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Simple Back Exercises - Introduction

The cost of low back pain to society is very great, with high financial costs in terms of lost income, lost production and time off work and the costs of medical and physiotherapy and other treatments. This is apart from the personal consequences of the loss of one's work or job role, loss of the ability to do normal activities and the pain itself. Many back pain treatments have been developed, most of which do not have high levels of effectiveness, and much is down to self management. An exercise programme has been shown to be an important aspect of this and this includes stability work, gym or aerobic exercise and lumbar and pelvic ranges of movement.

To function normally in our daily activities we need our joints to perform through their normal full ranges, a requirement which does not make itself obvious until we have a problem. This is clearly illustrated by taking the shoulder as an example. The shoulder is an extremely mobile joint which allows us to put our hands in useful positions whilst our eyes are able to watch, requiring large movements of the arm behind the neck, behind the back and above the head. Illnesses and injuries can alter the joint by damaging the surfaces, causing laxity of a ligament or contracture of a joint from the healing process. Contracture involves the tightening up of ligamentous structures around a joint, limiting available movement.

At a point about two and an half weeks after an injury the healing scar of the damaged area begins to tighten and during this period doing movements to stretch the area gently stimulates length in the healing structures. It also stresses the scar so it remodels to a tissue more closely resembling the original than if it was left immobile and still. A restriction in joint movement can interfere significantly with normal abilities and also be painful. In our hands or our shoulders a restriction in joint mobility is very clear to us so we work on it, but in the back any joint stiffness is not that obvious so we don't notice it and don't do anything about it.

A back injury or back pain episode forces us to maintain the injured area as still as possible to impose minimal stresses on the damaged structures to reduce pain and further injury and inflammation. The pain then settles and the joints begin to move more normally again. Guarding of the damaged and painful area is often maintained beyond the necessary time for the state of healing of the joints, leading to a potential movement loss. Our spinal joints can easily compensate for loss of movement so a restriction is often not noticed but it can lead to changes in the way the lumbar spine functions or the risk of injury re-occurring. 

Our tendency after an episode of low back pain injury and pain is to hold the injured joints still to reduce any stresses through them which might cause further injury or pain. This is reasonable in the immediate post-injury period to allow healing to progress and the joints to resume normal movement. A loss of movement can occur however if this guarding is maintained inadvertently beyond the time of the acute pain. This movement loss may not be noticeable as the back joints can compensate and we do not notice small reductions in movement but we can re-injure the stiff joint and it causes alterations in our back function.

An exercise programme over the long term, performed regularly over a period of months or years, is one of the key points for self management of low back pain syndromes. Instructing and correcting the initial programme is important, with strategies to help patients keep exercising up over a long period. 

To have a fit back we need to take account of several aspects of what fitness means, including lack of pain, good range of movement, strength, endurance, stability and functional skill. Pain can be addressed by treatment from a physiotherapist or other therapy professional, stability can be learned from the same practitioners or a Pilates instructor and strength and endurance developed by a gym programme. Once instructed, range of movement exercises can be regularly performed by us at home to maintain joint movement and counter any restrictions.

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