Exercises that cause back pain is a controversial topic that always creates heated debate among patients and doctors alike. On one hand, exercise is great for the body and is a necessary part of a healthy lifestyle. However, exercise is also cited as one of the leading causes of back injury and back pain, making it a particularly frightening proposition for people with a history of acute or chronic dorsalgia.
Exercise therapy is one of the most widely utilized and popular forms of treatment for a wide range of back pain problems. This fact is also controversial, with many experts arguing about its efficacy or indication in many of the most common patient scenarios.
This important dialog tackles the tough topic of whether or not exercise can cause back pain, as well as discussing other exercise-related considerations, such as the use of exercise as a therapy modality for back pain sufferers.
Exercise consists of any physical activity. There are exercises that are not very efficient and those which are incredibly efficient in making the body perform to its limits. Simply standing and walking are forms of low level exercise. On the opposite end of the spectrum, swimming, martial arts and aggressive running earn top scores for maximum benefit for time invested.
Ironically, there does not seem to be any correlation between the level of exertion involved in the exercise and the incidence of back pain generated from participation. Patients may cite the start of back pain or the worsening of present symptoms from any form of exercise, no matter how innocent and stress-free it might seem. This should be no surprise, since many people complain that other completely innocuous activities also exacerbate their pain, such as sitting, reclining and even sleeping. Meanwhile, many of the most active and conditioned athletes constantly push themselves with extreme physicality day after day, yet do not suffer any pain or negative consequences from their exertions.
Therefore, we see no reason to suspect that any particular form of exercise actually causes back pain when compared to any other form of exercise. Patient statistics point to far more innocent activities as contributory factors than the types of activities one might logically suspect in most cases. In essence, more people complain of worsened pain from standing, walking and light housework than they do of pain due to swimming, hiking, or sports-related strain. This is an interesting point to consider.
However, we would be amiss in not telling the whole truth of this story, even if the activity-related facts presented do not necessarily or inherently lead to painful expressions. High risk activities might carry increased chances for injury to the back, spine or anywhere in the anatomy. Exercises such as horseback riding, martial arts, rugby, American football, serious weight lifting, rowing, gymnastics and high level parkour are known to create the ideal circumstances for injury to exist. However, as reported previously, we see no indication that people who participate in these activities demonstrate any special susceptibility to chronic back pain.
Back pain can be caused by direct injury or as a consequence of degeneration and breakdown of the spinal structures to the point of dysfunction. However, injury should heal in a short timeframe, while degeneration is completely normal and expected in the human vertebral column and rarely reaches the degree of becoming pathological.
Injury to the spine or the back muscles is a common consequence of exercise. Anyone can “overdo it” and suffer mild to moderate soft tissue strain. It is also possible to injure the bones or discs of the spine from focal traumas. Exercise that involves impact or violence usually increases these risks significantly. Injury can result in acute pain, mild sharp pain or dull burning pain. In most cases, symptoms should resolve completely and organically, especially in athletic individuals. When injury becomes a chronic problem, as it often does, then one must suspect that something other than the exercise might be the original culprit from the onset. This is logical being that the anatomy’s primary imperative is to heal and heal it should in virtually every circumstance. Hence, we put forth the widely accepted idea that many “injuries” are nothing more than perception of injury, where the activity is blamed for the cause, but in reality, some other non-structural process is actually causing the pain. In most instances, this mystery process is regional oxygen deprivation.
Athletic activity can certainly worsen and accelerate the spinal degenerative processes. Continual repetitive activity is known to increase the expression of osteoarthritis, degenerative disc disease and overall deterioration of the spinal tissues. Furthermore, repetitive stress can cause similar problems in the soft tissues, such as scar tissue formation, tissue detachments and muscular imbalances. Exercises virtually always involve repetitive motions that can instigate and stimulate this occurrence, with some, such as gymnastics, being well known to reshape the spine at a dramatically premature age. Just remember, spinal degeneration is not inherently painful. More people demonstrate mild to moderate degeneration that is considered completely normal, yet still have these age-related changes unfairly and illogically blamed for causing their pain than do people with extreme degeneration. In fact, we routinely see many imaging studies of people with shocking levels of extreme spinal deterioration who experience no pain whatsoever.
Since exercise is often implicated as a direct cause of back pain, it is rather ironic that it is also one of the most popular and widely utilized treatments for back pain. In fact, many patients who have been told they injured themselves while exercising are then given more exercises to fix the damage. How does this make sense?
The fact is that exercise therapy is always great for the body and improves general health. However, unless the goal is to rehabilitate a specific actual injury that is past the acute stage, or to correct a muscular imbalance, then exercise really does not stand much hope of curing back pain. It certainly seems illogical when used to treat spinal structural issues, such as osteoarthritis, herniated discs and spondylolisthesis, yet it remains one of the most prevalent therapies for these and other spinal conditions. Typically, the explanation tells that “exercise helps support the spine” which is more of a cop-out answer than we can deal with in this essay, but we have written on this subject before. Basically, the spine does not need any more support than it normally receives. The muscles of the back are unbelievably strong and capable. They get plenty of exercise throughout life by just doing their job of keeping us upright.
Our experience has shown that normal exercise activities are virtually never the cause of lasting serious back pain, although they may be contributory or causative for short-lived minor injuries that do result in some pain. Likewise, exercise stands little hope, from a scientific viewpoint, of providing true and lasting relief for the most commonly diagnosed causes of pain, yet it seems to work well for many patients even when the reason for its efficacy seems mysterious. We defer back to one of our most important lessons as the true reason why exercise works to some degree in most patient profiles, but rarely provides a lasting solution for pain: Most back pain is misdiagnosed and therefore the exercise works mainly as a placebo and as a countermeasure to some of the more likely true causes of pain, such as ischemia.