People feel better about their chronic lower back pain with exercise therapy despite any changes in physical function/performance (i.e., strength, range of motion, muscular endurance).
So what’s happening here?
Other possible explanations for positive outcomes are due to changes in the brain and how our body maps are represented, and the support offered by a patient-therapist interaction.
Also, exercise has psychological benefits by showing a patient that moving doesn’t produce harm to the back thereby tempering irrational thoughts and cognitive appraisals of what the back pain might mean. All the while the exercise increases physical function as well.
This questions if we need to use specific exercises to target the lower back. Well, because therapists tend to uniformly treat lower back patients by rote with the same back exercises with varying results, then the answer is no.
Takeaway: The problem may not be in the back itself. The assumption that pain is due to a physical deficit is unsubstantiated.
So perhaps all the fancy, detailed, and ultra-specific exercises you’re doing for your back isn’t doing what it’s assumed to be doing. Still helpful but takes pressure off from adhering to strict constraints of exercise and frees us up to do exercise(s) we enjoy.
Let’s take the focus away from ‘fixing a physical deficit’ to ‘enjoying health-promoting physical activity.’
F. Steiger, B. Wirth, A. F. Mannion, “Is a positive clinical outcome after exercise therapy for chronic non-specific lower back pain contingent upon a corresponding improvement in the targeted aspect(s) of a performance?”A systematic review.” Eur Spine J. 2012 Apr;21 (4): 575-598