Sports Medicine Approach to Low Back Pain

Mathew W. Lively, DO

South Med J. 2002;95(6) 

In This Article

Applying the Sports Medicine Model

When patients present with LBP, they should first be advised to avoid bed rest and return to activities of daily living, including work, as soon as possible. Some individuals may require initial lifting restrictions or limited time at work, but every effort should be made to return the patient to a safe work environment. Patients who are severely limited in function due to discomfort should be advised to change position frequently throughout the day. Urging patients not to stay in any one position for more than 30 minutes encourages frequent movement and activity while avoiding bed rest. It must also be emphasized that some element of these position changes should include walking, even if only for brief periods.

Patients should also be instructed to start a low-level aerobic exercise program. Walking is typically the easiest activity for patients to begin, but riding a stationary exercise bicycle or swimming are also acceptable. Patients should be told to perform an activity at least once daily for a specified length of time, followed by weekly increases in the duration of the exercise. Initial time goals may need to be set low for some individuals. For example, a severely limited individual may be advised to walk on a level surface for only 5 minutes each day for a week. The following week, they should increase the time to 7 minutes of daily walking, and the next week they should progress to 10 minutes a day. The patient should continue the weekly increases until the goal of 30 minutes of daily walking is reached. An individual with a higher functional baseline would be able to start the activity at a longer duration but should continue to progress in weekly increments.

While this approach tolerates and expects some complaints of pain, it does not seek to ignore all of the patients' pain. Medication for adequate pain control is often necessary to enable patients to take part in an exercise program. Since the goal is to increase functional activity throughout the day, analgesic medication is often more effective when used on a time-dependent dosing schedule rather than on a symptom-dependent "as needed" basis. Patients must also be warned to seek medical attention if they develop bowel or bladder dysfunction, saddle anesthesia, bilateral paresthesias, and/or lower extremity weakness. Those who question the safety of low-level exercise with LBP can be assured that, in studies utilizing activity in the treatment of both acute LBP[21,22,23,24] and chronic LBP,[25,26,27,28,29,40] there has been no evidence of adverse complications. In fact, an in vivo investigation of disk pressures has shown that walking exerts no more force on the spine than sitting.[41]

After initial recovery from functional limitations, patients may require an individually tailored exercise program based on their specific diagnoses, muscle imbalances, or job tasks. These individuals will need referral to a formal physical therapy program to complete their injury rehabilitation. Patients should also be encouraged to continue their aerobic exercise program to help prevent future recurrences of LBP and to take advantage of the general health benefits of frequent exercise. The sports medicine approach for the management of LBP is summarized in the Table 1 .

Low back pain is a common and recurrent problem in the general population. Recent evidence has shown that early activity and exercise is more beneficial than bed rest for both initial recovery and secondary prevention of future problems. Based on this knowledge, the sports medicine model of injury rehabilitation utilizing early and progressive activity can be effectively applied to the management of LBP in the general population.

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