Lower back pain (LBP) affects 50-80% of adults at some point during their lives. (1) It can cause adverse health effects such as depression, anxiety, sleep disturbance, and distress. (2) Due to COVID-19, outpatient medical visits have plummeted as patients limit personal contact. (3) Although the volume of medical visits has declined, their necessity has not. LBP patients are still suffering with chronic pain and its health effects.
Patients can utilize at-home exercises such as bridges, knee-to-chest stretches, and seated rotational stretches, as a replacement for in-person physical therapy (PT) or physician’s visits during COVID-19. (4) They can be guided by their primary care physicians or physical therapists through the use of telemedicine or other online resources. This can allow for professional guidance during exercises to ensure proper movement. At-home exercise guided by PTs online (in combination with in-person PT visits) may be the future direction of PT post-COVID-19 as more activities move to an online or hybrid modality.
At-home exercise to combat LBP has been proven by a multitude of studies to be highly effective. A study comparing aerobic exercise + home exercise, PT + home exercise, and just home exercise found all three to be effective in diminishing pain and increasing aerobic capacity. All three groups showed similar decreases in patient pain, with no significant differences between groups. (1) It is worth noting that while all three groups showed similar results related to pain levels, the PT + home exercise group fared better regarding disability and psychological disturbance reduction post-treatment. (1) This finding indicates that while at-home exercise is effective at pain reduction, it may be most effective when paired with professional PT treatments to also improve disability and address the mental health challenges associated with LBP. Accordingly, at-home exercise can be utilized both during the COVID-19 pandemic and afterwards as an LBP treatment plan.
Another study investigated using at-home exercise to treat non-specific LBP, or LBP not caused by a known pathology or syndrome. The results were similarly encouraging, with pain and disability improving significantly more in patients assigned at-home exercise compared to controls who were treated with nonsteroidal anti-inflammatory drugs. (5) A third study compared supervised exercise, at-home exercise, and spinal manipulation as treatments for LBP. Researchers found no significant difference between these treatments in terms of pain reduction or individual short and/or long-term patient outcomes. However, supervised trunk exercise patients were the most satisfied with their care, and experienced the most improvement in trunk muscle strength and endurance. (6) This study confirms the results of the previous research and confers that at-home exercise is indeed effective in treating LBP but is most effective when combined with PT treatments. Physical therapists and physicians can recommend at-home exercise as a temporary replacement for PT during the COVID-19 pandemic and as an additional treatment afterwards.
Sources:
1. Koldaş Doğan, Ş, Sonel Tur, B., Kurtaiş, Y., & Atay, M. B. (2008). Comparison of three different approaches in the treatment of chronic low back pain. Clinical Rheumatology, 27(7), 873-881.
2. 1. Field, T., Hernandez-Reif, M., Diego, M., & Fraser, M. (2007). Lower back pain and sleep disturbance are reduced following massage therapy. Journal of Bodywork and Movement Therapies, 11(2).
3. Bokolo Anthony Jnr. (2020). Use of telemedicine and virtual care for remote treatment in response To Covid-19 pandemic. Journal of Medical Systems, 44(7).
4. Back exercises in 15 minutes a day. (2016, May 03). Retrieved February 13, 2021, from https://www.mayoclinic.org/healthy-lifestyle/adult-health/multimedia/back-pain/sls-20076265
5. Shirado, O., Doi, T., Akai, M., Hoshino, Y., Fujino, K., Hayashi, K., . . . Iwaya, T. (2010). Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain. Spine, 35(17).
6. Bronfort, G., Maiers, M. J., Evans, R. L., Schulz, C. A., Bracha, Y., Svendsen, K. H., . . . Transfeldt, E. E. (2011). Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: A randomized clinical trial. The Spine Journal, 11(7), 585-598.
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