Not At Higher Risk Of Low Back Pain

There is a current, albeit unproven, thought about the dangers of repetitive spinal flexion.   Those who repeat this unfounded belief feel repetitive forward bending places the spine in a less than optimal position leading to back pain or injury.  These thoughts have been disproven by the research and forward bending of the spine does not place undo harm on the spinal tissues.  In addition, these statements do not account for the majority of Americans and athletes who repeatedly enter into this range of motion without injury or pain.  

A study by Foss and colleagues examined the prevalence of low back pain symptoms among former endurance athletes (Am J Sp Med. 2012).  Athletes were grouped by the direction of loading required by their sport including flexion (cross country skiing), extension (rowing), and compared them to their age matched peers.  The authors found no difference between the athletes and the control group in regard to LBP recurrence over the previous 12 months.  Although the authors reported a training volume of >550 hours per year was determined as a risk factor for the onset of low back pain during the prior 12 months.   This article highlights the safety of repetitive movements in the spine.  

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Utilizing Spinal Manipulation for Chronic Low Back Pain

The Journal of the American Medical Association recently reviewed the evidence on the utilization of spinal manipulation for patients with acute back pain.  Authors reported moderate evidence to support its' use to both decrease pain and improve function.  The majority of research on spinal manipulation is currently being performed by Physical Therapists to determine best practice patterns for its' utilization, as well as, the mechanisms behind its' effectiveness.  A recent review article was published on spinal manipulation's effects on patient's with more persistent low back pain.

Coulter and colleagues pooled the data of 9 trials including over 1100 patients with persistent low back pain (The Spine Journal. 2018).  The authors reported spinal manipulation significantly reduced low back pain and disability.  In addition, spinal mobilization was found to also reduce pain within patients with low back pain.  The authors found spinal manipulation produced a larger effect on these treatment outcomes than spinal mobilization.  In our Boulder Physical Therapy practice we find spinal manipulation to be effective in the short term to reduce pain and disability allowing a rapid transition to advanced exercise programs.  Long term relief of low back pain is best achieved using core, upper and lower body strengthening programs. 

Contact the Boulder Physical Therapy Experts at MEND to learn more about solving your low back pain.