Wednesday, March 04, 2009

What works best for lower back pain

The surprising thing about this study is that anyone thought it was surprising …

What's the best Rx for lower-back pain?: Scientific American Blog

We did an evaluation of high quality studies on the prevention of back problem episodes in adults [and] found that, surprisingly, exercise is the only intervention that works, and other popular interventions don't work," says Stanley Bigos, emeritus professor of orthopedic surgery at the University of Washington in Seattle, and lead author of the analysis published recently in The Spine Journal. ..

… Exercises such as lifting free weights and doing leg and trunk lifts to fortify core muscles proved effective at staving off pain, Bigos says. The studies in the review focused mainly on exercises to build muscle strength and endurance – not intense cardio workouts, but Bigos says that speed walking, cycling, and other activities that increase heart rate and improve overall fitness also benefit back health.

Only an orthopedic surgeon could be surprised by this study.

My recollection is that exercise and fitness has been considered the best way to manage lower back pain for at least fifteen years. What’s a bit more controversial is how much strengthening is really needed (and thus worth paying for). When I finally decided to rehab my own back I opted for the extreme strengthening approach of a local team – the Physicians Neck and Back Clinic.

I suspect their regimen is far beyond anything Bigos looked at, but I think they’re probably on the right trail.


Jonathan said...

I'm specifically NOT asking you for advice (I know how awkward that can be for medical things) but can you describe what constitutes "extreme strengthening"? My not-terribly-well-functioning spine is curious.


John Gordon said...

When I took care of patients I would prescribe an ill-defined regimen of walking, stretching, bicycling, cross country skiing, abdominal exercises, etc.

I think that actually is enough for a lot of people.

The group I went to had me doing pretty aggressive extension weight lifting, abdominals, big quad lifts, etc.

Too aggressive to be done without expert supervision, but impressive.

So I think not for everyone, but it taught me that there's a big range of possible core strengthening interventions.