Rethinking exercises for chronic back pain

Chronic back problems are common among Australians, affecting 16 percent of the general population. It is also the leading cause of disability in Australia, affecting 28 per cent of the total population and costing the economy US$4.8 billion each year.

It can affect a person’s quality of life, and in addition to the pain, patients typically experience physical and psychological distress. By definition, chronic low back pain is pain that lasts longer than three months.

Contemporary management of chronic low back pain typically includes pain education and combined exercises such as traditional bodyweight and “core” exercises. However, a new study published in Clinical Rehabilitation by researchers at UNSW Sydney suggests that powerlifting-style training is a safe and effective alternative to these bodyweight movements.

“The key findings of this article were that powerlifting is safe and effective for people with chronic low back pain when combined with education about how pain works. This was compared to more traditional bodyweight and core exercises and we found no difference between the groups,” explained Dr. Mitchell Gibbs from the School of Health Sciences at UNSW Medicine & Health.

Continue reading: Study reveals uncertainty about the efficacy and safety of analgesics for back pain

Gaps in the current literature

The paper highlighted a gap in the literature regarding whether an exercise mode was better associated with pain education. The purpose of the study was to compare general calisthenic training to a powerlifting-style program, both coupled with consistent pain education for chronic low back pain.

“In the context of the literature, this study underscores that exercise and pain education can help people with chronic low back pain. What is new about this study is that it is one of the first to examine different exercise types in conjunction with the same training. This tells us that exercise can be beneficial in all forms, which means we can prescribe the best program for the person, not the condition,” said Dr. Gibbs.

dr Gibbs said the main implication of the findings is that exercise for chronic low back pain does not have to follow traditional systemized approaches and heavy lifting is both safe and just as effective. “This is important because it allows us to appropriately dose people with chronic low back pain to achieve positive health-related outcomes, rather than just focusing our prescription on those with low back pain.”

During the study, the powerlifting group did a maximum of one repetition (1RM) for the squat, bench press, and deadlift, which means they lifted the maximum possible weight for one repetition. “This tells us that people with chronic back pain shouldn’t shy away from exercise,” said Dr. Gibbs.

dr Gibbs said these findings give practitioners more tools in the metaphorical toolbox to reach and help many Australians with chronic back pain. Photo: Shutterstock

More tools for practitioners to treat back pain

The researchers said they are optimistic about how the findings could support exercise-based practitioners in treating people with chronic low back pain.

“It has been reported that 50 to 70 percent of people with chronic low back pain do not adhere to an exercise program, possibly due to the rigid and systematized nature of the prescribed exercises. This introduces the ability to prescribe meaningful practice, allowing practitioners to focus on those key elements of practice like enjoyment and compliance, while indicating individual agency in the counseling process.”

dr Gibbs said these findings give practitioners more tools in the metaphorical toolbox to reach and help many Australians with chronic back pain. Additionally, the ability to appropriately dose exercise for people with chronic low back pain to achieve health-related outcomes allows practitioners to prioritize and educate individuals about the broader benefits of physical activity.

The study authors acknowledge that a key limitation of this study is its advertising as an exercise-based study, previously suggested as a potential bias to only recruit patients with positive beliefs about physical activity. This recruitment method may explain the low initial clinical and behavioral score compared to previous literature.

dr Gibbs said more research is needed to understand whether involving people in the prescribing process to find the type of exercise that will best benefit the person — in terms of overall health and compliance — produces better outcomes for people with chronic back pain.