Colin Hoobler (physical therapist): Treat cause of chronic low back pain with effective exercises
Dear Colin: My low back has been hurting for the last five months and my doctor isn't sure why. I've tried chiropractic, physical therapy, acupuncture, even hypnosis and nothing seems to help except for pain medication. The MRI and X-rays of my back show only "mild arthritis" that, according to my doctor, isn't likely causing the degree of pain I'm having (it worsens when standing, relieved when sitting). I'm desperate! Is there anything else you recommend?
-- Rachel W.
Dear Rachel: While it's impossible to provide specific recommendations without doing a formal examination, I have three suggestions that are "common denominators" for treating chronic low back pain (CLBP) when imaging studies show no clear reason for pain.
1. Maintain a proactive approach. Most people's instincts tell them to do less when CLBP is involved, which will only make it worse (Spine 2001, 2004). If your pain worsens with movement, you're moving unsafely and should get professional guidance from a physical therapist to strengthen and stretch specific muscles responsible for your pain. This way, you're addressing the cause of pain as opposed to just treating the symptom. Interestingly, the idea of "core strengthening" is not preferred, as studies show more impressive results with strengthening the hips and thighs as opposed to trunk muscles (Journal of Orthopaedic & Sports Physical Therapy 2007). A key exercise to gain protection for your low back via leg strength is the squat. When done correctly, the leg muscles protect the spine from high forces during daily tasks.
2. Involve a pain specialist. A pain management specialist is a doctor trained in the diagnosis and treatment of pain. A public perception that a pain management specialist only prescribes narcotics is not true. The specialist works closely with your regular doctor and physical therapist using various methods to alleviate pain. Dr. Carl Balog, a pain management specialist in Portland, says, "Although CLBP can be difficult to treat, there are effective ways to prevent it which include effective exercise followed up with adequate rest. With pain onset, this becomes even more critical." Given that the majority of CLBP cases are caused by overuse, the working relationship between medical providers is crucial so you address the cause (such as poor movement mechanics or weakness) rather than relying on costly pain medications.
3. Be patient. Probably not the sexiest two words you'll hear today, but still key, because there isn't a "cure" for CLBP. Remember, when you have CLBP and imaging studies are normal, it is probably being caused by overuse. In other words, you have to start moving in different ways to better protect your back or it will continue to worsen. This takes time. Eventually, however, exercises designed to help protect your back get easier to do, which usually correlates to less pain.
(published in The Oregonian, 9/8/10)
