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Can You Exercise for the Wrong Reasons?
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Posted on: 11/30/1999
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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.
To help focus what we do know and summarize the evidence, researchers from the Netherlands put together this report on deconditioning and chronic low back pain. They raised some interesting questions like is exercise being done for the wrong reasons by patients with chronic low back pain? That's an important question because intense physical training is often a major part of the rehab program for 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.
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.
Researchers who have studied the differences between men and women and by age in patients with chronic low back pain versus controls (adults without back pain) haven't found links between these factors and level of physical activity. What they did find was that people who continued working despite their back pain had better physical fitness and conditioning. The conclusion of the studies was that people should be encouraged to stay active at work. They were unable to say for sure that working prevents deconditioning.
In summary, current research has not been able to show that low activity or fitness levels in healthy adults is a risk factor for developing chronic low back pain. In the opposite vein, we don't know that having low back pain for months to years results in deconditioning. There just hasn't been enough studies done evaluating physical (muscle strength, postural control) and physiologic changes (fat metabolism, oxygen saturation) in patients with chronic low back pain.
That leads to the authors' final conclusion that future research is clearly needed around the topics of physical activity levels, deconditioning, and low back pain. They suggest that both sides of the equation should be considered: does low back pain cause deconditioning or does deconditioning contribute to low back pain?
There is also a need to consider the role of catastrophizing, fear-avoidance behaviors, motivation, and attitude on physical activity and deconditioning. High-quality studies will need to use valid and reliable tools to measure physical activity, activities of daily living and fitness. Carefully matched controls are essential. Patients should be matched with healthy adults of similar age, sex, work status, and sports activity.
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References:
Jeanine A. Berbunt, et al. Cause or Effect? Deconditioning and Chronic Low Back Pain. In Pain. June 2010. Vol. 149. No. 3. Pp. 428-430.
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