In this post we discuss what really works for back pain and why what you’ve tried so far hasn’t helped.
Lower back pain is one of the most common ailments that humans suffer with. Up to 80% of us will experience a debilitating episode at some point in our lives.
Its ubiquity means there are financial rewards available to those who can resolve it. Or at least say they can.
Search online and you’ll see a plethora of options from stretches to surgery. Let’s take a look at the evidence to see what actually works.
What really works for lower back pain?
For 90% of people suffering with lower back pain the specific source can’t be identified.
In other words there is no clear structural abnormality responsible. Those affected are therefore classified as having non-specific lower back pain.
In 2018 The Lancet published a comprehensive review by world leading back pain experts, which examined the evidence to determine what actually works for lower back pain.
What do studies on lower back pain show?
Top of the list is education and advice to remain active, as most cases of lower back pain will resolve by themselves.
This is a crucial part of the treatment process that’s not always done particularly well. Unskilled language by health care professionals can certainly make back pain worse.
Reassurance that there’s nothing seriously wrong and advice to keep moving as much as possible, will help many people feel better however.
In around 10-15% of cases either the pain doesn’t resolve, or more commonly, it appears periodically.
Here the authors suggest exercise therapy as the best evidence based course of action.
As you’re probably aware however, not all exercise is the same.
Whilst some people will find a walking programme helpful, others may find it makes their symptoms worse.
What the evidence does suggest is that people who suffer with chronic or ongoing back pain, are more likely to have weakness in the muscles of their lower back.
The best exercise for lower back pain
If you go to a rehab professional for lower back pain and you’re given exercises, they will invariably involve your core and your glutes.
Whilst there’s no standard definition of what the core actually is, think of it as your trunk or torso.
The glutes are the muscles that fill the lateral and posterior aspect of your pelvis. Your butt muscles if you like.
Very few practitioners will give you specific exercises for your lower back muscles, other than stretches.This is a pity.
As we’ve already seen, these muscles are likely to be weak in individuals with chronic or ongoing lower back pain. Something which stretching certainly won’t help.
Even if exercises which involve the lower back muscles are given, they’re either not specific enough, or they lack a key component of strength training exercise, progressive overload.
Progressive overload is the gradual addition of resistance over time to stimulate adaptation in the muscles. It’s critical if you’re to move past your present state.
This is extremely hard to achieve with exercises that only use the weight of your body for resistance however.
How can you make an arm or a leg heavier in a progressive manner? Or even more difficult, how can you make them lighter?
The gold standard exercise therefore is progressive strengthening exercise for the lower back muscles in the most isolated way possible.
There’s plenty of evidence to suggest this type of approach reduces back pain over time. Even in cases where surgery has been indicated.
Summary
Whilst lower back pain is seemingly ubiquitous, effective treatment for it sadly isn’t.
Don’t waste your time looking for magic solutions as they don’t exist.
Focus instead on a resistance training programme that strengthens the lower back muscles in particular, as well as those of the lower and upper body.
Over time your back pain will recede and confidence in your body will be restored.