Exercise – Key to Good Health and Back Pain Management

Thomas E. (Ted) Dreisinger, PhD.

Therapy Advisors – San Diego, CA

Exercise for health and disease management is not a new idea.  Claudius Galen’s (129-210 B.C.) influence regarding what has been called ‘the things non-natural’ (clean air, healthy food, appropriate sleep, good working bowels, balanced passions and proper exercise)1 informed physicians well into the 19th Century to include exercise as an important part of their medical practices.2  Next to Hippocrates, he was the most influential physician of the ancient world.  He taught these principles were interactive, and if used in moderation as dictated by natural law, good health would be the result.  It was not until the late 1800s, when western medicine and healthcare became focused on ‘sick care and disease’ that the emphasis on prescribed exercise slipped into the background of medical practices.3

In the 1960s, there was a changing focus in the American population as it related to overall wellbeing.  Heart disease was a public epidemic. In addition, smoking and excessive alcohol were seen as deterrents to good health, and people began, once again, to take an interest in their own wellness.  While it seemed this shift in focus was a new phenomenon, historically, physical activity served as a platform for good health.4 Exercise received much more emphasis as healthcare began to find a balance within the monolith of ‘disease management and rest’ that had dominated medicine in the United States for more than 80 years.

Today, there is little controversy regarding the importance of exercise in healthy lifestyles, longevity, quality of life, mental wellness and the management of many chronic diseases, including low back pain. 5-9 In point of fact, exercise is the only meaningful way to increase functional capacity.10 Rather than the value of exercise in the management of back pain, there may be more of a question as to its place: alone or in combination with cognitive and/or biopsychosocial strategies.11-13

Systematic reviews have consistently provided recommendations for more, rather than less, activity as an aid to recovery.14,15 Thirteen countries and two international groups, in addition to subgroups within professional societies, insurance companies and other stakeholder agencies, have published clinical guidelines for the treating of low back pain that include exercise as an integral part of the clinical management strategy.15 

In patients with acute back pain, early activation should ideally begin in the primary care setting.  Unfortunately, a large percentage of primary care physicians do not recommend exercise for their back pain patients.16,17 Some general practitioners cite patient preferences that override their clinical judgment even when they know the importance of recommending increased activity.18 This suggests a need for improved dissemination of information regarding the value of continuing to be active.  It is important to uncover the patient’s own motivations and then align them with appropriately active treatment goals; this can be accomplished by skillful practitioners.19

There also is good evidence for the use of exercise directed therapy for patients with chronic back pain; such therapy is generally within the context of a rehabilitation setting. 14,20,21 When compared with other therapeutic approaches, exercise demonstrates positive results both by itself and in combination with cognitive interventions.  Furthermore, structured exercise has been shown to be cost effective in reducing disability.22,23 

It seems strange that we have allowed most back pain in this country to be treated under a medical model.  It is further curious that we have felt we need research, systematic reviews and clinical evidence to encourage people to exercise when their back hurts.  Hippocrates and Claudius Galen would be turning over in their graves!



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4.  Kimble C. Health in America. Wilson Q. Spring 1980:60-101.

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14.  Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. May 3 2005;142(9):776-785.

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16.  Little P, Smith L, Cantrell T, Chapman J, Langridge J, Pickering R. General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines. Bmj. Feb 24 1996;312(7029):485-488.

17.  Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C. Orthopaedists' and family practitioners' knowledge of simple low back pain management. Spine (Phila Pa 1976). Jul 1 2009;34(15):1600-1603.

18.  Schers H, Wensing M, Huijsmans Z, van Tulder M, Grol R. Implementation barriers for general practice guidelines on low back pain a qualitative study. Spine (Phila Pa 1976). Aug 1 2001;26(15):E348-353.

19.  Rollnick S, Miller WR, Butler C. Motivational interviewing in health care : helping patients change behavior. New York: Guilford Press; 2008.

20.  Rainville J, Jouve CA, Hartigan C, Martinez E, Hipona M. Comparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per week. Spine J. Nov-Dec 2002;2(6):402-407.

21.  Hartigan C, Rainville J, Sobel JB, Hipona M. Long-term exercise adherence after intensive rehabilitation for chronic low back pain. Med Sci Sports Exerc. Mar 2000;32(3):551-557.

22.  Smeets RJ, Vlaeyen JW, Hidding A, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC musculoskeletal disorders. 2006;7:5.

23.  Smeets RJ, Severens JL, Beelen S, Vlaeyen JW, Knottnerus JA. More is not always better: cost-effectiveness analysis of combined, single behavioral and single physical rehabilitation programs for chronic low back pain. Eur J Pain. Jan 2009;13(1):71-81.              


Thomas E. (Ted) Dreisinger, PhD.

Therapy Advisors – San Diego, CA

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