Prevent back pain with exercise, not orthotics, review says

Low back pain is one of the most commonhealth problems in theworld,with at least 80 per centof people experiencing at leastone episode in their lives, says an Australian report.

About 90 to 95 per cent of adultshave"non-specific back pain," it says.That's medical code for a pain whosecause cannot be pinpointed.

The science on lower back pain

9 years ago

Duration 2:02

Most Canadians will likely deal with lower back pain at some point in their lives. Now there's some scientific consensus on the most effective way to get relief.

The key to preventing lower back painisnot expensive shoe insoles and back straps, but exercise, says ChrisMaher, a health researcher and professor with the George Institute for Global Health at the University of Sydney.

In a recently publishedscientificreview in JAMA Internal Medicine, Maher and his colleagues analyzed data from more than 20 studies with about30,000 participantsfrom around the world with a history of back pain.

Researchers then looked at the best approach to preventback pain, including educationcombined withexercise, exercise alone, and the use of orthotics and back braces.

What they found was surprising,says Maher. The only preventive measuresupported by evidence isexercise programs.

Maher says the review found that lots of other things that people try, including "orthotics in shoes, back braces, redesigned workplace," weren't shown to be effective.

Many people believe in good faith that using a back braceis a good way to preventback pain,Maher told CBCNews. But it's not particularly useful, and the same goesfor those insoles in your shoes.Maher calls using braces and insoles "amisguided approach."

Dr. RajaRampersaud, an orthopedic surgeon at Toronto WesternHospital, told CBC News,"One of the challenges is,we'realways looking for quick fixes.For the majority of individuals, I'd say 80 to 90 per centofpeople, there's no quick fix."

He agrees thatexercise is the best medicine for back pain.

"If you see10 people,"he says, "we'll get 12 opinions as what is wrong with yourback and what you should do." But the one thing that is consistent,"actually comes down to exercise,"he says.

At Pilates Processin Toronto, owner and fitness instructorLaura Helsel says about half her clients have come because of back pain, and half of those have lower back pain.

"There are certain quick fixes that people arenaturally drawn towards.It's not surprising that those products are
overprescribed, and perhaps overused," she says.

"Movement is good. We are meant to move. Every study has pointed to that fora very long time."

Exercise provides a bonus,Maher and his team found."The interesting thing is the effect of exercise was quitelarge. In one of the trials, it halved the risk of lower back pain inthe next year."

But Maher noticed recurrences after 12 months if participants stopped exercising.

Aging population

Lower back pain is not only a painful condition,it generatesenormous costs in treatments and time lost from work, the review says. In anaging population such as Canada's, the number of people affected islikely to increase.

With a high recurrencerate of lower back pain, the study states, "It's important to knowwhether it is possible to prevent LBP and, if so, which interventionsare most effective."

But getting research funding into back pain has been, well, a pain inthe neck for Maher and his colleagues.

He says there's a reluctanceto spend money on pain research."When you speak to people who fundmedical research,they seem to think of back pain as atrivial issue."

Acommentary attachedto the JAMA reportsays there is concrete evidence on the value ofexercise to prevent lower back pain, but"formal exerciseinstruction after an episode of LBP is uncommonly prescribed byphysicians."