I’ve never been a big fan of passive physical agents in the treatment of chronic low back pain. I just don’t think they have much to offer (for the record, short of cyrotherapy [ice], I don’t think they have much to offer in just about any case. I’ve done one ultrasound treatment in the last 7 years and only because I was “ordered” to do so.).
Sure a little ice or heat can certainly reduce pain and temporarily increase mobility in the pre or post-exercise period, but as far as making a huge impact in reducing symptoms or increasing function…well, it just doesn’t happen.
On the other hand, exercise is typically the “fix”.
Oddly enough, aerobic exercise tends to be quite successful in this regard.
In the most recent Physical Therapy journal (Phys Ther. 2007 Mar;87(3):304-12) there was a pilot study that showed just that.
They compared a passive physical agents group (diathermy, ultrasound, electric stimulation, and laser treatments) who did no exercises to an aerobic exercise group. The aerobic exercise group progressively increase exercise time to 50 minutes at up to 85% of their heart rate reserve.
They then compared pre-study scores of subjective pain and disability to post-test score for each group.
Guess what?
The exercise group recorded reduced pain and disability after the 12 weeks, and the control group who just received the passive physical agents didn’t change at all. They also reported reduced feelings of depression and anxiety (so much for anti-depressants…do you think there’s a connection between the number of folks on anti-depressants and the ever increasing sedentary lifestyle of Americans??).
A couple things to keep in mind. The subjects who were successful in this study progressively increased the intensity of the exercise. I think this is an important point.
They weren’t walking casually. They were eventually running on the treadmill for 50 minutes at a good clip.
Intensity is the key to most forms of exercise. We know that higher intensities of activity promote greater fat loss AND promote higher levels of fitness overall over a shorter time period.
Now there’s evidence in that it’ll help your back pain too.
Perhaps we need to adjust our mindsets to “Work harder, not smarter.”
Later
P.S. I’d like to see the results with some strength training and even higher-intensity intervals thrown in.