Lower back pain (LBP) affects most people in their lifetime. In fact up to 60% need to take time off work to deal with the symptoms. Thankfully for the majority of individuals recovery within 5 days is possible and they go back to their normal activity. After the initial event most individuals forget about the event and return to their old habits and fail to take care of their back. That is until they hurt it again!

Unfortunately some individuals are not so lucky and the LBP persists impacting on their quality of life, their physical activity, their family, and employment and commits them to a cycle of chronic pain

So how can you avoid this sequence? How can you ensure that you do not end up like 20% of adults and suffer form persistent LBP?

The medical evidence now says that is individuals who stay active immediately after the onset of acute, severe low back pain (LBP) reduce their pain-related disability and the length of their sick leave compared with patients who are advised to adjust their activity to accommodate their pain, according to a new study. In addition, stay-active patients experience a steady increase in their activity levels compared with the adjust-activity group, the studies show.

“The evidence supports the beneficial effects of physical activity on most musculoskeletal conditions, including lower back pain,” the researchers wrote. They concluded that individuals should stimulate early activity and a return to work among patients with acute lower back pain (BMC Sports Sci Med Rehabil 2015;7:19. ). Dr. Dominic Hegarty, Clinical Director at Pain Relief Ireland, believes this is very achievable.

Should Exercise be prescribed as a management strategy? If so, how much and how soon?

The early implementation of the “stay-active” advice after severe acute LBP is relatively new.

Dr. Hegarty recommends that “Staying active” is achieved by walking, standing and performing daily activities; it utilizes the body’s own pain control mechanisms. These activities break up spasms, which helps to minimize pain, reduce reliance on the health care system, speed recovery, and minimize time off from work. These do not have to be very much at the start but individuals should build up the activity.

It is now recommended that a targeted level of activity, as measured by a pedometer during the first three days should be 10,000 steps (the daily step count generally recommended for fitness) is possible and helpful. In a study of 99 individuals with acute LBP, from the Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg, Sweden, almost all patients recovered within the week after the start of the severe acute LBP problem, irrespective of the treatment advice. The minimal activity achieved was 6,600 steps. So it appears that 60% of the “normal” fitness level is enough.

Importantly this can be achieved without reverting to any specific “exercise” outside the day-to-day activity.

But I will not be able to “stay-active” because the pain will stop me?

An important finding was that individuals who follow the stay-active regimen, report that pain is not an obstacle to their recovery.

In fact most individuals with acute lower back pain tend to comply with treatment advice, despite the mild to moderate pain. This suggests to physicians that the stay-active advice is the appropriate treatment strategy to prevent pain-related disability and sick leave due to back pain. In most LBP the bases of treatment is simple analgesics. The combined multidisciplinary approach used by the team of physiotherapists at Pain Relief Ireland will ensure that if pain is limiting your recovery we can provide the solutions needed.

Why should this work and why should it be promoted?

There are a few reasons why “prescribing activity” is a good idea

• In the majority of patients with acute-onset low back pain, staying active and maximizing what we can do, while maintaining proper body mechanics and posture, is the best way to relieve the pain of the acute episode and minimize the probability of developing deconditioning related to pain, secondary pain generators and pain. By staying active, such as walking, standing and performing daily activities, utilizes the body’s own pain control mechanisms. These activities break up spasms, which helps to minimize pain, reduce reliance on the health care system, speed recovery, and minimize time off from work and family obligations.

• There are immense psychological benefits to staying active and psychosocially engaged that can also help minimize the emotional component of pain.

• It is an inexpensive “treatment” to help patients with acute severe LBP regain activity levels and return to work earlier. It avoids the need for oral or perhaps intramuscular injection in the early phase. Providing pedometers and advice on how to stay active would be more useful.

• It demonstrates that even higher levels of physical activity can be promoted with these methods to prevent recurrence/chronicity of pain and for additional health benefits.

• It teaches the individual to think about the negative aspect of pain ( or catastrophize less) about subsequent acute pain experiences, providing the person the confidence to address and deal with acute pain in a less disabling manner in the future.

Looking Long Term

Although the study does provide good information about managing acute LBP, Dr. Dominic Hegarty, Clinical Director Pain Relief Ireland believes it would be important to consider the long-term effects. “Individuals who experience an episode of acute LBP are more than likely to suffer a repeat episode again, so having a “plan” in place is paramount to dealing with the next event”.

“What may not have been studied, but what may be extremely important, are the potential long-term behavioral effects of maintaining activity during an episode of acute low back pain vis à vis subsequent pain experiences”.

“Staying Active” will ensure you recover from lower back pain quicker

So not only will the “Staying Active” model ensure you recover from your present acute episode of lower back pain quicker the unseen benefits include potential long-term behavioral effects of maintaining activity during even when there is no LBP. It help promote general well being and this is priceless.