Got Low Back Pain? Then Get Moving (Part 3)Patients with low back pain often find they're unable to do the things they are used to doing. Simple daily tasks can be difficult, and work may seem next to impossible. Certainly the physical pain affects patients' ability to function normally. But what other factors may be involved?
This study was part of a series that looked at the effects of exercise therapy on low back pain. In this last part of the series, the authors tried to pin down factors that prevent patients with low back pain from doing their daily activities. In particular, the authors wanted to know the extent that physical performance, feelings and beliefs, and pain affected patients' ability to do their regular tasks.
Participants included 148 patients who had been having pain off and on for an average of 11 years. More than half of them were women. The average age was 45.
Patients did one of three exercise programs twice a week: physical therapy, muscle training with special devices, or low-impact aerobics. Before and after three months of exercise therapy, patients did a series of physical tests. They also filled out questionnaires about their low back pain, ability to do daily tasks, ways of coping, depression, and fears about their pain.
Before treatment, several factors seemed to affect whether patients felt able to do activities. Severity of pain was the most important. The greater their pain, the harder it was for patients to do their regular activities.
Depression and the belief that low back pain was "the end of the world" increased patients' feelings of being unable function normally. So did believing that low back pain was inevitable and likely to worsen with work or physical activities. Not being able to use certain back muscles and having poor range of trunk movement prevented patients from going about their days as usual.
After treatment, patients said they were better able to do tasks, no matter which of the three exercise therapies they had. What caused this change? Contrary to what the authors expected, improvements in physical performance weren't the key to reducing the patients' sense of disability. Instead, changes in pain, depression, and fears about work and physical activity factored heavily in improving patients' ability to do tasks.
Although the exercise therapies used in this study didn't focus on patients' feelings or beliefs, the treatments seemed to have positive effects in these areas. After three months of exercise therapy, patients were less likely to think their condition was "the end of the world." They less often thought that work and physical activities would lead to low back pain. And they believed more strongly that they could control their own pain.
Exercise therapy seems to help patients in many ways. First, it gets them to use their back muscles again. But perhaps more important, it shows patients that they can safely do activities without hurting themselves. At its best, exercise therapy may give patients the confidence to return to the tasks of their daily lives.
Anne F. Mannion, PhD, et al. Active Therapy for Chronic Low Back Pain: Part 3. Factors Influencing Self-Rated Disability and Its Change Following Therapy. In Spine. April 15, 2001. Vol. 26. No. 8. Pp. 920-929.
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