Rehabilitation and exercise for a healthy back People who suffer from lower back pain are often encouraged to participate in their own recovery through exercise and physical therapy, but they are seldom given the knowledge and tools needed to accomplish this. This discussion will help you acquire a basic understanding of the reasons for lower back pain, and take charge of your own health by taking the appropriate steps to exercise and rehabilitate your back. Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Fortunately, you can improve your chances of avoiding recurrences by rehabilitating your back through appropriate exercise, whether you are experiencing your first bout with low back pain or have had extensive treatments or even surgery. Exercise and causes of back pain There are several structures in the back that can cause and/or contribute to low back pain. Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber as we go about our activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting or other trauma). And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common. Making matters worse, the pain often prevents us from getting enough exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities and exercise cause the disc to swell up with water and then squeeze it out - much like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate. Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material. The muscles, ligaments and tendons in the back are also very important in maintaining proper spinal balance and strength. With decreased activity, the connective fibers of ligaments and tendons can begin to adhere to each other and lose resilience and may tear when sudden overload occurs. Unlike discs or connective tissue, however, when muscles are injured, they can quickly repair themselves. However, muscles contribute to chronic back pain. When nerves are cut or pinched, the muscles they control cannot work, as sometimes happens when a herniated disc presses on a nerve. Also, since muscles are in constant communication with the central nervous system, anger or anxiety can tense the muscles and cause muscle spasms. Ongoing tension inhibits normal muscle function and leads to muscle wasting and further stability problems, which in turn can lead to chronic lower back pain. Acute vs. chronic back pain It’s important to note that acute pain is different from chronic pain. We have all experienced acute pain from a sudden soft tissue injury, such as a sprained ankle, or even just a simple paper cut. The pain is immediate, but gradually resolves as the injured part heals. Unlike acute pain, chronic pain comprises a constant low level of stimulation to the nervous system that eventually becomes a pattern. It may even persist as a “neural memory” after the initial source of irritation has resolved. The adaptation of our nervous system to this chronic stimulation creates an environment in which events that previously caused no pain become a source of pain. Pain may even progress to uninjured areas. Emotional distress and certain medications can exacerbate this phenomenon. An effective solution is to distract the nervous system by means of active exercise in a controlled, non-destructive manner. Active exercise also helps to create the physiological conditions that allow the injured structures to heal.