Recently some research has been published that has really changed the game in treatment in low back pain, specifically in treatment of long term debilitating back pain. In one particular study published in Spine a group of researchers set to discover what factors best predicted a worker who has been out on leave for their low back returning to work. The researches set out to use medical, psychological, and sociodemographic predictors that would have an significant impact on ability to return to work.
Medically speaking it was found that by using a light mobilization program workers were much more likely to return to work than those who did not have a light mobilization program. What makes this so important is that it shows that the old standard of restricting motion in the lower back during injuries does not only not help but can make problems worse. Inactivity was actually found to delay recovery. While certainly there is a psychological factor in this. People who are inactive tend to develop a “sick” mind frame that becomes difficult to over come. While people who are more active view themselves as healthy people who simply have a bout of low back pain.
As a chiropractor when I read this study I see that beyond the mental changes that develop due to inactivity there are strong anatomical factors at play as well. When inactive our surrounding structures of our spine begin to change. Muscles atrophy ligaments, shorten and tighten, proper blood flow and nutrition fails to flow into our intervertebral discs. All of these changes lead to an inability for our spines to function as a normal unit therefore increasing the possibility of further injury and creating a downward spiral of inactivity leading to more injury that leads to more inactivity and so forth.
While there are certainly times to restrict spinal motion to prevent injury in the vast majority of cases that should be for only a short period of time to help promote return to proper spinal motion as soon as possible. Click here for some exercises that are great to increase core strength and train proper spinal motion.
In addition the researchers found those who did not return to work to be influenced by sociodemographic factors as well. The study found that non-returners:
- Were older.
- Had more children.
- Had more children living at home.
- Had been in one job for more years.
- Reported more physical workload.
- And had reduced ability to perform ordinary work.
Haldorsen E, Indahl A, Ursin H. Patients with low back pain not returning to work. Spine 1998;(23)11:1202-1208.