Back pain is the most common cause of disability in the world amongst the general population (1, 2). It is estimated that 84% of the adult population will experience at least one episode of debilitating back pain during their lives. It is also believed that each year, around a third of the UK adult population will suffer from back pain and around one fifth will seek medical help (3). Dealing with back pain isn’t straightforward. There is often uncertainty surrounding the process of diagnosing why back pain occurs and the therapy options are broad and in many cases aren’t well supported by scientific evidence regarding efficacy. There are also many beliefs amongst the medical professions as well as the general public, regarding back pain that are not science based and that can be unhelpful in the management of this all too common pain disorder. When it comes to the topic of back pain amongst sporting populations, more layers of confusion can be found. As an example, many people who experience persistent and recurrent back pain, are advised to reduce or modify their sporting activities in the belief that this will in some way spare their spinal structures from damage. Others are advised to follow specific exercise programmes that target the trunk or “core” muscles, in the belief that this will in some way support and protect the spine. Neither of these strategies have any scientific validity. 

Less isn’t More

Before we discuss the pros and cons of core exercises for back pain, let’s consider the idea that reducing sport could in some way spare the spine from potential damage. This idea is probably based on the widely held belief that the spine will wear out quicker, the more it is used and that wear and tear changes are directly linked with levels of back pain and disability. Where the sporting back is concerned, there is probably a seed of truth in this assumption. Studies have shown that certain sports such as weight lifting and football result in more pronounced spinal degenerative changes (as measured by MRI scanning) when compared to non sports people. However the presence of degenerative spine structure didn’t result in more low back pain in these sporting groups. In fact the opposite was true (4). Regular sport participation was associated with a lower incidence of back pain. This same study also confirmed what other studies had found regarding the association between the structure and strength of spinal discs in runners, in that regular running is associated with stronger discs than in age matched non runners (5, 6). These studies suggest that regular sports participation can reduce the chance of succumbing to back pain. They also support the studies that show there is no direct link between degenerative spine changes that MRI scans detect and  back pain. Either at the time of the scan or in the future (7).

References

1 Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968-974.

2 Aimin Wu, Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017Ann Transl Med. 2020 Mar; 8(6): 299

3 Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13(3):205–217.

4 Videman T, Sarna S, Battié MC, Koskinen S, Gill K, Paananen H, Gibbons L. The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine (Phila Pa 1976). 1995 Mar 15;20(6):699-709

5 Belavý DL, Quittner MJ, Ridgers N, Ling Y, Connell D, Rantalainen T. Running exercise strengthens the intervertebral disc. Sci Rep. 2017;7:45975. Published 2017 Apr 19.

6 Mitchell, Ulrike H et al. “Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study.” PloS one vol. 15,2 e0229457. 21 Feb. 2020

7 Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine (Phila Pa 1976. 2005; 30:1541-1548