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Low back pain is the most common reason for physical therapy visits, the top cause of disability in the United States, and the prevalence is continuing to rise! About 65% of people will experience LBP each year and 70-84% of people will experience low back pain at some point in their lives. Acute low back pain (less than 3 months from onset of pain) has a good prognosis with up to 72.5% of people recovering within a year. On the other hand, only 41% of patients with chronic low back pain (greater than 3 months since onset of pain) recover within a year. Also, reoccurrence is very high, up to 84% within three years. That is a lot of words (and numbers) to say that low back pain is a big issue.
If anyone is feeling like Michael, you are not alone. It is beyond the scope of this blog post to cover low back pain entirely and this is not medical advice. I do recommend consulting a physical therapist or physician if you are experiencing pain, especially if chronic in nature. Below I have provided some facts to correct a lot of the fiction I hear surrounding low back pain.
Fiction: The low back pain experience is purely because of a physical injury and tissue damage. Fact: Pain, especially chronic pain, is a complex experience that is impacted by mental health, mood state/emotions, stress, and sleep habits. Pain does not necessarily mean damage and higher pain does not correlate to more tissue damage/injury.
Fiction: Imaging (x-rays, MRIs) is needed to “know” what is wrong with my back. Fact: Numerous studies have demonstrated that structural abnormalities DO NOT CORRELATE TO PAIN. Many people have pain and clean imaging and many people do not have pain but have structural abnormalities on imaging.
Fiction: Bed rest or complete rest when in a pain flare up or acutely painful is needed to let the back heal. Fact: “Active rest” is when you purposely stay active despite pain but do not perform higher demand work or exercise. This is recommended with acute pain or pain flares NOT bed rest.
Fiction: Low back pain is mainly because of weak core muscles. Fact: Some people with low back pain have overly tense muscles and need to know how to relax them. The point is not that core muscle strength is not important. In fact, core muscle strength has consistently shown to be an effective treatment for low back pain and studies have shown weak core strength as a predictor for back pain. The point is that treatment should be addressed to your specific needs (ie: low back muscle relaxation vs strength, etc), which is why core strengthening will not work for everyone.
There are many other exercises outside of core strengthening for the low back, but purpose of this blog is to focus on core muscle strengthening exercises.
All of the following core exercise variations can be regressed so that anyone can do them and progressed to the point they can challenge anyone. Also, you do not need equipment, and they can be done anywhere. The effectiveness and feasibility of these exercises makes them a go to for me in the clinic and the gym!
In closing, low back pain does often improve with conservative care. If your pain is persistent or you want more guidance, it might be a good time to contact a physical therapist!
Disclaimer: This content is designed for information & education purposes only and is not intended for medical advice.
-Dr. Dylan Michel
Bull City Physical Therapy
References:
1. George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021 Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942.
2. Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ; Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57. doi: 10.2519/jospt.2012.42.4.A1. Epub 2012 Mar 30. PMID: 22466247; PMCID: PMC4893951.
3. O’Sullivan PB, Caneiro JP, O’Sullivan K, et al. Back to basics: 10 facts every person should know about back pain. Br J Sports Med. 2020;54(12):698-699. doi: 10.1136/ bjsports-2019-101611.
