Back pain might put you off moving your body – whether you’re worried about making an injury worse or exercise is uncomfortable. But compared to no treatment, placebos or manual therapy, exercise is the most effective approach to reduce low back pain and increase function in the long term. Exercise makes your back muscles stronger, and also makes your brain feel safer about moving.
Around 90-95% of back pain is ‘sore muscles’ and not related to any damage, while ~1% of back pain has a ‘specific’ cause. This means that most of the time, we can approach it the same way we’d look at any other muscle group. Here’s what you need to know about exercising for lower back pain.
So, what’s happening when I have lower back pain?
Whenever something hurts, it’s normal to want to know what’s going on. In this case, it’s important to draw a line between back pain you get from an injury — such as falling down the stairs or lifting something heavy — and back pain you may experience day in and day out. But in both cases, the explanation for what’s happening is quite similar. To put it simply, any time you do something your body doesn’t have the ‘resources’ to do — something too fast, too long, too heavy — it will become sore.
To frame this another way, there’s a reason a strong man can perform a 500kg deadlift with no injury when most of us would die if we had to move 500kg. The strongman has spent time allowing his body to develop and adapt to this kind of weight.
Injuries: Load vs capacity
The reason is load vs capacity. Load can be anything — the period of time, the weight of an object, the angle you’re lifting it, you name it. Capacity is simply your muscles’ ability to tolerate the stress you are putting it under. You might pick up a box 100 times no problem, but 101 and your back ‘goes’. Someone might throw you a tennis ball, and you catch it no worries, but a bowling ball might hurt you. Maybe you’ve been sitting for hours at your desk, and when you twist to put your seatbelt on, surprise — back pain.
In all these examples, it comes down to the relationship between load and capacity.
So how can exercise prevent lower back pain?
Resistance exercise is when you exercise your muscles using an opposing force e.g. your own body weight, dumbbells or resistance bands. Resistance exercises for upper body and lower body will reduce your chances of developing back pain by 35%. Using advice from from an appropriately educated professional reduces the likelihood by 45%. Add specific lower back exercises provided by the right professional, and we’re at a 96% chance of no back pain.
If you’re confident to move your body, the best rule for self-assessment is to ask yourself: does this feel better, worse, or the same? A little bit of discomfort is okay (rating 1-2 out of 10), and once you stop, ask yourself if you feel better, worse, or the same.
Better or the same, do a little more. If you feel worse, have a rest. Wait for your pain to return to normal, and do the move again, but make it a bit easier by decreasing reps, using less weight, or reducing your range of motion.
If you’ve hurt your back, go to the doctor. They will screen you for ‘red flags’ to make sure you’re not in the ~1% of people with a serious issue. After that, consult an Accredited Exercise Physiologist. You can find us here, and if you ask your doctor for a referral, they can provide a care plan, which is subsidised by Medicare.