More Evidence that Exercise Prevents Low Back Pain

A recent review of medical literature revealed that exercise—not shoe inserts or other supportive devices—may cut your risk of developing back pain in half.

If you are worried about developing back pain, it might be time to commit to a regular exercise routine. According to a comprehensive review of medical literature, exercise combined with exercise education provided by a doctor or physical therapist may be the most effective way to reduce your risk of a spate of low back pain.

The literature was described in an article published online by JAMA Internal Medicine, in which Daniel Steffens, PhD, and his co-authors focused on 23 published reports encompassing 21 randomized clinical trials.

"Our review found evidence that exercise alone or in combination with education is effective for preventing low back pain," said Chris Maher, PhD, a co-author of the study and also the head of the musculoskeletal division at The George Institute in Australia. "The effect is quite large: Exercise halves your risk of getting low back pain."

In addition, Dr. Maher explained, the review found that techniques and devices meant to prevent low back pain—shoe insoles and back belts, for example—did not protect against the development of low back pain as well as exercise.

While it's unclear exactly how exercise works to prevent low back pain, there are two likely explanations, according to Dr. Maher who is a physical therapist. "The first is that exercise strengthens the muscles that support and control the spine, meaning that your spine is better able to cope with the load that you put on it during daily life," he said. "The second explanation is that the tissues that make up the spine, ligaments, discs and bones need regular movement and activity to stay strong and healthy."

Generally, the trials that the authors looked at included exercises to improve strength, flexibility, skill, and aerobic fitness, Dr. Maher said. "The exercises did not just focus on the spine but included upper and lower limb exercises as well," he said.

Dr. Maher notes that the data for the review he and his co-authors recently completed came mainly from small trials. “For this reason, we are desperately in need of a large definitive trial to confirm this result," he said. "The return to society would be enormous if we can confirm that exercise can halve the risk of future low back pain."

Already in Pain? 

As far as treating existing back pain, while exercise may factor in as a treatment, whether it’s effective or not depends on what's causing the pain to begin with, said Sayed Emal Wahezi, MD, Fellowship Program Director of the Multidisciplinary Pain Program at Montefiore Health System in New York City. 

Generally, the main modalities for treating back pain are: physiotherapy (i.e. massage, physical therapy), medical management  (oral medications), interventional management (injections) and surgery, Dr. Wahezi explained.

"The treatment depends on the patient," he said. "A fractured spine or bad arthritis in your back may not do so well with physiotherapy alone. So not all patients will benefit from exercise and education. Those that will must be carefully chosen."

Low back pain is more common than upper back pain, Dr. Wahezi said. "It’s one of the most common reasons for people to miss work," he said. "Those who do heavy labor for a living are at risk because their muscles may be constantly sore. Those who sit at a desk all day also are at increased risk since their abdominal and back muscles get weak."

For individuals with non-specific low back pain, education as well as exercise are key. "During physical therapy, the therapist will walk you through the moves so you understand them and can do them properly at home," he said.

One of the best ways to protect your back from pain is to strengthen your core. Having a strong core puts less strain on the back. Dr. Wahezi recommends 4 exercises to keep your core strong. Talk to your doctor before incorporating the movements into your exercise routine.

Activities that put excessive stress on your back—lifting heavy weights, squatts and climbing—are generally not advised. Running, jumping and step aerobics can also aggravate low back pain.

Slide Show: 4 Exercises to Strengthen Your Core

Updated on: 02/02/16