Move it: the radical new approach to beating back pain
Intense exercise – at least once a week – is the key to warding off joint and muscle pain in later life, according to a study. But there are other ways to protect yourself.
About a third of the population live with musculoskeletal pain, with lower back and neck pain the most common forms. But could intense exercise be the key to preventing this type of persistent bone, joint and muscle pain that affects so many of us as we age?
This month researchers at the University of Portsmouth published findings that suggested that, for midlifers, activities and workouts that work up a sweat, such as digging the garden, cycling or jogging, could prove a solution for chronic MSK pain.
Nils Niederstrasser, a senior lecturer in the department of psychology, and his team looked at data from 5802 people aged 50 or older over 10 years. By the end of the study period almost half of the participants reported suffering from MSK pain.
A recent report by the charity Versus Arthritis shows the devastating toll that MSK pain can take, “affecting how we move, think, sleep and even our ability to work”.
Women suffer more persistent pain than men, something the Portsmouth team suggested may be down to hormonal differences. And although it becomes more common across the board with increasing age — about 40 per cent of 35 to 64-year-olds live with some form of MSK pain — the young are certainly not immune.
So what can we do to protect our backs, necks and shoulders from pain? Here’s what the experts suggest.
Vigorous exercise can help your back
“Any physical activity helps people to feel well and better than they do if they are inactive,” Niederstrasser says. “But it was only what we termed vigorous activity – digging with a spade or hard physical labour, swimming, jogging, cycling and tennis – in relatively high levels that appeared to lower the risk of someone developing MSK pain in the long term. And you need to do this level of activity at least once a week. Doing it once a month is not enough to make a difference to MSK pain prevention.”
It’s not the first time that intense exercise has been shown to help to prevent pain. Last year a team of Japanese researchers analysed data from 4882 participants in the English Longitudinal Study of Ageing. Their findings, reported in The Journal of Pain, showed that those who did moderate or vigorous activity several times a month had a reduced risk of back pain by the end of the study compared with those who did less.
Dalton Wong, the celebrity fitness trainer who works with Olivia Colman and Jennifer Lawrence, says weight training is essential for maintaining a strong back. “Strong muscles will help to avoid back, neck and shoulder pain, yet many of us neglect to work them. Strong shoulder muscles will release tension in the head and neck.”
Plenty of squats, lunges and glute bridges will protect your back. “Glutes and core muscles play an important role in keeping your lower back and spine strong and healthy,” Wong says.
Research is increasingly showing that many of the approaches we have used to tackle back, neck and shoulder pain are ineffective. In 2019 Daniel Belavy, an associate professor at the Institute for Physical Activity and Nutrition at Deakin University in Australia, reviewed all available evidence for a range of popular back-pain gadgets and therapies for a study published in the British Journal of Sports Medicine. He and his team found that many of the approaches were useless unless combined with physical activity. Regular and varied exercise trumped everything else when it came to reducing pain and boosting the mood of back-pain sufferers, Belavy concluded.
Will supplements such as glucosamine help?
The market for supplements promising to help chronic pain – from turmeric to glucosamine and chondroitin – is worth millions of dollars. Yet studies have failed to produce convincing evidence that even many of the most popular of these help to relieve back pain.
Some experts say applying a cream containing capsaicin, the substance that gives chillies their heat, may have a short-term benefit by easing discomfort for some people, but won’t treat the underlying cause of pain. “There isn’t a supplement that will cure back pain,” says Uzo Ehiogu, a physiotherapist at the Royal Orthopaedic Hospital in Birmingham and a spokesman for the Chartered Society of Physiotherapy. “Use it if you believe it helps, as there may be a placebo benefit, but otherwise don’t waste your money.”
Is it worth investing in a special office chair?
The vast array of orthopaedic options for office chairs can be bewildering, not to mention expensive. If you are still sitting on a dining chair from the kitchen, does it matter? Not as much as you might think. What really matters is how you sit on it, says Christopher Martey, a musculoskeletal physiotherapist who works in GP surgeries in the southwest of England and who is also a spokesman for the CSP.
“If you sit in the same position for five, six or eight hours in an expensive orthopaedic chair your back and shoulders will still ache,” he says. “If you move around little and often, varying the places that you sit and stand, you will be less likely to have problems, regardless of the chair you use.”
Will massage or acupuncture help my neck and back?
A soothing massage is the go-to treatment for many people with back pain. However, a Cochrane review involving 3096 patients with low-back pain found that massage was better than doing nothing when it came to improving pain and function in the short term, but offered no additional benefits in a long-term follow-up.
When compared with other interventions such as stretching and other manual therapies, general massage offered no long-term improvements in functional movement. Up to 25 per cent of participants in some of the studies reviewed said their back pain intensified after massage.
Some types do have more medical backing; Thai massage, in which a therapist manipulates the body into a variety of positions, twice a week for four weeks, was shown to reduce symptoms of low-back pain significantly. Belavy reported that all so-called hands-on treatments – including massage, manual therapy, chiropractic work, osteopathy or acupuncture – were less effective than exercise-based options at dealing with back pain.
Do I need to do pilates?
Because of its focus on the muscles of the core and pelvic floor, Pilates is often hailed as the ultimate back-saving exercise. It can help, but should be one part of a varied activity plan for pain prevention – and don’t expect miracles.
In his research Belavy found Pilates was no better for easing or preventing back pain than aerobic exercise – walking and swimming, for example – and resistance training. And he found that doing ordinary trunk stabilisation exercises that worked the deep abdominal muscles, such as planks, held as many benefits as regular Pilates.
Eat plenty of berries, olive oil and avocados
A study presented at the Association for Academic Psychiatry conference last year showed that what you eat can have more of an impact on reducing back pain than previously thought. Valerio Tonelli Enrico, a physical therapist and researcher at the University of Pittsburgh who was involved in the research, says chronic inflammation in the body plays a role in conditions such as arthritis or back pain, and that a diet packed with anti-inflammatory foods such as wholegrains, olive oil, berries and other fresh fruit and vegetables can help to counter this.
Enrico and his colleagues found people who had the most pro-inflammatory diet – packed with highly processed foods, sugar and salt – had a 42 per cent or higher chance of having low-back pain compared with the group with the least pro-inflammatory diet.
Try to lose weight
Being overweight or obese is a significant risk factor for low-back pain, and not just because it loads pressure on to joints and bones. Studies have shown that the more excess body fat someone has, the higher their levels of damaging inflammatory markers that raise the risk of many conditions, including MSK pain. “Being overweight has a negative impact on metabolic health, and that is associated with a rise in joint, bone and muscle pain,” Martey says.
Losing weight will relieve pressure on your spinal discs – a study at the University of Hong Kong, published in Arthritis & Rheumatology, showed that overweight adults were significantly more likely to have disc degeneration than those of normal weight.
Heated pads and patches can help . . . a bit
Soothing heat packs or patches promise targeted relief from MSK pain by increasing blood flow to the affected area, thereby boosting oxygen and nutrients to aid the healing process. However, a Cochrane review concluded that there was limited evidence for them providing long-term benefit.
In one paper a heated blanket provided “significant” short-term relief for acute back pain, and a trial of 100 patients with low-back pain showed that using a heat wrap in conjunction with exercise helped to reduce pain after a week. “Evidence suggests they might provide a moderate level of short-term relief, but they are not a cure,” Ehiogu says. “Overall, most studies have shown these things do little to reduce back pain when used on their own.”
MRI scans can cause false alarms
Imaging studies have shown that unnecessarily using MRI scans can cause false alarm in people with back-pain problems. About 70 per cent of adults will have some disc degeneration, increasing to 80 per cent of those aged 50-plus. “Even when back pain does persist for more than a few months, scans are often unhelpful and don’t change management for the majority of people,” Ehiogu says. “They can cause unnecessary anxiety and make people worry about moving their back normally.”
Don’t be afraid to twist and bend your back
Your spine is designed to move in different directions and to withstand heavy loads. “It’s an absolute myth that you shouldn’t bend and twist your back and neck, because that is what they need to stay healthy,” Martey says. “People who don’t twist and bend for fear of harming their backs are the ones most likely to experience pain.”
If you have acute back pain, you will need to take more care until it gets better. But the reason you experience a muscle spasm or strain in the first place is probably because your back lacks fitness and strength. “My favourite saying for back, neck and shoulder pain is that ‘you can’t go wrong with getting flexible and strong’, so move your spine as much as you can,” Martey says.
Will a heavy schoolbag ruin my child’s back?
Heavy bags have long been blamed for damaging back muscles, particularly in schoolchildren, yet the consensus has shifted. A 2018 review in the British Journal of Sports Medicine found no evidence to associate carrying heavy bags with back pain in children and adolescents, and the message was that even heavy backpacks are not necessarily detrimental to back, neck and shoulder health.
Nor are anatomically designed bags a necessity. Symmetrical styles such as a rucksack will even out the weight you carry and prevent you from favouring one side, but you should also change the position of the bag you carry on a regular basis. “It is not heavy schoolbags that cause back problems in children, but the fact their backs have become deconditioned through inactivity,” Ehiogu says.
A good mattress helps, but getting enough sleep is more important
You can buy the most expensive memory foam mattress, but it won’t improve your back and neck pain unless you get enough sleep – and that means getting six to eight hours a night.
“A lack of sleep can cause people to feel stressed and anxious, which, in turn, influences areas of the brain, such as the anterior cingulate cortex, thalamus and insula, that trigger pain,” Martey says.
A 2021 study published in the journal Scientific Reports looked at a total of 8601 people who took part in three consecutive surveys over 22 years. During the first two surveys none of them reported chronic back pain, but by the time of the third survey those with long-term poor sleep had nearly twice the risk of back-related disability as those who had good sleep.
Ehiogu says an expensive mattress doesn’t automatically result in better sleep. “What matters is how much you move and change position at night,” he says. “If you lie still all night on a very expensive mattress you will likely wake with a stiff, sore back.” Using a memory foam, or visco-elastic polyurethane, pillow has been shown to be a useful adjunct in the treatment of chronic neck pain for some people.
Are phones and tablets to blame for teenagers’ neck and back pain?
While Martey says there’s no evidence that back and neck pain are rising more sharply than before in young children and teenagers, “it is still an incredibly common problem across all age groups”.
However, it seems we are wrong to blame the fact that they crane their necks over their phone and tablet as the cause of MSK problems. A study in the European Spine Journal looked at the time 150 young people spent texting and playing games on their phones, and their body position when using them, to see if there was a correlation with increased back, neck and shoulder problems. Results showed no link, and the researchers said it challenged “the belief that neck posture when using a mobile phone is associated with the growing prevalence of neck pain”.
“Looking at these devices for a long time is no more harmful to muscles and joints than reading a book or doing intricate DIY for a long time,” Ehiogu says. “It’s not the devices that are the problem.”
Instead the problem is – as with adults – inactivity. This leads to muscle deconditioning and lack of muscle development, which can in turn lead to pain.
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