Exercise Prevents Low Back Pain in Sedentary Office Workers

Research Review: Exercise Prevents Low Back Pain in Sedentary Office Workers

By Stefanie DiCarrado DPT, PT, NASM CPT, CES, & PES

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: Sihawong, R., Janwantanakul, P., Jiamjarasrasi, W. (2014) A prospective, cluster-randomized controlled trial of exercise program to prevent low back pain in office workers. European Spine Journal 23:786-793 - ARTICLE

Caption: Posture evolution of man

The Evolution of Man

Why is this relevant?: Low back pain is a common complaint among various populations (1). Meucci, et. al (2015) found that 4.2% of individuals aged between 24 and 39 years, 19.6% between ages 20 and 59 years, and in 25.4% of individuals over 60 years suffered from chronic low back pain (CBP) (2). Individuals working in office settings tend to sit for prolonged periods of time, which may alter connective tissue length and place excessive load on passive tissues of the lumbar spine. This study suggests that exercise may be preventative of low back pain for sedentary office workers.

Study Summary

Review & Commentary:

This study presents strong evidence due to a strong methodological approach. The researchers used a large sample size (IG n=281, CG n=282), with specific inclusion criteria and subject assessment, an intervention designed to target a specific impairments which may contribute to low back pain, and a highly standardized methodology. The subjects in the study were comprised of only individuals with limited trunk extension and/or decreased trunk muscle endurance. Using specific objective measures and an intervention to address these limitations, rather than applying a "standardized" low back exercise protocol to a general population, increased the validity of the results. Using assessment as a precursor to intervention, also allowed for better specificity and treatment selection based on this evidence. The authors clearly cited low back pain criteria and listed specific questions used during the subjective assessment. To reduce intervention/interviewer bias, a computer program randomized the subjects and a blinded examiner performed all measurements. Researchers collected data including smoking, exercise habits, working hours, years working, frequency of computer use, work activities, self-rated ergonomics of work stations, and work conditions to assess correlations. The authors clearly defined the physical examination elements and provided sources for validation. The intervention was designed to address the likely effects of prolonged sitting: posterior pelvic tilt and decreased lumbar lordosis with stretching and muscle endurance training. Subjects stretched their iliopsoas (determined to be tight/short) for 30s 2x/day at 10am and 2pm. The authors purposed designed a stretching schedule during workday hours to reduce the time spent in poor sitting posture. Subjects trained muscle endurance (erector spinae , multifidus , quadratus lumborum , and transverse abdominis ) with repeated contractions (10x with 60s rest between muscles) 2x/week when at home on Wednesdays and Sundays. To ensure compliance, subjects received text messages at 10 am each day during the initial 3 months, as a reminder to perform their exercises. Subjects were 31% compliant with stretching and 55-57% compliant with the endurance exercises. It is interesting that the authors tracked and documented this information. Based on the outcomes of this study, positive changes can be made, even with lower than desired compliance.

This study is not without limitations, especially since the incidence of low back pain was measured using a journal and subjective criteria. The authors noted some subjects may have failed to recall incidences or may have been biased by knowing that they were in the experimental group and subconsciously did not acknowledge the pain. These are the risks of any study using subjective data, and although examination by a clinician would have provided stronger evidence, this is also costly. The study does not describe the specific iliopsoas stretch technique used, which reduces the ability to fully replicate and therefore tests the validity of the study. The authors should consider including that information in the supplemental material provided.

Why is this study important?

This article is important as it demonstrates the importance of exercise for sedentary workers and the prevention of low back pain. Further, this study highlights the importance of specificity of intervention design. The authors chose specific postures and specific mobility limitations to address rather than the application of a general intervention to a general population.

How does it affect practice?

Practitioners should strive to achieve a better understanding of how prolonged postures and sedentary activity may contribute to low back pain. This article offers clinicians validation that an intervention to address specific movement impairments related to the lumbar spine, specifically psoas flexibility and core muscle endurance training, may reduce the likelihood of low back pain.

How does it relate to Brookbush Institute Content?

This study provides evidence that addressing movement impairment with exercise may prevent pain - an assumption made in the development of all predictive models of postural dysfunction . Specifically, this study demonstrated that exercise may prevent low back pain in an ever-growing population, the sedentary office worker.

The assessments and evaluation used by the Brookbush Institute are designed to identify deviations from optimal movement, and the maladaptive changes in myofascial length/activity and arthrokinematic dyskinesis that result from them. Prolonged sitting often results in a sitting posture that includes a posterior pelvic tilt and rounded shoulders, along with (as noted by the authors of this study), a shortened iliopsoas . However, further consideration of the effect prolonged sitting has on standing posture and motion, may give further consideration to shortening of the iliopsoas , reciprocal inhibition of the gluteus maximus , and their contribution to the more commonly noted anterior pelvic tilt. An anterior pelvic tilt is likely the most commonly noted postural change in those exhibiting Lumbo Pelvic Hip Complex Dysfunction (LPHCD) .

Corrective exercise to address LPHCD includes release and stretching the iliopsoas (as was mentioned in this research study), as well as all short/overactive hip flexors - rectus femoris, tensor fascial latae (TFL) , and anterior adductors . After releasing and lengthening over-active/short muscles, the Brookbush Institute advises mobilization of joints exhibiting dyskinesis, including the lumbar spine, hip, sacroiliac joint, etc.. This is followed by isolated activation exercises for under-active/long muscles, typically the gluteus maximus , gluteus medius , and transverse abdominis (similar to the techniques used for enhancing muscular endurance of core muscles), and integration of the posterior oblique subsystem (POS) . The videos below provide a short sample corrective exercise routine to address LPHCD :

Tensor Fascia Latae Static Release:

Kneeling Static Hip Flexor Stretch:

Transverse Abdominis TVA Isolated Activation:

Quick Glute Activation Circuit:

Squat to Row (POS) Integration:

Bibliography

1. Triki, M., Koubaa, A., Masmoudi, L., Fellmann, N., Tabka, Z., Libyan, J. (2015) Prevalence and risk factors of low back pain among undergraduate students of a sports and physical education institute in Tunisia. Libyan Journal of Medicine. 10:26802; 1-10
2. Meucci, R.D., Fassa, A.G., Faria, N.M. (2015) Prevalence of chronic low back pain: systematic review. Revista de Saúde Pública. 49. 1-10

© 2015 Brent Brookbush

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