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Monday, October 22, 2012
Exercises for spinal pain - What's the use?
The following is borrowed from Matthew Long at Clinical Development International (CDI) where you'll find the full article and it's references.
Quite a few large studies investigating the effectiveness of different exercises for chronic low back pain (cLBP) have come up with apparently confusing results. As a group these exercises are directed at specific functional weaknesses in the core muscles which act as a dynamic 'girdle' to support the lower spine and pelvis. Do these exercises work?
The answer is no. The answer is also yes and it's not always for the reasons we think.
Generally people report subjective improvement with exercise but some report reduced pain even when there is no real change in muscle recruitment and vice versa; others display improved muscle tone but don't report a reduction in pain. Pilates and core stability clinics have gone through a phase of being the next panacea for cLBP sufferers but it's not backed up by research. What's going on?
One problem is that cLBP isn't a diagnosis so people experiencing cLBP do not share exactly the same problems. A one size fits all approach is a big issue with cLBP studies as they do not target specific conditions. However there is still useful information to be gleaned.
Chronic pain (lasting past an expected healing time) is produced by the brain. It's a kind of memory of the injury and the brain becomes hypersensitive to normal movement. The brain can act as a thermostat lowering the threshold or required intensity of sensations from joint movement and give the perception of pain during normal movement. After all the function of pain is to stop you from injuring yourself but if the injury is in the past...... It's thought to be a normal protective mechanism which can get out of hand. People with cLBP have displayed reduced cortical or grey brain matter so it appears that chronic pain actually results in brain atrophy.
'Move it or lose it' makes even more sense these days than it did before. Overall ANY movement or exercise which the patient undertakes and enjoys or is otherwise motivated to perform has the ability to improve both joint mechanics and the way the brain 'feels' or perceives the joint structures.
It's important for patients to understand that moving is what we are primarily evolved to do and the lack of it leads to body AND brain wasting.
Conversely chronic neck pain (cNP) is a little different with improvements in neck muscle function coinciding with reduced pain both in the neck region and interestingly in distant areas like the lower leg (so like cLBP cNP also appears to have a 'thermostat' component).