One of the keys to recovering from an episode of back pain or surgery, and to help avoid future recurrences of back pain, is to undergo proper rehabilitation in terms of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned.
There are three types of muscles that support the spine:
Extensors (back and gluteal muscles): used to straighten the back (stand), lift and extend, and move the thighs out away from the body.
Flexors (abdominal and iliopsoas muscles): used to bend and support the spine from the front, they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body.
Obliques or Rotators (side muscles): used to stabilise the spine when upright, they rotate the spine and help maintain proper posture and spinal curvature.
While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.
Any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilise the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain.
Stretching exercises should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a role in lower back pain, as it is clear that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back.
Specialised equipment is available that helps repetitions to be done in the same manner so that progress can be identified and the level of exercise regulated.
It is thought that re-injury is less likely to occur if back strengthening is accomplished rather than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercises to prevent a recurring cycle of pain and weakness.
Low-impact aerobic conditioning
Finally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.
Examples of low impact aerobic exercises that many people with back pain can tolerate include:
Water therapy – (also called pool therapy or hydrotherapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water alleviates gravity and provides buoyancy as well as mild resistance.
Walking – Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.
Stationary biking – Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward.
Depending on your injury and exercise preferences, you may prefer a different form of exercise. It may be helpful to discuss your options with your physical therapist, or physician to identify an appropriate form of aerobic exercise for you and incorporate it into your exercise routine.