I’ve never been a big fan of passive physical agents in the treatment of chronic low back pain. I just don’t think they have much to offer (for the record, short of cyrotherapy [ice], I don’t think they have much to offer in just about any case. I’ve done one ultrasound treatment in the last 7 years and only because I was “ordered” to do so.).

Sure a little ice or heat can certainly reduce pain and temporarily increase mobility in the pre or post-exercise period, but as far as making a huge impact in reducing symptoms or increasing function…well, it just doesn’t happen.

On the other hand, exercise is typically the “fix”.

Oddly enough, aerobic exercise tends to be quite successful in this regard.

In the most recent Physical Therapy journal (Phys Ther. 2007 Mar;87(3):304-12) there was a pilot study that showed just that.

They compared a passive physical agents group (diathermy, ultrasound, electric stimulation, and laser treatments) who did no exercises to an aerobic exercise group. The aerobic exercise group progressively increase exercise time to 50 minutes at up to 85% of their heart rate reserve.

They then compared pre-study scores of subjective pain and disability to post-test score for each group.

Guess what?

The exercise group recorded reduced pain and disability after the 12 weeks, and the control group who just received the passive physical agents didn’t change at all. They also reported reduced feelings of depression and anxiety (so much for anti-depressants…do you think there’s a connection between the number of folks on anti-depressants and the ever increasing sedentary lifestyle of Americans??).

A couple things to keep in mind. The subjects who were successful in this study progressively increased the intensity of the exercise. I think this is an important point.

They weren’t walking casually. They were eventually running on the treadmill for 50 minutes at a good clip.

Intensity is the key to most forms of exercise. We know that higher intensities of activity promote greater fat loss AND promote higher levels of fitness overall over a shorter time period.

Now there’s evidence in that it’ll help your back pain too.

Perhaps we need to adjust our mindsets to “Work harder, not smarter.”

Later

P.S. I’d like to see the results with some strength training and even higher-intensity intervals thrown in.

Question: Why the big concern over upper back mobility in regard to building heathly shoulders?

Answer: Poor mobility of the thoracic spine (upper back) is often associated with a slouched, or more specifically, a kyphotic posture. This altered spinal alignment prevents the scapulae (the shoulder blades) from tilting backward as you raise your arms. This lack of tilt narrows the space in the shoulder joint that the rotator cuff runs through (the subacromial space) and makes it more likely that your rotator cuff will get pinched, called impingement. Over time, if you impinge frequently, you’ll most likely end up with some form of rotator cuff injury.

The mobility of the thoracic spine also directly affects the strength of the lower trapezius which is an upward rotator of the scapulae. If the thoracic spine lacks mobility the lower trapezius will test weak, thus limiting upward rotation. A lack of scapular upward rotation also narrows the subacromial space making impingement more likely.

There’s actually more to it, but you can see in just these two instances why thoracic spine mobility is so important. That’s why Mike Robertson and I included exercises specifically designed to improve throacic spine mobility in our Inside-Out: The Ultimate Upper Body Warm-up.

Later

Everyone wants evidence for everything these days.

In the PT world, the hot topic is evidence-based treatment even though a large portion of the techniques and methods that many PT’s learn in continuing educations courses and utilize every day haven’t been scrutinized in double-blinded, peer-reviewed research.

In the fitness and sports training world, I think the best evidence-based methods come from the coaches who’ve been training clients and athletes for a long time and keep accurate records of what worked and what didn’t.

Nothing beats real-world experience.

It’s been said that exercise-related researchers tend to be exercise historians because they research those methods that successful coaches have been using for years only to find out why they work.

I can’t entirely disagree, but I don’t think we can just ignore the research because it is not performed in realistic environments. Knowing some of the “whys” allows us to make better training decisions.

With that in mind, I want to give you a “heads up” on a new blog by Bryan Chung. Bryan is a PhD (with a strong rehab background) who also happens to be one helluva researcher and critical thinker. He’s also not a total geek as he has some “under the bar” and a broad athletic experience.

He’s just getting started with the blog and he’s quite busy as he continues his education, but I’d put his blog on your favorites list. Whether you agree with him or not, he’s going to stimulate some thought.

Check him out here Evidence-Based Fitness.

Later