Exercise as it relates to Disease/The effects of exercise on chronic back pain

Back pain is considered chronic if it lasts for more than three months. Chronic back pain affects a wide array of people usually from the time they reach adulthood to late adulthood. Those affected by chronic back pain are at greater risk of unemployment, lost productivity in their workplace, functional limitations, economic difficulty, social limitation, and disability[2]. Chronic back pain can be classified into three different groups: simple musculoskeletal back pain, spinal nerve root pain, and serious spinal pathology. Simple musculoskeletal pain is the most common form of chronic back pain as it accounts for 95% of cases [1].It affects people between the ages of 20-55, and is usually articulated as upper leg pain existing near the buttocks and the lumbosacral area [1]. Spinal nerve root pain accounts for 4-5% of chronic back pain[1]. It is generally described as pain extending from the knee to the foot, with well localized, sharp and electric shock-like pain [1].Serious spinal pathology is the rarest form of chronic back pain affecting only 1% [1]. This type of pain is extremely noteworthy as it eludes to other health complications such as: spinal tumors, infection, inflammatory diseases, cauda equina syndrome, and trauma [1]. The longer chronic back pain persists, the greater the risk will become for long-term disability [2].

Side Effects and Complications of Chronic Back Pain
The presence of chronic back pain is linked to the following:
 * Long-term disability [2].
 * Depression [3].
 * Increased levels of psychological distress [3].
 * Negative impacts on sufferers' quality of life and personal functional performance.
 * Limitation (conscious and unconscious) of activities which may bring about back pain due to the fear of injury.
 * Restriction of movements [5].

Exercise Goals in Relation to Chronic Back Pain
Exercise goals with aim to reduce chronic back pain include but are not limited to:


 * Increase and or maintain musculoskeletal and cardiovascular function [5].
 * Strengthen the back [5].
 * Increase back flexibility [5].
 * Increase cardiovascular fitness [5].
 * Increase para-spinal musculature [5].
 * Increase spinal movement [5].
 * Decrease back pain intensity [5].
 * Increase trunk-stability.
 * Increase tissue length and tissue resilience.

Treatment Options for Chronic Back Pain
The following methods are options for treating chronic back pain[3]:

Drugs- The following drugs are prescribed to help manage and maintain chronic back pain: Psychology- Psychology is utilised individually and in group settings to minimise pain and increase function. Cognitive behaviour therapy helps to educate people about the distinction between acute and chronic pain, and it also helps educate people on relaxation techniques.
 * Non-steroidal anti-inflammatory drugs (NSAIDs)
 * Optoids
 * Acetaminophen
 * Tricyclic antidepressants (used for neuropathic pain)
 * Anticonvulsants (used for neuropathic pain)
 * Methocarbamol (used for muscle spasms)
 * Balcofen (used for muscle spasms)
 * Benzodiazephines (used for muscle spasms)

Physical Therapies- Different physical therapies are used in patients with chronic back pain to improve disability through aerobic exercise. See exercise recommendations in Table 1 for further guidance.

Interventional Treatments- These treatments are conducted to reduce the need for back surgery. They include epidural injections in the caudal and lumbar regions to reduce musculoskeletal pain. They also include transforaminal nerve root injections which reduce the need for back surgery. Additionally, facet joint injections are performed to provide short term relief for musculoskeletal back pain, but are not yet proven to alleviate chronic back pain long term[3].

Transcutaneous Electrical Nerve Stimulation (TENS)- TENS units are applied to lessen pain short term in sufferers with chronic pain.

Spinal Cord Stimulation- Spinal cord stimulation can be very effective if it is preformed on carefully selected patients.

Acupuncture- Acupuncture has been found to alleviate chronic back pain temporarily.

Surgery- Surgery is a last resort option for treating chronic back pain, but has been found to positively affect nerve root pain.

Exercise Recommendations
Exercises recommended to decrease chronic back pain: Table 1