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Week 12

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Reason 12

Exercise Decreases Lower Back Pain

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Lower back pain

Many people experience lower back pain (LBP). It is a common complaint in seniors and increases disability and creates functional limitations in later life. Most of the time, lower back pain resolves on its own within a few weeks. However, in some cases, the pain may become chronic. Chronic lower back pain is pain that lasts for more than three months. It affects nearly 20-25% of adults aged over 65 years and is the leading cause of disability worldwide.

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Back pain can frequently affect seniors

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Exercise and lower back pain

The study by Hicks and co-workers from the Tuscany region in Italy shows how group exercises can help with lower back pain. In their study, 392 adults between the ages of 50 and 88 participated in a physical activity programme for two days every week for a period of 12 months. More than 60% of the participants noticed that their back pain had improved during the 12-month period [1].

Exercise and Degenerative Spondylolisthesis (DS)

In the spine, vertebrae are arranged one over the other. Behind each vertebra is a ring of bone. All the rings, one over the other, form a canal through which the spinal cord and the nerves travel. In degenerative spondylolisthesis one of the lower lumbar vertebrae slips forwards. As the vertebra slips forward, the upper ring slips forward in relation to the lower ring. When one ring slips over the other, the space available for the nerves that pass through decreases. The edge of the ring traps the nerve as it slips forward, and this causes pain [2]. The narrowing of the space for the nerves is technically called stenosis.

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Degenerative spondylolisthesis, where one of the vertebrae slips forward, is the commonest cause of back pain and sciatica in seniors. Women are around five times more likely to develop this condition than men. The pressure on the nerve causes lower back pain and nerve pain down the legs (sciatica).

In the past few decades, surgery has become a popular intervention for degenerative spondylolisthesis. However, surgery is not absolutely necessary.

A study published in 2017 investigated this by following 120 patients with moderate degenerative spondylolisthesis, with an average age of 68, for 3.3 years [3]. At the start and end of the study, participants were asked to report their leg and back pain on a 0-100 pain scale, where 0 is “no pain at all” and 100 is “as much pain as possible”. In the 3.3 years, the leg pain of 32% of participants spontaneously improved without any surgery.

Additionally, 36% of participants had spontaneous improvement of their back pain, again with no surgery [3]. The study concluded by supporting reluctance to surgery if the symptoms levels are tolerable for patients. The multi-centre SPORT trial [4] compared surgery and non-operative treatment for degenerative spondylolisthesis. 107 patients underwent surgery and 103 patients were treated none operatively and followed up for eight years. Pain and outcomes improved in both the groups over the period of eight years, but the improvement in the surgical group was better than the non-operative group. Oswestry Disability Index is measured on a scale of 0 to 100, where 0 indicates “not disabled” and 100 indicates “most severe disability”. At the start of the study, the average disability of the patients was 42.4 [4]. Patients who underwent surgery decreased their disability by 18.1 points, while the non-surgical group decreased their disability by 7.9 points [4]. In summary, if non-surgical methods are not successful, then surgery could be considered.

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The leg pain in one-third of the patients improved spontaneously

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There also exists some controversy on the type of exercises that need to be performed for degenerative spondylolisthesis. Some suggest flexion exercises (bending forwards and increasing the flexibility of the spine), whilst others suggest stabilisation exercises (strengthening rather than flexibility exercises). The study by Nava-Bringas and team investigated both these exercises. 92 patients over the age of 50, were randomly allocated to either lumbar stabilization exercises or flexion exercises [5]. Participants received six sessions of physical therapy (monthly appointments) and were instructed to execute the exercises at home each day during the six months of the study. Lower back and leg pain intensity were measured using the 0-100 pain scale described previously. These measures were taken before, during and after the intervention. After six months, both groups had reduced pain in the lower back by an average of 24.8 points on the 100-point scale. Both groups also reduced the pain felt in the legs by an average of 15.31 points. Additionally, disability was measured using the 0-100% Oswestry Disability Index (ODI). On this scale, a score closer to 100% means completely disabled and 0% means no disability. Following the exercises, participants in both groups reduced their disability scores by an average of 12.75% [5]. These results show that both lumbar stabilization and flexion exercises offer similar results with regards to controlling pain and decreasing disability in patients with degenerative spondylolisthesis.

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Aerobic and strengthening exercises can help with back and neck pain

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Ageing gracefully – increased sedentary time by watching TV

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Ageing gracefully – less activity with increasing aches and pains

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Ageing healthily – associated with increased activity

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Ageing healthily – associated with consuming plant-based foods

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Metaphor 12 – How Do I Make My Back Strong?

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What is the story?

Prabhu went camping with his family. They put up a tent and secured it with guy lines.

On the second morning, Prabhu noticed that the guy lines seemed to be slack, but since the tent pole was erect, he ignored the slack guy lines and did not tighten them.

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So, what went wrong?

The guy lines were slack in the morning. For the tent to remain standing, it needs both the pole and the guy lines. If the guy lines had been tightened, then the tent wouldn’t have collapsed during the day. The guy lines need to be constantly tightened in order to support the tent.

How can we relate this story to our health?

We are only able to stand upright because of both the bones and the muscles which surround them. The bones by themselves will not be able to keep us upright. Similarly, the tent pole by itself cannot keep the tent erect. The guy lines are as important as the tent pole in keeping the tent erect. Similarly, our muscles are equally important as the bones in keeping us upright. Unfortunately, X-rays and MRI scans seem to focus on the bone and joints and ignore the muscle. Just as guy lines need to be constantly tightened, our muscles need regular exercise to keep them healthy and powerful, enabling them to provide the necessary support.

Moral of the story

For a strong back – regular exercise and maintenance help our muscles provide support.

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Exercise Notes For Week 1

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“Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.”

“At vero eos et accusamus et iusto odio dignissimos ducimus qui blanditiis praesentium voluptatum deleniti atque corrupti quos dolores et quas molestias excepturi sint occaecati cupiditate non provident, similique sunt in culpa qui officia deserunt mollitia animi, id est laborum et dolorum fuga. Et harum quidem rerum facilis est et expedita distinctio. Nam libero tempore, cum soluta nobis est eligendi optio cumque nihil impedit quo minus id quod maxime placeat facere possimus, omnis voluptas assumenda est, omnis dolor repellendus. Temporibus autem quibusdam et aut officiis debitis aut rerum necessitatibus saepe eveniet ut et voluptates repudiandae sint et molestiae non recusandae. Itaque earum rerum hic tenetur a sapiente delectus, ut aut reiciendis voluptatibus maiores alias consequatur aut perferendis doloribus asperiores repellat.”

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Remember the traffic light system should be used when you exercise.
Please do not go through the red light or break the pain barrier!

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Short intro of encouragement to compliment the notes above.

Please now go to the video page and begin you exercise plan for the week.

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Head and Neck

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Lower Back

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Otago

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References

Hicks GE, Benvenuti F, Fiaschi V, et al. Adherence to a community-based exercise program is a strong predictor of improved back pain status in older adults: an observational study. Clin J Pain. 2012;28(3):195-203.
Tenny S, Gillis CC. Spondylolisthesis. [Updated 2020 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/
Wessberg P, Frennered K. Central lumbar spinal stenosis: natural history of non-surgical patients. Eur Spine J. 2017;26(10):2536-2542.
Abdu WA, Sacks OA, Tosteson ANA, et al. Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2018;43(23):1619-1630.
Nava-Bringas TI, Romero-Fierro LO, Trani-Chagoya YP, Macías-Hernández SI, García-Guerrero E, Hernández-López M, Coronado-Zarco R. Stabilization Exercises Versus Flexion Exercises in Degenerative Spondylolisthesis: A Randomized Controlled Trial [published online ahead of print, 2021 Apr 1]. Phys Ther. 2021;pzab108.

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