Clinical: Lumbar paraspinal muscles
Written by Craig Benton, DC   
Tuesday, April 08, 2014 07:17 PM

Dr. Craig Benton shares with us that most of the clinical guidelines for back and neck pain show some of the highest evidence for treatments with spinal manipulation and exercise therapy.  Patients need to exercise because lower back pain has a recurrence rate of 73% within a one year period (pretty high), and one study for neck pain showed a recurrence rate of 85% in 5 years. 

Most patients, in my opinion, probably won’t do exercises for their back or neck so it is highly likely that they will have a flare-up in the next few following years, hopefully they will be educated to come back to our office for care.   So here are some studies about muscle strength and exercise.


 
This study showed that chronic lower back pain patients had smaller paraspinal and multifidus muscles

http://www.ncbi.nlm.nih.gov/pubmed/23504343

these patients had recovered from chronic back pain but still showed alterations in the multifidus structures on MRI.

http://www.ncbi.nlm.nih.gov/pubmed/23369927

This study showed that obese firefighters had weaker core muscles.

http://www.ncbi.nlm.nih.gov/pubmed/23213491

More atrophy of multifidus muscles in chronic lower back pain patients.

http://www.ncbi.nlm.nih.gov/pubmed/11261613

So we know these people need to exercise or they will have a very high rate of recurrence (which can not be blamed on the statement that chiropractic didn’t work). So these show that exercise does work.
 
They like using firefighters so this showed one-half of them doing core exercises and the other half nothing.  After 24 weeks the ones doing core exercises had great endurance.

http://www.ncbi.nlm.nih.gov/pubmed/24524384

This showed office workers that did core strengthening and endurance had less back pain in a 12 month period than those that did no exercise.

http://www.ncbi.nlm.nih.gov/pubmed/24492949

Rehab following lumbar stenosis surgery patients did better.  (how many lumbar surgery patients do you see getting rehab?)

http://www.ncbi.nlm.nih.gov/pubmed/24323844

The rest of these are all about the same some are including neck exercises for neck pain.

http://www.ncbi.nlm.nih.gov/pubmed/22895940
 
http://www.ncbi.nlm.nih.gov/pubmed/20651013
 
http://www.ncbi.nlm.nih.gov/pubmed/20147878
 
http://www.ncbi.nlm.nih.gov/pubmed/16034925
 
http://www.ncbi.nlm.nih.gov/pubmed/15556955

Here is a Youtube video on Stuart McGill PhD recommended lower back core strengthening exercises.  I personally do these each day and they do make my back feel much better.  If I can do them anyone can do them.

https://www.youtube.com/watch?v=kukmaW9CmSU

So here is some of the research for exercise for lower back pain.  I realize this will be hard to believe but I could not find any research on the use of opioids or benzaprines on how it effects muscle strength or core muscles.