CHRONIC RELIEF Chronic low-back pain sufferers who have no tissue damage can exercise without worry, studies indicate.
An interesting piece of research caught my attention this week. Not the sort of headline-grabbing research that typically gets publicised in newspaper health supplements, but something relevant to a lot of people all the same.
The study, by a group from the University of New South Wales and published online in the Journal of Clinical Rehabilitation, looked at whether powerlifting might be better than bodyweight training for people with chronic low back pain. At this point, it might be best to use Socrates’ theory that ‘the beginning of wisdom is the definition of terms’ and make it clear just what we’re talking about.
Firstly, when we talk about pain, the term chronic has little to do with the severity or intensity of symptoms, instead it refers to longevity. Chronic pain is usually defined as long-standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. In most cases we consider any pain that has lasted longer than three months. It is also important to note that chronic pain needn’t be constant, and can vary depending on a multitude of factors.
In the study, the participants did one supervised and three unsupervised exercise sessions per week. The supervised session lasted for one hour, with 15 minutes of pain education at the end. In the supervised session, the powerlifting group did weighted squats, bench press, deadlifts, leg press, lat pull-downs and pin-Pendlay rows.
Then in their unsupervised sessions they performed a modified version of the same exercises using a wooden bar and resistance bands. The bodyweight exercises included progressions and variations of squats, lunges, bridges, side leg raises, curl ups and press ups. Participants completed the same workouts in both supervised and unsupervised sessions.
What were the results? Both groups showed small improvements in pain and disability, and these improvements were still visible at a six-month follow up. Research has usually shown that chronic pain tends to be resistant to treatment and, most importantly, that any improvements don’t tend to be maintained. The researchers suggested that this may be due to the education component.
You might wonder why education is so important in treating chronic pain. The answer lies in the complexity of the condition. Chronic pain, as defined earlier, is pain that exists beyond what would be considered a normal recovery period for an injury. The tissue should be well healed, but the pain is still there. In many cases this is borne out on MRI, where findings for people with chronic pain match pain-free subjects of the same age.
With this in mind, people who are suffering with chronic pain need to be shown that their pain doesn’t necessarily equate to tissue damage. And if there isn’t tissue damage, there is no concern of doing any more damage. Instead, we need to find a level of exercise that the patient can tolerate and is happy to do, then progressively increase the intensity from there.
The second interesting thing to consider, is that both exercise programmes showed similar results. Now, we could make the argument that the exercises are similar enough to produce similar results, and there is probably an element of truth in that. But we could also wonder, does the type of exercise make any real difference? Other research into chronic low back pain has produced similar findings – that the specifics of the exercise are less important than doing the exercise consistently.
In short, the most key things to remember for people with chronic lower back pain is that pain doesn’t equate to damage, so exercising with some pain is okay. And, most importantly, that the best exercise is the one you actually do, so find an exercise you enjoy and do it regularly.
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.