Ten-Year Study for Back Pain: Is Strengthening or Flexibility More Helpful?


Low back pain (LBP) is a big problem, with approximately eighty percent of people reporting back pain at some point in their life. This pain can be the cause of much stress, lost function, lost productivity and financial expense. Exercises have been shown in many research articles to be effective for LBP, but it is not clear as to the parameters. This study by Aleksiev looks into some specific exercises to see which are most helpful over a ten-year period, including frequency, intensity and duration. They looked at the long term effect of strengthening versus flexibility as well as the additional effect of abdominal bracing for everyday activities.

This study included six hundred patients with non-specific low back pain randomized into four treatment groups, each with one hundred and fifty participants. One group performed strengthening exercises alone, one group performed flexibility exercises alone, the third group performed strengthening exercises and did abdominal bracing for everyday activities, and the last group did flexibility and abdominal bracing for everyday activities. All the participants were followed for ten years, and were interviewed on a yearly basis about their symptoms. The participants were asked about maximal pain intensity and duration in days during the latest recurrence of pain as well as the number of episodes of pain during the year. They were also asked to report the number of exercises per day, minutes per session and intensity of the exercise sessions.

The exercises for the strength group were a held crunch movement and a back extension with legs and hands behind head, like superman. Each exercise was to be performed at fifty percent of maximum effort and held for three seconds, they were instructed to perform three sets of ten repetitions. The flexibility exercises included flexion stretch for the back muscles and an extension stretch for the abdominals. The stretches were held for ten to twenty seconds, three to five times. For groups who performed the abdominal brace they were all instructed to incorporate bracing into the regular activities. They were instructed to “brace and breathe,” and to initiate this before any whole-body movement or exercise as often as possible. Bracing intensity and duration were self selected.

This research found that both strength and flexibility exercises were equally effective if done daily to decrease pain. In fact, the more frequent the exercises the better the pain relief. Frequency was more important than intensity or length of time exercising. If abdominal bracing was done for daily activities this also significantly decreased the pain reported over the ten-year study, over one and a half times compared to the groups without abdominal bracing. The largest improvement occurred over the first two years and then the pain reducing effect slowly lessened.

The author hypothesizes that the bracing was more beneficial because it automatically increased the frequency of abdominal and back muscle contraction, therefore increasing strength. The groups doing the abdominal bracing also had increased frequency of exercise, possibly due to the fact that doing the abdominal set reminded them that they should do their exercises, which also increased strength gains.

In conclusion, this study presents abdominal bracing as the most effective method when combined with regular exercise to decrease nonspecific LBP for the long term.