Does aerobic exercise cure lower back pain?

Chronic lower back pain is a growing problem for today’s society, costing the UK economy £12.3 billion per year (Donaldson 2009). No surprise then that it is now the most common muscular skeletal problem, that will according to recent studies affect 60-80% of all adults at some point in their lives (Ebadi et al. 2013). NICE (2009), defines chronic non-specific lower back pain as ‘tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain’. Common perception nowadays has moved towards corrective exercise, strengthening the core stabilising muscles to help reduce the pain, this article will look at whether the evidence surrounding aerobic training and lower back pain will validate its place as a worthwhile remedy for the increasing problem lower back pain presents in todays society.

Low aerobic fitness has been positively associated with Chronic lower back pain (Duque et al. 2009) and several studies have looked at aerobic exercise as an intervention technique.

Chatzitheodorou et al. (2007), looked at 20 patients over a 12-week training period. They found that patients in the experimental group who trained at 85% of their maximum heart rate, running on a treadmill 3 times per week had a reduction of 41% in their lower back pain (significant to p<0.001) compared to a control group who had no intervention. This study did however exclude people with a BMI of >30 therefore cannot be generalised to a population who are heavily linked to suffering from lower back pain. (Chou et al. 2016)

Chan et al. (2011), took one step further by comparing aerobic exercise of a lower intensity (40-60%) to standard physiotherapy techniques (core stabilisation, lower back mobilisation etc.) in 46 participants over an 8-week period. The same procedure of 3 sessions a week was implemented and the aerobic condition showed a 47 % decrease in pain based on a self-report questionnaire, 7% higher than the physiotherapy group. This furthermore suggests aerobic training to be being a useful technique in reducing back pain. This study does however make the point that the aerobic training was additional on top of the physiotherapy techniques so the difference aerobic training made was only 7 %. This may further highlight corrective exercise techniques may be more beneficial as a primary intervention technique.

Shnayderman & Katz-Leurer (2013) present one of the only studies directly comparing aerobic exercise to muscle strengthening techniques specific to the lower back. Their 6-week intervention study took 52 patients, half training twice a week at 50% of their maximum heart rate walking on a treadmill, compared to a specific lower back strengthening programme, results from this showed a 20% reduction in reported lower back pain for the walking group compared to 15% for the strengthening group. This goes against Chens study and suggests that aerobic training has a bigger impact for reducing lower back pain alone than strengthening exercises.

In summary the bulk of evidence suggests aerobic training to have a significant impact on reducing non-specific lower back pain and therefore should definitely be part of programmes looking to improve this issue. This being said the evidence highlights clear confusion as to how to best implement this. All the studies implemented different intensities and type of aerobic training along with different lengths of interventions illustrating a need for more research into the details of how aerobic training should be implemented to be most effective. In terms of aerobic training as a lone technique the evidence is weak and evidence supporting corrective exercises cannot be ignored suggesting a mixed intervention technique to be most beneficial. Individual differences in results would imply that trialling different variations of training is the best way to find out which one works for you. Enjoy!

CHATZITHEODOROU, D. et al., 2007. A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain. Physical Therapy, 2007;87(3), 304–312

CHAN C.W. et al., 2011. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 92(10),1681–1685

CHOU, L., 2016. The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men. Medicine, 95(15), 3367

DONALDSON, L., 2009. Pain: Breaking through the barrier. Chapter in 150 years of the Annual Report of the Chief Medical Officer: On the state of public health, London, Department of Health [Viewed 27th November 2019]. Available from http://www.sthc.co.uk/Documents/CMO_Report_2009.pdf

DUQUE I.L. et al., 2009. Aerobic fitness and limiting factors of maximal performance in chronic low back pain patients. Journal of Back and Musculoskeletal Rehabilitation, 22(2), 113–119

EBADI, S. et al. 2013. A study of therapeutic ultrasound and exercise treatment for muscle fatigue in patients with chronic non-specific low back pain: a preliminary report. Journal of Back and Musculoskeletal Rehabilitation, 26(2), 221-226

NICE, 2009. Low Back Pain: Early Management of Persistent Non-specific Low Back Pain. London, Royal College of Practitioners [Viewed 27th November 2009]. Available from https://www.ncbi.nlm.nih.gov/books/NBK11709/

SHNAYDERMAN, I. and M. KATZ-LEURER, 2013. An aerobic walking programme versus muscle strengthening Programme for chronic low back pain: A randomized controlled trial. Clinical Rehabilitation, 27(3), 207–214