Most adults (80%) will experience low back pain at least once in their lifetime and low back pain is the most common reason for missed work.¹ Additionally, work accidents to the back occur twice as often as other injuries. Most episodes of lower back pain are sudden and temporary; in fact, 70% get better within one month and 90% get better within 3 months. Only about 1% of all episodes require surgery.

The most identifiable contributing causes for low back pain are:

• Poor posture
• Muscle weakness
• Muscle imbalances
• Improper biomechanics
• Chronic poor flexibility
• Upper body obesity
• Smoking

The reason most back pain occurs in the lower back is because the low back (lumbar vertebrae) supports most of the body’s weight. Low back pain is often felt after lifting a heavy object, moving suddenly, sitting in one position for a long time, or incurring an injury or accident. It's important to note that before the accident or injury the structures in one's back were losing strength or changing due to many of the above mentioned causes. These causes lead to a mechanical breakdown of the low back such as lumbar strain or sprain (70%), degeneration of disks and facets (usually age related) (10%), herniated disk (4%), and others reasons each accounting for 3% to less than 1%.

Therefore, the aim of a recent study² was to identify the effectiveness of two different forms of exercise and self-care strategies in the reduction of low back pain for adults. These interventions are relatively inexpensive when compared to ongoing visits to a medical practitioner or health practitioner to alleviate this issue.

A total of 228 adults with chronic low back pain were randomly assigned to either 12 weeks of viniyoga, 12 weeks of conventional stretching exercises or 12 weeks self-care book guidance. The viniyoga classes included 5 to 11 relatively simple postures with variations and adaptations (important because all the study subjects were exercise novices), deep breathing exercises, and guided deep relaxation.  The stretching classes consisted of 15 stretching exercises that emphasized the trunk and legs and 4 strengthening exercises. The self-care subjects received the book, "The Back Pain Helpbook."³

Since participants only attended the exercise class once per week each exerciser was given a corresponding CD or DVD to do the exercises at home and record their time spent in said activities. The self-care group was to log, as well, and indicate how much of the book they read.

Prior to the study, participants engaged in a disability questionnaire and a “bothersomeness of pain” numerical scale. Study outcomes were assed at baseline, 6, 12, and 26 weeks.

Results Highlights:

• The median number of classes (out of the 12) attended by the yoga and stretching subjects was 10 vs. 9, respectively.
• Nine or more weekly home practice logs were completed by over 70% of class attendees (63%) of yoga and (82%) of stretching.
• At both the 6 and 12 weeks most participants reported practicing at home 3 days per week.
• Eighty six (86%) of the self-care subjects read some of the book with nearly half reading 75% of the book.
• The yoga participants (85%) reported higher probability of recommending the class to others vs the stretching group at 54% probability of recommendation.
• Back Related Dysfunction (RDQ) scores declined over time in all 3 groups.
• The yoga group compared with the self-care group reported statistically significant superior function (less RDQ) at week 12 and 26.
• The stretching group compared with the self-care group reported statistically significant superior function (less RDQ) at week 6, 12 and 26.
• There was no statistical significance between the yoga or stretching interventions.
• The self-care group did not reduce their pain medication intake until week 26, whereas the exercise groups reported less medication usage at weeks 12 and 26.
• The yoga benefits were widely attributable to the exercise benefit and not to the mental component of yoga.

1. The amount of stretching performed in the stretching classes is substantially greater than that typically found in publically available classes. The national recommendation is to perform stretches for 15 to 60 seconds per muscle group for 4 repetitions or more. Thus, if a person did 6 stretches of 4 repetitions for 60 seconds but we will assume the total stretches is 12 in order to stress both sides of the body (in many cases) the total time spent stretching would be 12 exercises x 60 seconds x 4 repetitions = 48 minutes of stretching. This would be close to total time the subjects spent stretching in the once per week class (53 minutes out of a 75 minute class) and most subjects stretched 3 times per week for 20 minutes on their own (with a DVD).
2. The classes were taught by highly trained and very experienced instructors. This is important for desired outcomes.
3. The fact that exercise participants were asked to exercise on their own and they successfully did that, seems to imply internal motivation due to validated pain reduction.
4. For some chronic low back pain such as sciatica pain, certain low back stretches will actually increase the pain.
   

How can we correct low back problems with exercise?

Check in next month for a follow up on low back pain for assessments tips, body mechanic corrections tips, and exercises to strengthen and stretch for a sound, strong lower back! Until then, check out our previous related blog, Don't Forget About Your back. 

¹ Valifors, B. Scan J Rehab Med Suppl, 1985.

² Sherman KJ, Cherkin DC, Wellman RD, Cook aj, Hawkes RJ, Delaney K, and Deyo RA. A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. Arch Intern Med. 2011;171( 22).

³ Moore JE, Lorig K, VonKorff M, Gonzalez VM, Laurent DD, The Back Pain Helpbook. Reading, MA: Perseus books; 1999.