You will find some advice regarding exercises and interventions in case of chronic lower back pain.

Hip mobility/Flexibility training: The relationship between the hip and back is well known. As Kim and Yim, 2020 stated, Offierski and MacNab introduced the concept in 1983, and they hypothesize that treatment in one area will improve the other untreated. This hypothesis is often correct and matches the osteopathic approach, considering the body as a unit. Research shows a significant difference after six weeks of hip stretching associated with core stability exercise in a population with low back pain (Kim and Him, 2020). Improvement has been seen in pain intensity, lower back instability, hip muscle, flexibility, disability level, balance ability, and quality of life. Winter (2015) shows positive results in home-based treatment targeting hip intervention in individuals with non-specific low back pain.

Based on Graber et al. 2011, flexibility training targeting hip muscles such as the psoas, piriformis, TFL, and hamstring must be done a minimum of 2-3 times per week, holding 10 to 30 sec until tightness. Different modes can be done: static, ballistic, or dynamic.

Posterior chain resistance training: Strong evidence shows significant results in terms of pain, disability, and strength management after 12-16 weeks of posterior chain resistance training compared to general exercises (Tataryn et al.,2021). In addition, research shows that resistance training improves flexibility.

Studies require 2-3 days per week for resistance training for novice to intermediate patients, with 60 to 70% of the one resistance maximal. With 8 to 12 repetitions, 2 to 4 sets, and 2 to 3 minutes rest between each set (Graber et al., 2011). Exercises could be, for example, squatting, deadlifting, pulling, with elastic bands or small weights And so during 12 to 16 weeks,

Those training complete manual therapy interventions, such as mobilization, manual osteopathic manipulation, and stretching. The exercises should be done in person with the physical therapist's supervision, followed by prescription exercises when the patient controls them.

Dr. Benjamin Petrolati

PT, DPT, French Osteopath

References:

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., Swain, D. P., & American College of Sports Medicine (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334–1359. https://doi-org/10.1249/MSS.0b013e318213fefb

Tataryn, N., Simas, V., Catterall, T., Furness, J., & Keogh, J. W. L. (2021). Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports medicine - open, 7(1), 17. https://doi.org/10.1186/s40798-021-00306-w

Winter, S. (2015). Effectiveness of targeted home-based hip exercises in individuals with non-specific chronic or recurrent low back pain with reduced hip mobility: A randomised trial. Journal of Back and Musculoskeletal Rehabilitation, 28(4), 811–825. https://doi-org/10.3233/BMR-150589

Kim B, & Yim J. (2020). Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. Tohoku Journal of Experimental Medicine, 251(3), 193–206. https://doi-org/10.1620/tjem.251.193