what exercise should i do for acute low back pain
The evidence for treating acute low back pain is messy. The two main approaches are pharmacological and non-pharmacological, such as physiotherapy.
While evidence suggests that exercise is crucial for managing low back pain, alongside reassurance, it’s often considered the best approach. However, key questions like what exercises to perform, why exercise works, and how long treatment should last remain unclear.
So, here are some questions for you, the reader, to ponder:
What exercises should we prescribe for acute low back pain?
Broadly speaking, the exercises fall into three main categories: strength, range of motion (ROM), and flexibility training. These are the preferred methods of exercise therapy for acute low back pain. They can either target specific muscles or involve the whole body, such as with activities like walking, swimming, or general aerobic exercises.
Questions about Strengthening Exercises:
We often say that back strengthening exercises are prescribed and that the back muscles need to be strengthened. But here are some important questions we need to ask ourselves. Please note, I’m not answering them here.
Why? Why do we need to strengthen the back muscles and, possibly, the abdominals? Are these muscles actually weak? If so, why did they become weak in the first place?
How does strengthening reduce pain in low back pain (LBP)? If it does, how exactly does it work?
Can strengthening exercises prevent future episodes of back pain?
Does strengthening change the underlying pathology of acute low back pain? For example, do extension exercises alter degeneration in the spinal joints or discs?
In terms of procedure, are we really performing strengthening exercises? How many repetitions and how much resistance are truly required to strengthen the trunk muscles?
Do the exercise in you prescribe follow the prinicples of overload to acheieve increase in strenght
We all know strenght is context depended- so for what are the context we are giving strenght training?
How long does it take to have a significant change in the strenght of the muscles of the trunk?
Do you teach flexion exercise? no? why? yes ? why?
Do you teach variations and progression? how do you do them?
how does exercise reduce pain? does it change the pathology?
Flexibility Exercises:
Should flexibility exercises be active, passive, or a combination of both?
Does it matter whether the exercises are active or passive?
Which movements should we focus on to improve flexibility: trunk, pelvis and hips, neck, lower limbs, or all of the above?
If you believe all joints are important, why?
If you think it depends, how would you decide which areas to target?
How many repetitions should the patient perform, and for how many weeks should they continue?
Can individual muscles become tight?
Can individual muscles be stretched?
What happens when you stretch a muscle? Does it become longer, and if so, will it return to its original length once the external force is removed?
what is the the therapeutic value of stretching? does it change the underlying pathology?
does it reduce pain- if yes how?
Overall, here are some additional questions for exercise therapy prescription:
If a patient reports pain from sitting for long periods, should our exercise program be adjusted? If so, how?
If one patient experiences pain primarily during extension and another during flexion, should the exercise program differ for each? If so, why? If not, why?
If a patient has a disc prolapse, should the exercise program be modified? If so, how?
Should the exercise program be adjusted based on the site of pain, the direction of painful movement, or any restrictions?
How long should a single exercise session last?
If a patient reports increased pain during exercise, what should you do?
Can a patient stop exercising once pain and disability have resolved?
With various exercise programs available, such as Pilates and free exercises, how should you choose which one to use?
Can women safely exercise during their menstrual period?
patient come and tells you my pain increased after the exercise? what should you do?
some of it may have a answer, some might. These are the questions i think research should try to answer in the next 20 years. not nonsence like anatomical vandhe bhart trains, rubber points, cracking the back and such.
Will be more than happy if you can hit me with your answers to specific questions.
love
K. hariohm