Putting a Stop to Future Low Back PainHealthy trunk muscles activate to hold the spine stable and safe during movement. Though small in size, the multifidus muscles that lay deep within the low back have become the focus of attention as a key contributor to spine stability. These important muscles lie on the back surface of the spinal column. The shortest ones cross from one vertebra to another. Others cross several vertebrae. They coordinate their actions with key muscles of the abdomen, the transverse abdominal muscles. Working together, the multifidus and transverse abdominal muscles control and protect the spine during movement.
A weak or injured multifidus muscle may make a person prone to low back pain. Even when a first episode of low back pain gets better, the multifidus muscle may not heal completely. This leaves the low back prone to reinjury. Could this be a reason why almost 90 percent of patients who've had low back pain once end up having it again--and again? These authors tested whether training patients' multifidus and transverse abdominal muscles after a first episode of low back pain would make patients less vulnerable to low back pain in the future.
Thirty-nine patients ages 18 to 45 participated in the study. All of the patients were experiencing their first episodes of low back pain, which lasted less than three weeks.
The patients were divided into two groups. Nineteen of them got advice on bed rest, pain medication, and time off work. They were advised to do their normal activities to the extent that their pain allowed. The other 20 patients got the same treatment plus specific exercises twice a week to activate and train their multifidus and transverse abdominal muscles.
The treatment lasted four weeks. The authors followed up one and three years later to see whether patients had additional episodes of low back pain.Â
Patients who did exercises to train their trunk muscles had less low back pain later. In the year after treatment, only 30 percent of them had low back pain. Meanwhile, 84 percent of patients who didn't do special exercises had low back pain again in the first year. That means patients who didn't do exercises were 12 times more likely to have low back pain.
Most of the patients who did the exercises said the second round of pain wasn't as severe as the first. However, more than half (56 percent) of the patients who didn't do exercises said the pain was just as severe as the first time.
In the second and third years after treatment, patients who did the trunk exercises still fared better. Only 35 percent of them had back pain. Seventy-five percent of patients who didn't do exercises had low back pain in the second and third year, though the severity of their pain had subsided somewhat from the first episode.
The study shows that an exercise program targeting the multifidus muscles combined with basic medical treatments and resuming normal activities lowers the chances of having future episodes of low back pain. To confirm this theory, the authors would like to see this program repeated for a larger group of patients.
The authors conclude that "In terms of prevention of recurrences [of low back pain], this study might represent one step forward in the optimal management of the acute low back pain patient."
Julie A. Hides, PhD, MPhtySt, BPhty, et al. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. In Spine. June 1, 2001. Vol. 26. No. 11. Pp. E243-E248.
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