FAQ Category: Lumbar Spine

All of the descriptions you just provided suggest a neurogenic source of pain. That means something in the nervous system is affected. Neuropathic pain can occur as a result of injury or destruction to the peripheral nerves (coming out of the spinal cord), pathways in the spinal cord, or neurons located in the brain.

This type of pain does not occur as a result of tissue damage, but rather by malfunction of the nervous system itself. For some reason, there is a disruptions in the sending and receiving of nerve impulses. The result is a change in the way you perceive touch, pressure, and/or temperature.

Neurogenic pain can be drug-induced, metabolic based, or brought on by trauma to the sensory neurons or pathways in either the peripheral (spinal nerve roots) or central nervous system.

It is usually described as sharp, shooting, burning, tingling, or producing an electric shock sensation. The pain is steady or evoked by some stimulus that is not normally considered noxious (e.g., light touch, cold). Some affected individuals report aching pain.

There is no muscle spasm in neurogenic pain. Acute nerve root irritation tends to be severe, described as burning, shooting, and constant. Chronic nerve root pain is more often described as annoying or nagging.

It is best to have a medical doctor examine you to determine the cause of these symptoms. Early diagnosis and treatment to amend the problem can save you years of chronic nerve pain that is difficult to treat.

There are literally thousands of studies done on back pain. What causes it, who will get better, who won’t, what type of treatment works best for each type of patient, and so on.

All kinds of variables have been investigated from age to sex (male versus female), body weight, education level, work load, general health, and even locale (rural versus urban setting).

Fluctuating back pain is an actual category first described by a researcher by the name of Dunne back in 2006. In the course of trying to classify or characterize low back pain, there were four categories described: 1) severe persistent pain, 2) moderate persistent pain, 3) fluctuating pain, and 4) mild persistent pain.

The term fluctuating pain was used to describe changes in frequency, intensity, and/or duration of pain. Someone could have severe pain one day, no pain the next, then mild pain escalating to severe again.

Or the pain might be rated as an eight on a scale from zero (no pain) to 10 (worst pain) at one point in time then drop down to a two on the same scale. Those are examples of fluctuating levels of intensity. Frequency (how often pain occurs) and duration (how long it lasts) can also change or fluctuate from day to day (or even within the same day).

It is believed that people with pain that comes and goes (or varies in any way) have a greater chance for recovery because the nervous system is still plastic (changeable). And the evidence from studies so far bears out that theory. By comparison, people with chronic, severe, unrelenting pain tend to experience fewer changes or improvement in their pain levels.

What happens to a condition like low back pain over time without treatment is referred to as the natural course of that particular problem. Most people do seek help for their low back pain, so the true natural course isn’t easy to discern.

Thanks to some research being done in Switzerland, we may one-step closer to an answer to this question. The Swiss are famous for carrying out population-based cross-sectional studies. Large numbers of people of all ages and backgrounds participate in group studies of this type. They fill out diaries with information of interest to the researchers. They have regular follow-up assessments.

This particular study was designed to observe the musculoskeletal health of over 16,000 people. Four hundred of those individuals reported having low back pain. The information they provided was used to analyze them as a subgroup.

None of these people with low back pain went to their physician or got any medical treatment for the problem. That was their decision — it wasn’t a requirement of the study. But they agreed to be part of the study and fill out some additional diaries and surveys week-by-week for a full calendar year.

They answered questions about their work, daily life, and participation in sports or recreational activities. They documented their pain level, medication use, and work or social limitations caused by the back pain.

From the results of this study, it looks like the natural course of chronic and recurrent (untreated) low back pain is one of shifting patterns. Most people fall into one of four clusters defined by pain described as: 1) severe persistent, 2) moderate persistent, 3) fluctuating, and 4) mild persistent.

Patients move in and out of these four different phases of low back pain. No matter which group they were in, most of the people in the study still had back pain a year later.

Whether or not these results would be the same with treatment is impossible to tell because the study group couldn’t be in both groups (treated vs. untreated) at the same time to compare results.

The first study you mentioned about drinkers outliving nondrinkers has raised more than a few eyebrows. You can be sure that the study will be scrutinized carefully by experts in order to understand the significance of the reported findings. Study design, statistical methods used, and even who financially backed the study will be examined.

The study from Denmark was designed to look for risk factors for workers on sick-leave that might predict who would be able to get back to work. They studied 325 men and women who were off work for at least three weeks (and up to 16 weeks) with either just back pain or back and leg pain. Leg pain signifies nerve irritation called radiculopathy. The underlying cause of the pain was disc degeneration (confirmed by X-rays and MRI).

The authors were particularly interested in breaking down the results to look at the link between disability and pain after one year, just disability at one year, change in disability during the same year-long follow-up, and change in back and leg pain. They also looked at how many patients were able to go back to work and percentages for each group (back pain only, back and leg pain).

After studying dozens of variables, they noticed worry and anxiety seems to play a key role in patients’ perceptions (how they view themselves). Behavioral or cognitive therapy might be helpful. Being older and overweight were two factors present in patients who did not return-to-work at all.

Older adults and those who don’t drink were also more likely to experience continued disability a year after treatment for low back pain. Does that mean workers still on sick-leave for low back pain after a year should drink more?

Probably not. It’s more likely an indication that their level of stress, anxiety, and mental distress is higher than in patients who drink more. The authors suggest that there may be a biologic explanation for this difference. Either way, more study is needed to understand the association between alcohol, disability, and return-to-work before specific recommendations are made.

Without any details about the reason for your back pain or what you’ve already done, we can tell you what the research shows and see how that fits your situation. It’s clear that psychosocial factors are linked with chronic low back pain, disability, and failure to return-to-work (i.e., remaining on sick-leave).

Psychosocial variables include things like blaming your pain on work, mental distress, anxiety, depression, marital status, and so on. Many of these fall under the category of individual perceptions and beliefs. Cognitive or behavioral therapy can be very helpful when this type of influence is present.

Based on some research done in Denmark, some additional risk factors have been added to the list. These include lack of exercise, diffuse tender points at the start of the treatment, older age, and being overweight.

What do the results of this study suggest? Besides counseling, exercise is a top priority for getting people with chronic low back pain back to work. For those who remain on sick-leave, there is evidence that a traditional physical therapy program is not as effective as graded activity.

With graded activity, improving function (not reducing pain) is the focus. Exercises are geared around function at home and at work. Usually patients with your goals in mind are referred to a physical or occupational therapist who has special training in the area of work injuries and functional rehabilitation.

Talk with your physician, case manager, or vocational counselor about services of this kind in your area that you qualify for. Compliance and cooperation with any rehab program is essential. Your positive “can do”, “want-to-do” attitude will go a long way in your recovery process.

You are fairly accurate in your description of the steps your surgeon performed to complete what’s called a transforaminal interbody lumbar fusion (TLIF).The TLIF technique is used to avoid the problems that come with entering the spine from the front (anterior approach).

Transforaminal means the surgeon gains access to the spine from the back and side. The surgeon makes a posterolateral incision and removes one of the facet (spinal) joints so the disc can be taken out.

Interbody describes how the fusion is circumferential (all the way around and from front-to-back). Once the disc is removed, the two vertebrae are distracted or pulled apart gently and a special device called an interbody spacer is slid into the disc space.

The spacer helps restore normal disc height. A normal disc space takes pressure off the spinal nerve roots as they leave the spinal cord and pass through the opening formed by the vertebral bones.

When performing a minimally invasive TLIF, the surgeon uses a special tool called a tubular retractor system. A small incision is made through the skin and soft tissues to allow the placement of a hollow tube down to the spine. The tube holds the skin and soft tissues open. There is less risk of scar tissue formation using these tubes to push aside muscle fibers.

The tube gives the surgeon a working channel through the muscles without cutting and stripping them away from the spine. The surgeon passes instruments through the tube to perform the fusion. A tiny TV camera on the end of the instruments allows the surgeon to view (on a computer screen) what’s going on inside the spine.

There are many advantages to the minimally invasive techniques. Experts in favor of minimally invasive procedures say there is less soft-tissue trauma since the surgeon doesn’t have to cut through all the layers of muscles and connective tissue.

For the same reason, there is less blood lost and less chance the patient will need a blood transfusion. The patient’s pain is usually less and the hospital stay is often shorter. We hope you experienced all of these advantages with your procedure.

Broadly speaking, fusion disease is the muscle atrophy (wasting) and weakness that can occur when muscles, nerves, and soft tissues are cut and stripped away from the spine during the fusion process.

In an open incision procedure, the surgeon has to get down to the level of the spine (bones) in order to remove the disc and fuse the two vertebrae together. Damage to the endplate can also reduce blood flow to the segment needed for healing. The endplate is the cartilage between the disc and the end of the vertebral bone.

Disruption of the end plate may result in what’s called adjacent segment disease. The vertebral level next to the fusion (usually the segment above) starts to degenerate faster than the other vertebrae. This can create another unstable lumbar segment requiring fusion.

Excessive cutting and pulling apart of the soft tissues is eliminated with a minimally invasive approach. Instead of making a wide incision to open the spine, the surgeon makes two tiny cuts.

A hollow tube called a tubular retractor is passed down through the soft tissues to the spine. The tube holds the skin and soft tissues open. There is less risk of scar tissue formation using these tubes to push aside muscle fibers.

The tube gives the surgeon a working channel through the muscles without cutting and stripping them away from the spine. The surgeon passes instruments through the tube to perform the fusion. A tiny TV camera on the end of the instruments allows the surgeon to view (on a computer screen) what’s going on inside the spine.

If you had a minimally invasive fusion procedure, your risk of fusion disease is minimal. There are other complications that can occur but for the most part, minimally invasive lumbar fusion is proving to be safe and effective.

Low back pain in the working population accounts for a large portion of sick leave, lost wages, lost productivity, and high medical costs. Different studies have been done looking at different risk factors.

But it’s difficult to analyze all the various possible reasons why workers experience back pain while lifting. Besides the obvious (lifting a heavy object), there may be twisting, bending, or awkward postures involved. Age and gender (male versus female) could be possible factors. Is it possible that the back pain would have happened anyway and it was just noticed for the first time while lifting?

And what about the size of the object, whether the object was being picked up or lifted overhead, use of handles and the distance the object was carried after lifting. What about factors like which shift the worker was on when the injury occurred (day, evenings, nights) or when during the shift the pain started (early, mid, late)?

Recently, epidemiologists from seven different medical research institutions in Canada, reviewed studies already published in this area (cause of low back pain in the work place). Epidemiologists are researchers who collect data over time and look for trends.

In this study, they searched various medical libraries, health journals, and even unpublished reports. They were able to come up with 2,766 different studies related to these questions. They used specific search terms such as low back pain, occupational setting, work place, and lifting to find what they were looking for.

They were unable to pinpoint one specific risk factor (or even a group of interrelated factors) that were linked with low back pain. It’s possible that there’s one (and only one) risk factor (like lifting heavy objects) but there could also be a group of factors that when present at the same time lead to an increased risk of low back pain.

The evidence to support lifting as a direct cause of low back pain in the work setting just isn’t there yet. It may be a matter of future research being designed so that data from more of the smaller studies can be combined (pooled) to yield statistically significant findings. Until that happens, there isn’t a known answer to your question.

Everyone believes that lifting heavy objects or even lifting light to moderately heavy objects when done repeatedly can cause low back pain. But does it really? Or is it more a matter that the back pain would have happened anyway and it was just noticed for the first time while lifting?

These were the questions posed by a group of epidemiologists from seven different medical research institutions in Canada. Epidemiologists are researchers who collect data over time and look for trends. In this study, they reviewed studies already published in what is called a systematic review.

By systematically searching various medical libraries, health journals, and even unpublished reports they were able to come up with 2,766 different studies related to these questions. They used specific search terms such as low back pain, occupational setting, work place, and lifting to find what they were looking for.

Thirty-five (35) studies met the criteria they had set up before starting the search. As the search terms suggest, that criteria included studies written in English or French related to low back pain, occupational lifting, and cause of low back pain. Each study had to have at least 30 subjects for the findings to be statistically significant.

There were many details reviewed from these studies: types of lifting, amount of weight lifted, severity of back pain, and whether or not sick leave was used. There was a broad range of specific occupations studied (e.g., nursing, retail salespersons, heavy manual laborers, administrators). The studies were conducted in 16 different countries including Nigeria as well as the U.S., Sweden, Russia, South Africa, Denmark, China, Turkey, Canada, The Netherlands, the United Kingdom, and India.

When all the data was analyzed, there simply wasn’t enough evidence to show a direct causal relationship between occupational lifting and the development of low back pain. This is not to say there isn’t a direct cause and effect between lifting and low back pain — it just hasn’t been proven without a doubt yet.

There are many expectations of the upcoming health care reform package. Experts offer a wide range of opinions about what to expect, when to expect it, and why. One large group of consumers who plan to change the way health care is conducted is the Baby Boomers.

The Baby Boom generation includes adults who were born between 1946 and 1964. This group of nearly 64 million people have reached (or will soon reach) the age of 65 and join the ranks of Medicare recipients.

As a whole, this group expects individualized care based on research evidence. Like you, they expect a patient-centered process that involves them and offers specific information about their condition. They want to know the benefits of suggested care, the chances of complications, and the expected outcomes or results.

Shared decisions about medical care is welcomed by many health care professionals. It is expected to help improve patient compliance (cooperation in following professional advice). Over time, increased patient understanding of their own health may yield better choices and improved health.

Spinal stenosis is defined as a narrowing of the spinal canal where the spinal cord travels down the spine. The effects of aging (e.g., bone spur formation, thickening of spinal ligaments inside the canal, disc degeneration) shrink the amount of space for the spinal cord.

Spinal nerve roots that leave the spinal cord can also be affected. The resulting pressure or irritation of nerve tissue can cause low back pain, leg pain, and other symptoms such as numbness, tingling, weakness, or foot drop.

The government reports that 1.65 billion dollars is spent in one year just in hospital costs for the surgical treatment of this problem. So, it’s not exactly a “fad” as much as it is a major trend in how the effects of aging catch up with the over 65 set.

When surgery is done for lumbar spinal stenosis, there are two main choices: decompression (remove the disc and/or remove bone from around the disc) and fusion. Younger, healthier, and less frail patients are more likely to be treated with decompression and fusion (compared with older adults with more comorbidities).

In fact, data collected from hospital records show that two-thirds of the patients having decompression and fusion are younger (less than 65 years old). The remaining one-third of the procedures are for just decompression and in the older group with more health problems.

Advancing age often comes with a whole host of other problems we call comorbidities. Additional health problems like high blood pressure, diabetes, heart disease, cancer, and so on add to the complexity of patient treatment.

So, it’s not a given that when you turn 65, lumbar spinal stenosis will require surgery. But the chances of developing age-related spinal stenosis, of course, increase with age. Many older adults with this condition never experience any symptoms and the problem goes undiagnosed. It isn’t until X-rays are taken for some other problem that the presence of stenosis is noted.

Why some people develop painful symptoms associated with lumbar stenosis and others do not remains a mystery. Likewise, the best way to treat this problem remains a puzzling challenge. Some people seem to respond to conservative care (physical therapy, exercise, medications) while others only find relief from the pain only after surgery.

The sacroiliac joint (SIJ) formed by the sacrum wedged between the spine and the hip is the subject of ongoing controversy and debate. Diagnosis of problems affecting the sacroiliac joint can be extrememly difficult.

The current tools we have include the patient interview, physical examination, and imaging tests. During the exam, the physician tests motion, carries out palpation and provocative tests, and then orders appropriate imaging tests.

Screening tests are very limited in what they can find so imaging studies (e.g., X-rays, CT, MRI) are often needed. Bone scanning can be done when the surgeon suspects tumors, inflammatory lesions, and other abnormalities.

A newer scanning technique called the fire scan combines CT, SPECT,and bone scan technology to create a colorful image. The CT scan is overlayed with the bone scan to produce an image that clearly shows the anatomy (as does the CT scan) with the sensitivity of the bone scan.

Studies have not been done yet to support the use of fire scans as a valid and reliable diagnostic tool. At the present time, there is no reference standard for making a clear or definite diagnosis of sacroiliac joint problems. Even with imaging studies like the fire scan, sacroiliac pathology can be hard to detect. Results of these test measures are often variable and unreliable.

The surgeon must take each patient on a case-by-case basis and conduct the examination one step at a time. Each diagnostic tool provides some information. The examiner must not lose sight of the big picture (the whole patient) when one finding is positive over another. Taken together, all the individual findings may eventually point to the sacroiliac joint as the cause of the painful symptoms.

The sacroiliac joint (SIJ) formed by the sacrum wedged between the spine and the hip is the subject of ongoing controversy and debate. Some experts refuse to believe the sacroiliac joint is a true synovial joint that moves. They base this opinion on the fact that there is very little sacroiliac motion that can be detected or directly measured.

But most agree that not only does the sacroiliac joint move, it can generate pain that is felt in the low back or buttock area. Studies to that effect report between 14 and 40 per cent of all cases of back pain are really caused by a problem in the sacroiliac joint.

Like all synovial joints, the sacroiliac joint can be subjected to change over time. Along with aging comes osteoarthritis of the SI joint. Other causes of sacroiliac-induced pain include the presence of other low-back problems, spinal fusion surgery, pregnancy, infection, or tumors.

There are ligaments holding the sacroiliac joint together and providing the support needed for proper alignment and movement. A sprained ligament is painful in the acute phase. But like other areas of the body, when healing occurs, pain may persist leading physicians and patients to believe the problem is still in the ligament.

It is more likely the case that there have been dynamic changes within the joint because of the lack of ligamentous support. Force and load on the sacroiliac joint can occur without proper stabilization normally provided by the ligaments. The joint may not be able to adapt. Postural changes develop to compound the problem.

So, in the end, the ligament heals but the joint doesn’t fully recover normal alignment, movement, or function. Treatment may be needed to restore one or all of these components.

Conservative (nonoperative) care can include manual therapy provided by an osteopathic physician, chiropractor, or physical therapist. The use of muscle energy techniques, strain-counterstrain, and mobilization or manipulation of the joint are often used by these professionals.

When the sacroiliac joint is extremely painful and unstable despite conservative care, then surgery may be an option. The most common surgical procedures performed on the sacroiliac joint include cutting the nerve(s) to the joint and fusion of the joint (referred to as arthrodesis).

By definition, isthmic spondylolisthesis is the forward slippage of one vertebra over another (the one below it). It happens because there is a defect (usually a tiny crack) in the pars interarticularis (one of the supporting columns of the vertebra). That defect develops early in life before the bones are fully grown and fused.

The last lumbar vertebra (L5) is the one most likely to slip forward (over the sacrum, S1). But isthmic spondylolisthesis can develop anywhere in the lumbar spine, particularly at the L4-L5 or L3-L4 levels.

Most cases of spondylolisthesis can be treated conservatively (without surgery). This is especially true for the low-grade type. Low-grade spondylolisthesis means up to 50 per cent of the vertebral body has shifted forward. A shift forward of more than 50 per cent is classified as a high-grade slippage.

Conservative (nonsurgical) care involves physical therapy, activity modification, and sometimes bracing and/or pain relieving medications. Physical therapists teach the patients lifelong skills of management including core training, correct posture and lifting, stretching, and aerobic conditioning.

Surgery is reserved for severe cases that are extremely painful and accompanied by neurologic symptoms. At age 16, she has probably completed her growth and will be more likely to be treated as an “adult”. Conservative care is almost always recommended first — even in difficult cases.

Your surgeon will advise you as to the best treatment approach for your daughter. The decision will be made based on the grade of slippage, desired activity level, symptoms, and patient/family preferences.

As an orthopedic condition, spondylolisthesis comes up often in the physician’s office. It’s a condition that develops in childhood but often shows up with symptoms of low back pain in early adulthood. Many children/teens don’t even know they have this problem until it becomes symptomatic.

By definition, isthmic spondylolisthesis is the forward slippage of one vertebra over another (the one below it). It happens because there is a defect (usually a tiny crack) in the pars interarticularis (one of the supporting columns of the vertebra). That defect develops early in life before the bones are fully grown and fused.

Studies have confirmed that the natural history of isthmic spondylolisthesis (i.e., what happens over time) has a very low incidence of progression. In other words, it stays the same and doesn’t get worse over time. Most cases of spondylolisthesis can be treated conservatively (without surgery). This is especially true for the low-grade type.

Conservative (nonsurgical) care involves physical therapy, activity modification, and sometimes bracing and/or pain relieving medications. Physical therapists teach the patients lifelong skills of management including core training, correct posture and lifting, stretching, and aerobic conditioning.

Your new symptoms may not even be related to the previous diagnosis of spondylolisthesis. The best thing to do before adding any exercise or change in lifestyle is to see your orthopedic surgeon for a re-evaluation. Make sure the low back pain is really coming from the spondylolisthesis.

After an examination and possibly new X-rays, your surgeon will be able to advise you about the best plan of care. Conservative care is likely still advised. Surgery is an option when the condition progresses to the point of compromising the neurologic system (pressure on the spinal nerve roots).

Many researchers, physicians, and workers have asked: what causes low back pain at work? Is it the lifting? The pushing? The pulling? Researchers from Canada have published a report on the 2,766 studies they found on low back pain in the work setting.

Type of occupational setting included various levels of manual labor. There were firefighters, nurses, salespersons, kitchen helpers, postal workers, shipbuilders, physicians, and steel mill workers, to name a few.

In theory, it makes sense that shearing forces are applied to the spine during pushing and pulling activities. Load and compression on the intervertebral discs occur. But are these forces enough to cause overload injuries to the low back area?

In this case of looking at the effect of physical activity (pushing/pulling) on low back pain, it would be helpful if the task measured by each study was described quantitatively (how much load, how often, direction, duration).

And these factors should be examined in light of when and how the low back pain occurs. The result would be a measure called dose response (i.e., what type of load is linked with low back injury).

But in the studies published so far, this type of information wasn’t gathered. And many of the studies were retrospective (after the fact). The results are subject to a phenomenon called recall bias — failure to remember accurately.

So at this point, there just isn’t enough evidence to say that pushing/pulling activities on-the-job causes low back pain. Nurses pushing and pulling heavy hospital beds do suffer low back pain. But whether it was the pushing/pulling activity or something else remains unproven. Likewise for any of the other workers (postal versus firefighters) engaged in occupations studied.

There is a need for high-quality studies using a prospective cohort design. Prospective cohort means the workers are studied on an ongoing basis rather than asked after they have suffered a back injury what factors were involved.

This type of design helps eliminates recall bias. Statistics gathered as the injuries occur are more accurate in detail (how, what, when) compared with asking workers weeks to months later what happened and how it happened.

You may be referring to a recent systematic review from the Ottawa Hospital Research Institute. A group of epidemiologists (people who study statistics and trends) did a literature review of all published studies on pushing and pulling as possible causes of low back pain.

They used well-known search engines (e.g., Medline, CINAHL, EMBASE) to look for any studies published between 1966 and as late as 2007 on this topic. They found 2,766 citation but after reviewing them all, there were only 13 studies that could be included.

In order for the information gathered to have validity, there had to be at least 30 people in each study. Workers with low back pain or injury was the target group so anyone with neck pain, whole spine pain, or on sick leave for other reasons was not included. Pushing and pulling were the only risk factors studied. Workers exposed to vibration, environmental factors, or psychosocial issues were not included.

When it was all said-and-done, it wasn’t that there was no link between pushing/pulling and low back pain. There just wasn’t enough evidence to prove the two are related. Of the 13 studies included, only eight were high enough quality to be taken seriously.

And even with the data combined from those eight studies, the statistical evidence to support pushing/pulling work activities as the cause of low back pain just wasn’t there. More studies of high-quality are needed in this area before firm conclusions can be drawn.

Even though you have opted out of surgery, your surgeon is still the best one to advise you. The standard of conservative (nonoperative) care is physical therapy and medications such as antiinflammatories.

Antiinflammatory drugs work well because they provide relief from pain. But they also reduce swelling around the nerve, thus taking pressure off the nerve and reducing irritation that leads to pain.

A specific type of physical therapy approach is used for patients with lumbar disc prolapse and resultant sciatica (leg pain). The concept is to find the direction of spinal movement that does not cause pain and does not reproduce the sciatica. The patient is then taught how to safely move in that direction repeatedly. The goal is to reduce the leg pain and centralize or move the pain to just the low back region (without leg pain).

Some physicians prescribe muscle relaxants like Valium but a recent study from Germany disproved any thoughts that this approach works. Patients in the placebo group (sugar pills) got twice as much pain relief, left the hospital sooner, and went back to work faster than any of the patients receiving the Valium.

Consult with your surgeon for the best plan for you. Factors such as severity of prolapse, intensity of pain, age, general health, and previous history of disc problems are just a few of the many variables that can direct treatment one way or another.

Researchers from the Netherlands recently put together a report that summarizes the evidence on deconditioning and chronic low back pain. They took a look at all the studies done on chronic low back pain sufferers with two things in mind: physical activity levels and physical fitness.

Physical activity included daily activities of living like cooking, walking, working, bathing, driving, brushing teeth, and so on. Physical fitness included muscle strength, endurance, postural control, and cardiorespiratory function.

Two interesting results were observed. First, the physical activity level of patients with chronic low back pain wasn’t that different from healthy individuals. And second, the risk of developing long-term back pain was highest among sedentary (inactive) people and those who participate in strenuous activities.

Several studies have shown that the disability associated with chronic low back pain really starts in the mind. Patients who perceived that they were losing function and became fearful of moving experienced more disability than those who worked and played despite their pain.

Patients who see their pain as threatening become afraid that movement will increase the pain, so they stop moving. This phenomenon has been labeled catastrophizing and may be a factor in deconditioning but that hasn’t been proven yet. Two other results of inactivity are weight gain and loss of bone density.

Researcher shows that people who continue working despite their back pain have better physical fitness and conditioning. The conclusion of the studies is that people should be encouraged to stay active at work.

This may be a bit like the chicken and the egg. Which came first: the pain or the deconditioning? Is there a link between the two before and/or after back pain develops?

These are all good questions and ones that researchers are taking a closer look at because so many back rehab programs are focused on exercise. Does exercise really work? Are we exercising for the reasons we think we are?

It makes sense that chronic back pain limits physical activity and exercise. But it has never been proven that a lack of daily activity and exercise contributes to the onset of back pain. And there isn’t convincing evidence that people with chronic low back pain become deconditioned from a lack of physical activity and exercise.

As far as physical fitness goes, we know that laying around (either being a couch potato or immobilized by bed rest or paralysis) does lead to muscle atrophy and loss of strength. This type of muscle wasting affects all muscles (legs, arm, trunk, back) from large to small. But whether or not the loss of muscle mass is directly related to low back pain is also unclear.

There’s plenty of room for debate and study on this topic. In general, it’s clear that physical activity and exercise benefits us in more ways than one. Exercise has been shown to improve immune system function, heart and lung function, and prevent obesity, diabetes, and other illnesses and diseases linked with a sedentary lifestyle. So, whether for your back, your heart, your lungs, or your general health, the best adivce is to get active and stay active despite the back pain.