The original article was featured on the Sports And Spine website, which can be found at http://www.sportsnspine.com.au/
Back pain has been very topical issue over the last month or so, since the release of the trio of papers in the Lancetjournal. The findings were interesting not in the least because of the multifactorial nature of back pain, causative and correlational factors and contributing morbidities. The optimal treatment for back pain was not made completely clear, and according to the research may never be completely clear due to the complexity of back pain, however there were several important points that could be taken away from the research that movement professionals such as Exercise Physiologists can immediately begin to apply to help our clients.
What we know about the nature of pain is that it is perceptive and by this we mean that the nociceptive response will not be the same for 2 individuals. People that suffer from chronic back pain seem to have a pain response that is not always in line with the physical input. This is not to say that the pain isn’t genuine – virtually everything in life is about perception and if it is perceived than it is present – but re-training the body to move through certain motions and perform tasks with minimal pain is the key with the management of chronic pain.
As Exercise Physiologists our job is to improve the health and wellbeing of our clients through movement (mainly) and our role in the management of back pain is to facilitate the safe and effective performance of daily tasks with minimal pain response. Once the acute stage has been passed and clearance has been given to perform a structured exercise program (something that should always be prescribed whether with an Exercise Physiologist or self-monitored) we aim to find movements and actions that can further alleviate pain, help the pain to become more manageable or identify movements and postures that do not elicit a pain response. A combination of all three of those parameters are the means with which to reach the medium to long-term goal of a return to functional capacity and peak health.
The research suggests that the most effective treatment that we are aware of at the moment for back pain is movement. Movement appears to be even more effective than analgesic medication in alleviating chronic back pain. Therefore, the initial plan would be to encourage as much movement within the day-to-day confines of work and life as possible. Exercise Physiologists are trained to work with clients to find the most manageable solutions to the problem of a lack of time for movement and exercise and the early prescription is usually very simple with things such as regular movement from a work desk or daily walk.
Once this goal has been met the progression with often then involve a more structured resistance exercise program with exercises that can either be performed at home or within a gym setting. We work to identify areas within the body that are weak or imbalanced with respect to other areas and bring those weak spots up to a point that they are no longer a potential issue. Back pain is complex and the concept of core weakness appears to not be a contributing factor to back pain as much as we thought it once was, however as Exercise Physiologists we always aim to improve weaknesses and create synergy within the system. If we can do that than we reduce the likelihood of other problems manifesting and create an environment of movement that is efficient.
The end goal is always self-management and to reduce reliance on Allied Health professionals for treatment. We gain no more pleasure than from seeing a client progress on to self-management and being pain free, or at least with vastly reduced symptoms. Once the optimal outcome is achieved we then have the option of managing the ongoing symptoms, if there are any, or re-framing the physical goal towards something more fitness or strength specific and that is where the fun really starts!