The BEST Exercise for Low Back Pain according to Research

Summary

This video from PhysioTutors debunks the myth of a 'one-size-fits-all' exercise for low back pain. It emphasizes the importance of a diverse exercise regimen, including strength, resistance, and stabilization exercises, tailored to individual needs. Studies reviewed indicate that while specific exercises like Pilates or walking show short-term benefits, a balanced approach yields long-term results. The video also highlights the role of patient-specific factors and the therapist's role in crafting personalized exercise plans.

Takeaways

• 🔍 There's no single 'best' exercise for low back pain; a multifaceted approach is necessary.
• 🏋️‍♂️ Strength and resistance exercises, as well as coordination stabilization exercises, are effective for chronic low back pain.
• 🧘‍♀️ Pilates exercises can be as effective as other forms of exercise, but long-term results vary.
• 🚶‍♂️ Walking is found to be as effective as specific exercises for the low back in the short term.
• 🏋️‍♀️ Core stabilization exercises may offer short-term benefits, but general strengthening is equally effective long-term.
• 🤸‍♂️ A balanced exercise program should include a variety of exercises like strength, power, endurance, and movement games.
• 🧠 The effectiveness of exercises isn't solely due to musculoskeletal changes; other factors like psychological improvements may play a role.
• 👤 Exercise selection should be tailored to the individual's needs, considering their condition, goals, and personal factors.
• 👵 Different individuals require different 'vitamins' in their exercise regimen; personalization is key.
• 👩‍⚕️ Therapists should listen to their patients' stories to determine the most appropriate exercises for their unique needs.

Q & A

What is the main message of the video regarding low back pain exercises?

The main message is that there is no single 'best' exercise for low back pain. Instead, a variety of exercises should be considered, tailored to the individual's needs and circumstances.

According to the video, what did the meta-analysis by Sol et al. in 2015 show about exercise for chronic low back pain?

The meta-analysis showed that both strength and resistance exercises, as well as coordination stabilization exercises, are effective in reducing pain in patients with chronic low back pain, although the effect sizes are usually small.

What was the comparison between Pilates exercises and stationary biking in the study by Marshall Adan in 2013?

The study found that Pilates exercises were superior at reducing pain at eight weeks, but the results were equal to stationary biking in the long term at six months.

How effective was walking found to be for low back pain in the study by Schneiderman and colleagues in 2013?

Walking was found to be as effective as specific exercises for the low back at six weeks, but it's important to note that the study participants were also deconditioned, so the results may not be generalizable to a more active population.

What did the research comparing core stabilization exercises with general strengthening exercises suggest about their effectiveness for low back pain?

The research suggested that low load stabilization exercises might be slightly better at reducing pain in the short term, but general strengthening exercises were equally effective in the long term.

What did the study by Acetel in 2015 compare in terms of low back pain exercises?

The study compared low load motor control exercises with high load exercises and found that the low load motor control group outperformed the high load group in the short term, but long-term results were equally effective.

Why is it important to incorporate a variety of exercise modalities for low back pain?

Incorporating a variety of exercise modalities can increase movement variability, which is often decreased in patients with low back pain, and can provide a more balanced approach to treatment.

What does the video suggest about the specific mechanisms responsible for the effects of exercise on low back pain?

The video suggests that the effects of exercise on low back pain may not be solely attributable to changes in the musculoskeletal system, but could involve other factors such as the release of pain-reducing chemicals in the brain, increased movement, or psychosocial factors.

How should therapists approach the selection of exercises for patients with low back pain according to the video?

Therapists should listen to the patient's story, consider what the patient needs from the exercise (e.g., increased tissue capacity, pain relief, improved movement strategies), and tailor the exercise selection to the patient's skill level and irritability.

What is the role of exercise adherence in the effectiveness of low back pain treatment?

Exercise adherence is crucial for the effectiveness of low back pain treatment. The best exercise is the one that the patient will consistently perform, so selecting exercises that the patient is likely to adhere to is important.

Why might a 'one-size-fits-all' approach to exercise for low back pain be ineffective?

A 'one-size-fits-all' approach may be ineffective because different individuals have different needs and responses to exercise. Factors such as age, fitness level, pain severity, and personal beliefs about their condition can all influence the effectiveness of an exercise program.

Outlines

00:00

🏋️‍♂️ No One-Size-Fits-All for Low Back Pain Exercises

This paragraph discusses the myth of a singular 'best' exercise for low back pain, emphasizing that such a simplistic approach is not supported by evidence. It highlights that various forms of exercise, including strength and resistance training as well as coordination and stabilization exercises, have been shown to be effective in reducing pain for chronic low back pain patients, albeit with small effect sizes. The paragraph also reviews different exercise programs, noting that Pilates, walking, and core stabilization exercises all have their merits but none is superior in the long term. The key takeaway is that any form of exercise is better than inactivity, and a balanced approach incorporating various types of exercises is recommended.

05:01

👩‍⚕️ Personalized Exercise Prescriptions for Optimal Outcomes

The second paragraph delves into the importance of personalized exercise prescriptions for patients with low back pain. It contrasts the need for a general approach with the benefits of structure-specific treatments, using Achilles tendinopathy as an example where targeted loading is beneficial. The paragraph underscores the necessity of tailoring exercises to individual patient needs, considering factors like tissue capacity, adherence, belief structures, and movement strategies. It also stresses the importance of patient-specific goals for each exercise and the need for therapists to be adaptable, adjusting treatments based on patient response. The video concludes by encouraging viewers to consider the 'vitamins' each patient requires and to select exercises accordingly, promoting a holistic and patient-centered approach to therapy.

Keywords

💡Low back pain

Low back pain refers to discomfort or pain in the lower region of the back. In the video, it is the central issue being addressed, with the discussion focusing on various exercises and approaches to alleviate it. The script mentions that there is no single 'best' exercise for low back pain, emphasizing the complexity of treatment and the need for individualized approaches.

💡Exercise

Exercise in the context of the video refers to physical activities designed to improve strength, flexibility, and overall health, particularly for managing low back pain. The video discusses different types of exercises, including strength and resistance, coordination stabilization, and core stabilization, and their effectiveness in reducing pain.

💡Meta-analysis

A meta-analysis is a statistical approach that combines the results of multiple scientific studies to draw conclusions. The video cites a meta-analysis by Sol et al. (2015) that shows strength and resistance exercises, as well as coordination stabilization exercises, are effective in reducing pain for chronic low back pain patients.

💡Pilates

Pilates is a form of exercise that focuses on core strength, flexibility, and overall body awareness. In the video, a study by Marshall Adan (2013) is mentioned, comparing Pilates exercises with stationary biking for low back pain, highlighting the comparative effectiveness of different exercise modalities.

💡Walking

Walking is a low-impact form of exercise that is often recommended for various health conditions, including low back pain. The video references a study by Schneiderman and colleagues (2013) that found walking to be as effective as specific exercises for the low back at six weeks.

💡Core stabilization exercises

Core stabilization exercises are designed to strengthen the muscles of the torso and improve overall stability. The video discusses research comparing core stabilization exercises with general strengthening exercises, suggesting that while low load stabilization exercises might provide short-term pain relief, general strengthening is equally effective in the long term.

💡Motor control exercises

Motor control exercises aim to improve the brain's ability to control muscle movement, which can be beneficial for pain management. The video mentions a study by Acetal (2015) that compared low load motor control exercises with high load exercises, indicating that while the low load group showed better short-term results, long-term effectiveness was similar for both.

💡Movement variability

Movement variability refers to the diversity of movement patterns an individual can perform. The video suggests that patients with low back pain often have decreased movement variety, and using different exercise modalities can help increase this variability, which may contribute to the effectiveness of an exercise program.

💡Exercise adherence

Exercise adherence is the extent to which a person follows through with an exercise program. The video implies that one of the goals of exercise selection should be to increase adherence, as patients are more likely to benefit from exercises they continue to do over time.

💡Patient-specific treatment

Patient-specific treatment means tailoring the therapeutic approach to the individual needs and characteristics of the patient. The video emphasizes that the 'best' exercise is not one-size-fits-all but should be selected based on the patient's skill level, irritability, and other factors to ensure it is person-specific and effective.

💡Exercise-induced analgesia

Exercise-induced analgesia refers to the reduction of pain that can occur as a result of physical activity. The video notes that while isometric exercises generally work well to decrease pain, research shows that exercise-induced analgesia might not occur in patients with central sensitization, and could even increase pain levels, highlighting the need for tailored approaches.

Highlights

There is no single best exercise for low back pain; a balanced approach is necessary.

A meta-analysis by Sol et al. in 2015 showed strength and resistance exercises, as well as coordination stabilization exercises, are effective in reducing pain for chronic low back pain.

Effect sizes for reducing pain with exercise are usually small.

A study by Marshall Adan in 2013 found Pilates exercises were superior to stationary biking at eight weeks but equal in effectiveness at six months.

Schneiderman et al. in 2013 found walking to be as effective as specific exercises for the low back at six weeks.

Core stabilization exercises might be slightly better at reducing pain in the short term compared to general strengthening exercises.

Long-term results show general strengthening exercises are equally effective as core stabilization exercises.

A study by Acebal in 2015 showed low load motor control exercises outperformed high load exercises in the short term.

Long-term results from the Acebal study were equally effective for both low and high load motor control exercises.

Doing some form of exercise is better than doing nothing for low back pain.

The best exercise is the one that gets done, suggesting the importance of patient adherence.

Exercise programs should be as varied as vitamins for a balanced diet, incorporating different types of exercises.

Different exercise modalities can increase movement variety, which is often decreased in patients with low back pain.

Treatment effects may not be attributable to changes in the musculoskeletal system alone.

Other factors like pain reducing chemicals in the brain or psychosocial factors might be responsible for the effects of exercise.

Exercise selection should not be specific to a body part but to the individual's needs and condition.

Even with structure-specific problems, treatment should be specific to the person, not just the affected structure.

Therapists should be flexible and adapt treatment based on patient response, even if it differs from research findings.

Different people need different 'amounts of vitamins' in their exercise programs, emphasizing the need for personalized approaches.

Exercise selection should be influenced by the patient's skill level, irritability, and specific goals.

Therapists should listen to the patient's story to determine which 'vitamins' they need in their exercise program.

Transcripts

in this video we're gonna reveal the

hands-down absolute best exercise that

you can do or give to patients for low

back pain enroll in our online course

now link is in the video description hi

and welcome to physio tutors we have

probably clicked baited you into

watching this video because you might be

looking for that magic exercise or fix

to make low back pain magically

disappear the truth is there is no and

can never be one single exercise that is

the best follow back pain or any other

hurtful body part or muscle or

whatsoever in fact this way of thinking

is very simplistic and focusing on a

body part or pathology rather than a

person if there was one best exercise

our profession would basically become

redundant and patients could follow

cookie cutter approaches but let's first

look at the effectiveness of different

forms of exercise for patients with low

back pain first of all a meta-analysis

by Sol at all in the year 2015 has shown

that strength and resistance exercises

as well as coordination stabilization

exercises

effective in reducing pain in patients

with chronic low back pain

although effect sizes are usually rather

small so that's pretty good news now

let's look a bit closer at different

exercise programs and their

effectiveness

I studied by Marshall Adan in the year

2013 compared Pilates exercises with

stationary biking and while Pilates was

superior at eight weeks the results were

equal in the long term at six months

then there is this pretty well known

study by Schneiderman and colleagues

from 2013 who have found that walking is

as effective as specific exercises for

the low back at six weeks it has to be

mentioned though that the people in the

study were also denturri so we cannot

assume that the

come would be the same in a more active

population furthermore there is tons of

research that compared core

stabilization exercises with general

strengthening exercises for the low back

some of these studies by Smith at all

Sarah Jo at all Luoma yogi Wang Coulomb

amongst others showed it low load

stabilization exercises might be a tiny

bit better at reducing pain at short

term but all of them showed that general

strengthening is equally effective at

long term at last

a study by acetal in the year 2015

compared low load motor control

exercises with that lift in a study the

low load motor control group

outperformed the high load group on

short-term but again long-term results

were equally effective so the good news

from all of these studies is that doing

something is better than doing nothing

so one might argue that the best

exercise is the one that gets done but

why choose for one form of exercise only

then komak from core kinetic compares

different exercise modes as different

vitamins that our body needs just like

in a balanced diet so you might want to

incorporate strength high load and low

load coordination power endurance and

graded exposure exercises as well as

movement games etc into a well-balanced

exercise program class going on in the

Year 2015 does also mentioned that an

optimal loading program consists of

different key variables and mechanisms

one thing we know from research is that

patients with low back pain often

display with decreased movement variety

so using different exercise modalities

might be one way to increase movement

variability what is interesting is that

we are always thinking that getting

stronger more flexible better at

activating certain muscles or improving

movement Falls etc is what explains the

effect of our exercise program

however a systematic review by Stiga on

in the year 2012 has shown that

treatment effects I'm not attributable

to changes in the musculoskeletal system

there might be other changes that are

responsible for the effects such as

diffuse noxious inhibitory control the

release of pain reducing chemicals in

your brain maybe just more movement in

itself or psychosocial factors such as

decreased movement related fear

increased confidence and so on but in

fact we just don't really know so how

specific should we be a specific

problems such as a specific low back

pain probably do not have to be body

part or structure specific but also

benefit from a more general approach on

the other hand a specific problems such

as Achilles tendinopathy in which we

know the nociceptive structure will

benefit from a more structure specific

approach such as load on the Achilles

tendon by conferences for example but

even if we have a structure specific

problem we should not only be specific

to a certain joint tendon or muscle but

specific to the person in front of us

research always looks at the average

effect of a group with two or more very

standardized interventions however the

person in front of you could deviate

from the standardised mean for example

isometric exercises generally work well

to decrease pain at the same time

research has shown that exercise induced

analgesia might not occur in patients

with central sensitization but actually

increases pain levels this means that we

will always have to be flexible and

adapt our treatment if it does not seem

to be effective in our patients after

say two or three sessions even if

research might suggest otherwise another

big reason that there can never be a

single best exercise for every person is

because different people need different

amounts of vitamin so what you'll have

to ask yourself with every exercise

you're giving to patients is

what do you want them to get from this

exercise it could be that you are trying

to increase tissue capacity or exercise

adherence another target could be to

challenge their belief structure or to

alter their movement strategies or it

could be pain relief on top of that the

ideal exercise is tailored to a

patient's level of skill and

irritability all of these different

areas should influence exercise

selection to make it person specific for

example a young weightlifter who has to

return to high level performance after

first episode of low back pain might

need maximum strength power and work on

his technique on the other hand a 70

year old sedentary pensioner with

chronic low back pain and apprehension

to bend forward due to maladaptive

illness believes will probably need a

greater exposure program with lots of

reassurance and education for the very

same reasons we cannot expect that

generic exercises will lead to optimal

outcomes the challenge for us as

therapists is to listen to our patient

story and to ask ourself which vitamins

he or she needs and then to select the

appropriate exercises to give them these

different vitamins

alright this was our video on the best

exercise for low back pain shout out at

this point to been comment from kinetic

who inspired us to discuss various

concepts in this video if you click on a

video right next to me you can watch how

we apply these concepts in different

exercise programs more in-depth

information can be found in our future

course on the spine on our website study

dot physio tutors calm this was k2

physio tutors thanks a lot for watching

bye