Directionally-preferenced exercises are effective non-operative treatment options for patients with low back pain, according to Joel Press, M.D., medical director of the Center for Sports, Spine and Occupational Rehabilitation with the Rehabilitation Institute of Chicago.
“Often, little direction is given to patients with acute low back pain episodes with respect to exercise,” Dr. Press said. “If advice is given, it is usually non-specific and general. Effective treatment for back pain is individualized treatment.”
While medications and surgery are often discussed for treating low back pain, Dr. Press believes many patients can reduce low back pain long-term by doing “directionally-preferenced” exercises rather than non-specific treatments. Studies with specific exercises reduced low back pain significantly at time points of three months and one year.
“Directionally-preferenced exercises are exercises that have a directional preference, meaning, if someone hurts when they bend forward all of the time, then we’ll initially move them in the opposite direction away from their pain. When you do a certain activity while assessing a patient and it makes the patient feel better, then those are the types of exercises to start to do with that patient. Progression to strengthening of the hip, back, side, abdominal and lower limb muscles, the so-called core muscles, is then addressed.”
“The problem with exercise and back pain is that everyone thinks there is one exercise, and everyone should do the same exercise or series of exercises,” Dr. Press said. “Non-specific treatment for a non-specific diagnosis is going to yield non-specific results. We need to examine the patient carefully to determine where and how the patient moves best, to best approach the management of her pain. Often, the treatment can be as individualized as the patient.”
“Long-term follow-up of patients with low back pain shows that although 95 percent of patients will have a functional recovery, meaning they’ll be able to go back to work, or do what they need to do, 31 percent of patients are not completely better,” Dr. Press explained. “Another study shows that 62 percent of patients suffered one or more relapses during a year of follow-up, and 40 percent were still suffering with low back pain at six months. So there’s a real distinction between what the functional outcome is, and what the pain outcome is. If not properly managed, people may have persistent pain.”
In many cases, the most satisfied patients, Dr. Press added, are those who get the best explanation of the cause of their pain and the steps needed to reduce that pain. These patients have a more successful outcome from rehabilitation. “Managing the pain is obviously part of it, but making sure we as health care providers explain it is just as important so we get a good functional outcome.”
The reason there is not a one-size-fits-all remedy to back pain is that pain generators for low back pain may involve nerve stimulation around any number of structures in and around the back including the discs, the facet joints, the ligaments, the nerves or the muscles. “The back is an incredibly complicated structure,” Dr. Press said.
Giving everyone a back book that lists 27 exercises is probably not going to make a difference for patients with low back pain, Dr. Press said “But, if you give a patient focused exercises, it could help. Increased activation with proper counseling can decrease chronic pain. Exercises can be an essential component of a rehabilitation program for low back pain, often in conjunction with other treatments such as medication, injections, manual treatments, braces or surgery to decrease low back disability.”