Exercise therapy has been shown effective with chronic low back pain (LBP). But physical therapists and other researchers are still grappling with what kind of exercise is best? Lately, there’s been a trend to use the core training or stabilizing exercises you mentioned. It seems these may be helpful during the early phases of recovery.
This type of exercise program focuses on specific muscles of the abdomen and trunk. Contracting these deep inner and outer corset muscles can help reduce pain and improve function. They do so by controlling spinal segmental motion.
Studying exercise and back pain is a challenge. The patients are heterogenous (very different). So it’s difficult to find a homogenous group to compare treatments with. Homogenous means they are more alike than different.
There are also many ways to study exercise. More than one treatment approach can be combined with other treatments such as manipulation or general exercises. Sometimes patients receive additional information to help them understand back pain. Adding this type of patient education may improve the results of an exercise program alone.
There are many possible factors to consider in sorting out what type of exercise(s) work and with which patients. In one recent study, working adults with recurrent nonspecific low back pain were placed in one of two treatment groups. Nonspecific means there was no medical cause for the back pain. It wasn’t something serious like a tumor, fracture, or infection. With nonspecific low back pain, symptoms typically occur with active movement.
The patients were randomly placed in either a spinal stabilization exercise program (the exercise group) or in a daily walking program (the reference group). A physical therapist supervised both groups for eight weeks.
Each subject in the exercise group was given a specific program teaching them how to contract and hold stabilizing muscles. The exercises were done during daily activities and in a variety of different positions (sitting, standing, moving). Patients were taught how to activate the stabilizing muscles whenever they were in situations that might cause pain. Positions known to cause pain were avoided. Patients were encouraged to breathe correctly and avoid increasing abdominal pressure with breath holding.
The walking (reference) group was told about the benefits of daily walks. They were advised to walk as fast as was comfortably possible without setting off their pain for a total of 30-minutes every day. If pain developed or increased, they were to slow down. The 30-minute walk could be done in two sessions of 15 minutes each.
There were many different ways to measure the outcomes or results of each type of exercise. There’s pain, disability, general health, patient satisfaction, self-confidence in attempting activities, and so on. With these two groups, there was a benefit to overall general health for everyone. But the stabilization exercise group was more satisfied with their results and felt they had more confidence on the job.
Since there’s an apparent benefit to either of these exercise approaches, it can’t hurt to follow one, the other, or even both. There may be an added benefit of doing both a walking program and core training. The important thing is to start an exercise program and stick with it. All the studies show that daily exercise benefits overall health. Specific exercises such as core training to improve spinal stabilization may be more effective in preventing a second bout of low back pain.