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What Exercises Are Best for Back Pain Patients?

Exercise choices for back pain used to be fairly straightforward, primarily because most people used the same approach. First described in 1937, flexion exercises developed by Paul Williams dominated for several decades. Williams felt that back pain was a direct result of lumbar lordosis and admonished people to "always sit, stand, walk and lie in a way that reduces the lumbar curve." Toward that goal, he suggested strengthening the abdominal and gluteal muscles. His exercise protocol included: partial sit-ups; knee-to-chest exercises; hamstring lurches; seated flexion; and squats. These exercises were selected to create flexion of the spine.

Then came McKenzie, with his preference for extension exercises. McKenzie's idea was to strengthen posterior trunk muscles under controlled and reproducible circumstances. He believed that predisposed factors for the development of low back pain are: prolonged sitting in the flexed position; frequency of flexion; and lack of extensive range, as it is an accumulation of flexion forces, not extension, which leads to back pain.

Both authors agreed, however, that the intervertebral disc was the primary cause of back pain. Thought the debate raged over which of the two exercise protocols was better, the treatment goals Williams and McKenzie were similar: they gave patients rationales for why back pain developed; they gave patients self-control techniques; and they agreed that the sooner patients became active, the sooner their backs would feel better.

In the past several decades, a number of other exercise programs have gained popularity, but none have gained dominance. While there are a number of different schools of thought on exercises for the back and which type of exercises is best, there is an agreement on the objectives of exercises:

· Decrease pain;
· Strengthen weak muscles;
· Decrease mechanical stress on spinal structures;
· Improve fitness levels;
· Stabilize hypomobile segments;
· Improve posture; and
· Improve mobility.

Conclusion: It may be more important that back pain patients perform some form of exercise, rather than focusing on any one type of exercise.

Hooper PD. Does is matter what exercise patients do for back pain? Journal of the Neuromusculoskeletal System 2000:8(2), pp 49-52.

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