While it may seem counterintuitive, the best way to treat chronic lower-back pain is with regular exercise, according to a new Canadian study.
"Don't take back pain lying down," said Dr. Jill Hayden, a research fellow at the Toronto-based Institute for Work & Health, echoing the slogan of an Australian public-health campaign.
Her research, one of the most exhaustive reviews yet on the benefits of exercise for back pain, confirms that remaining active is the most effective form of pain management, both in the short and long term.
But Dr. Hayden's study went further, looking at how patients should exercise to maximize the benefits.
"Going into the doctor's office and getting a sheet of exercises to do at home -- the most common approach -- is not effective," she said. Individually tailored, supervised exercise regimes work best, according to the research.
"Supervision ensures compliance," Dr. Hayden said. "And it's doing exercise regularly that really makes the difference." In fact, regular daily activity is as effective for easing back pain as painkillers, massage and other therapies, and when a patient exercises regularly, the impact of those other therapies also increases, the study found.
The research is published in today's edition of the Annals of Internal Medicine. The study was a meta-analysis, a compilation and analysis of previously published research. Dr. Hayden and her team looked at 61 trials that included a total of 6,390 adults with various forms of lower-back pain.
Lower-back pain is one of the most common causes of discomfort and disability. An estimated 80 per cent of adults have back pain at some point in their lives. Almost one in 10 adults suffers from chronic back pain, a leading cause of absenteeism and lost productivity.
The study revealed that exercise worked best for those in most need of help, those with chronic conditions. The longer a person stuck with an exercise regime, the more pain relief it provided, the data showed. For patients with acute back pain (lasting less than six weeks), exercise provided marginally more relief than inactivity.
Dr. Hayden and her team found that the best way to reduce absenteeism was with an exercise program that gradually increases the level of activity over time: "It's important for both clinicians and patients to realize that you have to stay active when you have back pain."
She conceded, however, that the availability of physiotherapists and occupational therapists, who can provide supervised exercise programs, is "really hit and miss around the country."
According to the Canadian Physiotherapy Association, more than 70 per cent of back problems begin during routine daily activities, or are due to poor posture and bad habits. Accidents and other traumas account for about 30 per cent.
Pain from muscle or ligament strains tends to abate within 24 to 48 hours, but injuries to discs in the spine, or caused by degenerative arthritis, can lead to chronic pain.
According to the CPA, more than 90 per cent of people with lower-back pain recover within four weeks.
André Picard