Lower back pain afflicts many people. Some statistics claim that people have a 65 percent to 85 percent chance of developing lower back pain at some point in their life. In addition, among those who do have back pain, anywhere from 28 percent to 75 percent experience relapses, often more than one. Since back pain can affect someone's ability to work and perform daily activities, and it is costly for the healthcare system, many researchers have tried to find ways to prevent back pain from occurring and how to relieve it once it's started.
Many studies have investigated the effectiveness of exercise in helping relieve back pain, but none have been conclusive.
In this prospective, randomized trial, researchers assigned 50 patients with diskogenic low back pain to either an exercise group or a control group, in which the patients did not receive treatment. The patients were young, average age about 31 years, and most had sedentary jobs. None had any history of trauma to the back.
The exercise consisted of a new program, the Back Rx program that involves a series of exercises. The first, series A, had the patients doing isometric muscle work through physiotherapy. The patients did this for six months. Series B built up on what was learned in series A with another six months of more dynamic muscle movements and yoga-based exercise that focused on the core muscles of the back. In this series as well, the patients targeted muscles in the chest, shoulders, abdomen, thighs, and hips. The patients in both the control group and the treatment group were allowed to take an anti-inflammatory (celecoxib) every day and a pain reliever consisting of hydrocodone and acetameniphen as needed.
Forty-four patients were available for follow-up after one year. Seventy percent of the patients in the treatment group reported a successful outcome while only 33 percent of the control group did. Over the course of the year, only 17 percent of the treated patients reported returning pain that lasted for more than three days while 48 percent of the control group had such pain. Finally, the treated group reported less frequent use of the pain reliever than did the control group.
The authors pointed out that the study did have a few weaknesses, the main one being the lack of testing to verify the diagnosis of diskogenic lower back pain. The researchers used patient history and symptoms to make the diagnosis. The authors also pointed out that the patients in the treatment group did report increased pain during the first three weeks of the exercise program and recommended that patients participating in such programs be warned about this possible occurrence.
The authors concluded that although the use of a back brace and oral medications may still be needed during treatment, a well-designed exercise program may be effective for patients with this type of back pain. They suggest that a larger scale, multicenter, controlled trial be undertaken to confirm their findings.
Vijay B. Vad, MD, et al. The Role of the Back Rx Exercise Program in Diskogenic Low Back Pain: A Prospective Randomized Trial. In Archives of Physical Medicine and Rehabilitation. May 2007. Vol. 88. Issue 5. Pp. 577-582.
