Consumers are educated. That goes for consumers of physical therapy as well. The internet is an amazing thing, however; it can also mislead people. More and more of my patients with low back pain are asking me “Won’t this just go away in a couple months?” Yes, studies such as this one, by Costa, et al which was just published at the beginning of this month support this fact while not discussing the ramifications of not addressing the causative issue.
While at school I was made aware that, most first time low back pain will in fact resolve on its own. BUT, to prevent its return, physical therapy, or some sort of specific training must be performed. This article from back in 2001 by Hides, Jull, and Richardson is a perfect article to combat those such as Costa, et al’s.
Below you will find the abstract for “Long-term effects of specific stabilizing exercises for first-episode low back pain” (google search it and select the result that says .pdf), along with my running comments from reading the article. Most important comments are this putrid color.
STUDY DESIGN: A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups.
OBJECTIVE: To report a specific exercise intervention’s long-term effects on recurrence rates in acute, first-episode low back pain patients.
SUMMARY OF BACKGROUND DATA: The pain and disability associated with an initial episode of acute low back pain (LBP) is known to resolve spontaneously in the short-term in the majority of cases. However, the recurrence rate is high, and recurrent disabling episodes remain one of the most costly problems in LBP. A deficit in the multifidus muscle has been identified in acute LBP patients, and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity. Any relation between this deficit and recurrence rate was investigated in the long-term.
METHODS: Thirty-nine patients with acute, first-episode LBP were medically managed and randomly allocated to either a control group or specific exercise group. Medical management included advice and use of medications. Intervention consisted of exercises aimed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle. One year and three years after treatment, telephone questionnaires were conducted with patients.
RESULTS: Questionnaire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group. One year after treatment, specific exercise group recurrence was 30%, and control group recurrence was 84% (P <>
CONCLUSION: Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone.
- There is a definite difference in chronic vs. recurrent. Chronic pain is one pain/episode that does not subside, while recurrent pain consists of different episodes of pain.
- 2-3% of all back pain will be chronic while 60-80% of all back pain will be recurrent
- Authors suggest that exercising the multifidus muscle and the transverse abdominis muscle can prevent the recurrent back pain
- As rehabilitation and fitness professionals we need to understand that even though someone’s symptoms have subsided, if they are not correctly trained, the chances of recurrent episodes are very likely.
- Small sample size
- An ANOVA was used for statistical analysis – I tried my hardest to stay focussed during this research class years ago but this was going on (seriously this was filmed in my Research class -Back of my head in the white sweatshirt on the left)
- There is a HUGE difference in cross-sectional area (CSA) with specific exercise for the multifidus vs. the control
- Although symptomatically “better”, the control group was not “healed”. As rehab and fitness professionals we need to make sure we train people properly, knowing that 90% of the time their symptoms will decline even when trained improperly.
- Patients in the control were over 12x more likely to experience recurrent back pain!
- Not only were recurrence rates less, if recurrence did happen in the specific exercise group the intensity was much less.
- Transverse abdominis exercises are gaining popularity, but multifidus exercises are not well known, most likely due to the difficulty of teaching them – Best I could find – I’ll have to record my own sometime soon
- Most people think that biomechanics are just needed for lifting and squatting activities, however; most people spend more time sitting than lifting, squatting, etc. The need for segmental spinal control during activities of daily living is just as important but often overlooked.
- I hope this article changed the minds of whoever thought bed rest and meds alone are a good course of treatment for unilateral, non-radiating low back pain.
- It must not be forgotten that the authors use the term SPECIFIC EXERCISES, not just exercises. Exercise must specifically work the multifidus and transverse abdominis. We cannot just use a shotgun technique and throw a bunch of core stability exercises at a patient or client and hope one sticks.
As rehab and fitness professionals, we need to make sure that our patients/clients are educated about their conditions and programs. When a consumer is more knowledgable they will make better decisions and this goes for our patients and clients as well.
Hides, Jull, and Richardson. “Long-term effects of specific stabilizing exercises for first-episode low back pain”. Spine. 2001 Jun 1;26(11):E243-8.