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Exercise and Low Back Pain

© Dr. David L. Phillips

Exercise has long been recognized as one of the keys to overcoming problems with the lower back. As a chiropractor, I regularly exhort my patients to exercise religiously. Mostly patients won't exercise consistently no matter how simple and short your recommendations. When someone is in pain, the motivation is the highest and the resolution the strongest, but once the pain is gone so are the exercises. It seems to take several relapses to convince people that they must become proactive, and a partner in the process of healing.

At first with most new patients I get the idea that they just want to dump their condition on my desk and they'll pick it up in a few days, much like their dry-cleaning. The distinct impression is that they wish to remain passive, more an observer, albeit an unwilling one, to the healing of their own low back. So after a few episodes of trouble and after they have missed a few days work again, or another couple of rounds of golf, they get mad. Then one of 2 things happens. Either they quit coming, preferring to take drugs, or to go somewhere else and have that health professional convince them that they need to take their trouble seriously, or they begin to listen and act as a partner in the interest of their own health.

Over the last few years the emphasis in health care has been towards what is known as 'evidence-based care'. In other words, if you can prove what you do works by randomized controlled tests and positive literature reviews, then what you do in health care will continue to get funding. Naturally as chiropractors we had to prove what we do six ways to Sunday before grudging approval was given, and then only if other therapists could be allowed to do it as well. Never mind how poorly trained or woefully inexperienced they were imitating us. Fundamentally what we do as chiropractors is adjust or manipulate/mobilize spinal joints, especially those of the lower back. And we do it very well, better than anyone.

Treatments that have been proven to work become part of a clinical guideline. Spinal manipulation and mobilization are now firmly imbedded in these evidence-based guidelines. However, once adjusted or manipulated, spinal joints then require rehabilitation. Rehabilitation of the spine can take on many forms: stretching, traction, electronic stimulation, heat and ice therapy, and on and on. But exercise is the cornerstone of skeletal healing.

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