# Exercise as it relates to Disease/Chronic lower back pain and the effect of exercise rehabilitation

This fact sheet is an analysis on the journal article ‘’Randomised controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilization trial’’

## What is the background to this research?

Lower back pain is chronic disability that is common in multiple age groups of the western society. The injury is related to time off work and results in a high economical cost for the population effected.

#### What is Lower back pain (LBP)?

Lower back pain is located in the lumbar region of the spine and back area(L1-L5). Lower back pain is the second most prominent chronic illness for physician visits; the pain from this disability is not only physical, but also can cause be psychological. Physical and psychological pain may include:
* Depression
* Anxiety
* Sleeplessness/Insomnia
* Sharp/Aching pain
* Pain from prolonged sitting
* Pain that travels to the legs and feet
* Distress

## Where is the research from?

The study was conducted at 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom by Professor Rory Collins and his team of specialists consisting of orthopaedic surgeons, statisticians, and physiotherapy researchers. Rory Collins is a professor of medicine and epidemiology at University of Oxford.

## What kind of research was this?

The research design was a multicenter randomized controlled trial (RCT), where the researchers allocated an intervention to a specific group or control group from a cluster of people, whilst the other group receives an alternative intervention or no intervention.

## What did the research involve?

This research involved a total of 349 participants within the age bracket of 18-55 with a minimum of one year’s duration of chronic back pain who were also considered candidates for spinal fusion. The test was conducted across 15 hospitals in the UK. The participants in the study were either assigned to surgery or rehabilitation. The aim of the study was to reach a conclusion of whether surgical stabilization of the spine would be more or less effective than the worthwhile relief of the pain and symptoms over a two year long intensive rehabilitation derived from the principles of cognitive behavior therapy. The methodology was overall solid as it consisted of an eligibility criterion (aged in between 18-55 and must have a minimum of one year’s history of chronic lower back pain) to eliminate possible errors of unreliability and invalidity. The surgeons also considered patients ineligible if they were affected by infection or other comorbidities, or if the patient has had previous surgical stabilization surgery they were also invalid.

#### Intervention - Rehabilitation Program

The rehabilitation program consisted of educational and exercise sessions 5 days a week over the period of 3 weeks which was led by physiotherapists and also included clinical psychologists in majority of hospitals. The type of exercises practiced were individually tailored and paced to increase repetitions and duration. The types of exercise include:
* Stretching of major muscle groups
* Flexibility of spine
* Muscle strengthening
* Various cardiovascular endurance exercise
* Hydrotherapy (majority of health centers)

## What were the basic results?

The number of patients who required further treatment after the intervention were significantly different, the number of patients who were involved with the surgery (176 people) who required further treatment was 97 (55.1%) whilst the patients who were involved with the rehabilitation (173 people), only 68 (39.3%) required further treatment post intervention. Although these numbers show importance it is also vital to note that only 139 (79%) people of the surgery group did not partake in the study, whilst 37 either switched or did not receive the allocated treatment. Furthermore only 151 (87%) of patients took part of the rehabilitation intervention, whilst the other 22 participants also switched or did not receive the allocated intervention. It is also notable that 19 patients had complications post-surgery, this includes complications such as; bone fracture, implant problems, excessive bleeding and many more in some cases leading to further surgery (2 years post). Close to three quarters of the patients who were undertaking rehabilitation avoided surgery by two years.

## What conclusions can we take from this research?

The final results of the study show that physical rehabilitation has a positive impact on the prevalent issue in today’s society, physical rehabilitation that includes the specific cognitive behaviour approach is also not widely available to all suffering from chronic lower back pain; although concluding from the study it needs to be available to everyone. The results in comparison to similar studies done on chronic lower back pain share similar conclusions that physical rehabilitation individually designed to one’s specific needs will have a positive impact on one’s wellbeing by reducing pain intensity.

## Practical advice

If you are seeking assistance on chronic lower back pain, it is good choice to consult a doctor and physiotherapist for advice, and requesting specialists to tailor a program to your specific needs as not all injury’s will be the same.

## Further Reading & Resources

* Guidance (long term): https://www.healthdirect.gov.au/back-pain
* Potentially benefiting (short term): https://www.spine-health.com/treatment/physical-therapy/physical-therapy-benefits-back-pain

## References

* 1 2 3 4 5 6 7 8 9 Fairbank J. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ. 2005;330(7502):1233-0.
* ↑ Maetzel A, Li L. The economic burden of low back pain: a review of studies published between 1996 and 2001. Best Practice & Research Clinical Rheumatology. 2002;16(1):23-30.
* ↑ Osborn M, Smith J. The personal experience of chronic benign lower back pain: An interpretative phenomenological analysis. British Journal of Health Psychology. 1998;3(1):65-83.
* ↑ Peloza, J. 2017 [cited 24 September 2017]. Available from: https://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment
* ↑ Merlin, T. 2017 [cited 24 September 2017]. Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
* ↑ van Middelkoop M, Rubinstein S, Kuijpers T, Verhagen A, Ostelo R, Koes B et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal. 2010;20(1):19-39.
* ↑ Hayden J, van Tulder M, Tomlinson G. Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine. 2005;142(9):776.