Sunday, October 9, 2016

Can Exercise Be Good For Your Back Pain?

I never really had low back pain before, not before my accident anyway. It's a different story after my accident, although thankfully it's more of an ache occasionally than back pain now actually.

I seem to get back ache when I see too many patients in a row now. I used to be able to go through an entire day without needing a break. Now on a long day I often give myself two half hour breaks. In fact when I was started working again after my accident, my wife would schedule a 30 min break for me after I see four patients and made sure I rested. I started working two hours a day, three, then four and and so on. Now I usually won't see patients for longer than seven hours at a time.

I see patients 2 times a week at Physio Solutions now and often go without a break. I always take a bus there and run home when I'm done. Every single time my back is sore/ achy I still run because my back always feels better during and after the run.

You must be thinking, how can this be? Can exercise alleviate back pain?

Here's the strange thing, I was worried too when I first had back ache after seeing patients at Physio Solutions and was wondering if I should still run home. I ran anyway and within the first three minutes, my back started feeling better. Each time I had back ache and ran I had same result, my back always felt much better.

But I can't just tell my patients with low back ache/ pain to just go running, I have to be able to justify and explain why running (or other exercise) helps.

So I was rather pleased when I came across the following article (Belavy et al, 2016).

The authors wanted to understand what kinds if sports and exercise could be beneficial for the intervertebral disc (IVD) and they did a review on IVD adaptation with loading and exercise. They also examined the impact of specific sports on IVD degeneration in humans and acute exercise on disc size.

2 levels of the vertebrae and disc
Here's a summary of what the authors found.

Our human spine likes dynamic, axial loading at slow to moderate speeds. This means that loading forces that are performed regularly for longer time periods that are dynamic (not static) but not rapid and of a magnitude up to approximately those seen in jogging/ running are likely to result in positive adaptations to the IVDs.

High impact loads, explosive movements, extreme ranges of movement as well as sedentary behaviour, disuse and immobilisation are likely detrimental to the IVD.

Static or very rapid loads, magnitudes that are too low (e.g. lying) or too high (lifting in flexion) are not beneficial to your IVDs. Yes sitting is bad for you as I've written before and also too much bed rest.

The authors also mentioned that running and upright endurance sports are either beneficial or at least not detrimental to the IVD. However, sports like elite swimming, baseball, weightlifting, rowing and equestrian riding are more likely to lead to IVD degeneration.

I was very surprised to see elite swimming on the not beneficial list. During the tumble turns, loading direction and speed of loading will be in torsion and/ or extremes of range. Amateur swimming is more likely to be at the very least less detrimental to the IVDs, but it is unclear whether it will be beneficial for the IVDs.

Come talk to me if you need to find out more. I have a compression fracture in my L1 and a fractured skull after my bike accident.


Belavy D, Albracht K et al (2016). Can Exercise Positively Influence The Intervertebral Disc? Sports Med. 46:473-485. DOI:  10.1007/s40279-015-0444-2.

*Many thanks to Elizabeth Boey who got me the article. Email me if you want a copy of the article.

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