Exercise-Based Rehabilitation in Low Back Pain: A Comprehensive Update for Physiatrists-Exercise-Based Rehabilitation in Low Back Pain: A Comprehensive Update for Physiatrists

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Video Summary

Exercise-based rehabilitation is a key component in the treatment of spinal pain. Research has shown that exercise can improve physical and functional impairments, pain intensity, and disability. There are many proposed mechanisms of how exercise works, including musculoskeletal, neuroimmunologic, and psychological factors. Spinal pain is often associated with reduced movement and activity, which can be reinforced by healthcare providers. In the acute phase, it is important to encourage patients to stay active to prevent muscle loss and maintain function. Exercise has been shown to reverse changes such as muscle atrophy and improve symptoms of spinal pain. However, addressing physical impairments alone may not be enough to improve pain or disability, especially in patients with chronic symptoms. Maladaptive fears, attitudes, and beliefs play a significant role in pain-related disability, and exercise can help address and improve these maladaptive behaviors. The underlying process of pain involves activation of sensory neurons called nociceptors, both in the peripheral and central nervous systems. Exercise has been shown to reverse injury-induced changes in these neurons and result in pain reduction. The exact mechanisms of how exercise induces these changes are still being researched. However, exercise is known to stimulate muscle precursor cells and alter signaling pathways in the nervous system. The choice of exercise technique doesn't seem to significantly impact outcomes, so it is important to focus on exercises that patients enjoy and will continue to perform regularly. Implementing exercise-based rehabilitation requires education, goal setting, self-monitoring, and behavioral practice. Physiatrists can play a role in empowering patients, providing positive messaging, and supporting behavior change. By addressing physical and psychosocial factors, and promoting regular exercise, physiatrists can help improve outcomes and quality of life for patients with spinal pain.

Keywords

exercise-based rehabilitation

spinal pain

physical impairments

pain intensity

disability

musculoskeletal factors

neuroimmunologic factors

psychological factors

maladaptive behaviors

pain reduction