THE LOWER BACK PAIN

The causes of back pain are nearly as numerous as terms used to describe the symptoms. Back pain is a primary reason people seek medical attention. Considering that almost 80% of the adult population will encounter some form of back pain, it could be said that back pain is a universal epidemic. Back pain recognizes no age, economic, or ethnic barriers. ACUTE - CHRONIC EPISODIC Typically back pain originates in the neck (cervical), mid back (thoracic), low back (lumbar), or a combination such as 'thoracolumbar pain'. Depending on the source of the pain, certain types of pain may be indicative of disease or a particular disorder. Pain may be described as sudden, sharp, persistent, or dull. Symptoms may be localized to a specific area of the back (e.g. neck) or may radiate into the shoulders, arms, low back, buttocks, legs, and even the feet. Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or weakness. Back pain is either acute or chronic. Acute pain may begin suddenly with intense pain usually lasting a short period of time. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain. Certain neurologic symptoms may indicate the need for immediate medical attention. These 'red flags' include bowel or bladder dysfunction, extremity weakness or numbness, severe symptoms that do not subside after a few days, or pain that prohibits everyday activities. A MYRIAD OF CAUSES A cause of back pain is muscle strain and spasm. Strain may result from the 'weekend warrior syndrome', heavy physical work, awkward bending or twisting, even poor posture. Whiplash Is a neck pain, which commonly occurs following an auto accident. This is typically caused by hyperextension and/or hyperflexion because the head is forced to move backward and/or forward ranapidly beyond the neck's normal range of motion. The unnatural and forceful movement affects the muscles and ligaments in the neck. Muscles may react by tightening and contracting, creating muscle fatigue, resulting in pain and stiffness. Osteoarthritis (Spondylosis) Spinal osteoarthritis, or spondylosis, is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the discs and spinal joints. Osteoporosis Osteoporosis commonly affects the thoracic and thoracolumbar regions of the spine and may cause debilitating pain. This disorder is caused by a loss of bone mineral density resulting in fragile bones, which may fracture. Osteoporosis may cause vertebral compression fractures, loss of height, stooped posture, even a humped back. The patient can control some of the risks for osteoporosis. These include poor diet, smoking, excessive intake of alcohol, and inactivity.

Herniated Disc A disc herniation is a disc rupture. The spine is made up of cylindrical bones called vertebrae. Between the bones of the spine are small discs made of a thick layer of cartilage on the outside and a soft and jelly-like material on the inside. The discs act to absorb shocks caused when the spine moves, and they allow the spine to bend. The spinal cord is a bundle of nerves running through the canal within the spinal column. It carries messages to and from the brain via nerve roots that branch out to the body along the length of the spinal cord. The nerves exit the spine through small openings on each side; these are called foramens (singular foramen; foramina is also used for the plural), after the Latin word for "window." If a foramen becomes narrowed by arthritis or a bulging disc, pressure on the nerve can cause numbness and pain, and even muscle weakness if severe enough. A herniated, prolapsed, or ruptured disc happens when the inner material bulges or bursts through the outer lining of cartilage and puts pressure on or damages the spinal nerves or the spinal cord. Herniated discs can occur in any part of the spine, but they are most common in the neck (cervical spine) and lower back (lumbar section of the spine). Herniated discs are more common in people between 30 and 40 years old, but they can occur at any age. Studies have shown that even some teenagers can be affected. As we age, the discs in the spine become less flexible, which increases the risk of injury. Other things that can increase the risk of a herniated disc include an injury such as a fall, repeated straining, improper lifting, excessive body weight, and smoking. When a disc is herniated, the soft material inside the disc comes through the outer lining of cartilage. Normally there is some space between the discs and the spinal column. But, when the herniated disc presses on a spinal nerve, this leads to symptoms of pain, numbness, and weakness. Not all people with a herniated disc have symptoms. But when a herniated disc presses on spinal nerves, symptoms can include pain, loss of feeling, tingling, or muscle weakness. The amount of pressure the herniated disc puts on the spinal nerves determines how bad the symptoms will be. Coughing, laughing, sneezing, urinating, or straining while defecating make the pain of a herniated disc worse. There are four stages: (1) disc protrusion, (2) prolapsed disc, (3) disc extrusion, and (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Sciatica The term 'sciatica' is commonly used to describe pain that travels along the sciatic nerve, the largest nerve in the body. The pain may be sharp, dull, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back of the thigh and leg. The most common cause of sciatica is a herniated disc in the lumbar spine. Compression Fracture A compression fracture is a common fracture of the spine that may range from mild to severe. Each vertebral body is separated from the other with a disc. When an external force is applied to the spine, such as from a fall or carrying a sudden heavy weight, the forces may exceed the

ability of the bone within the vertebral body to support the load. This may cause the vertebral body to crush. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture. Spinal Stenosis Spinal stenosis results when the small neural passageways termed 'foramen' narrow. The narrowing of the foramen may compress and entrap nerve roots. Nerves react to pressure by swelling, which further reduces foraminal space. Stenosis can cause excruciating pain, numbness, tingling, or burning in the involved extremity (e.g. leg, arm). Stenosis can also occur with compression from a disc, osteophytes (e.g. bone spurs), and ligaments. Scoliosis Scoliosis causes the spine to curve laterally to the left or right and affects children and adults. Scoliosis is a complex three-dimensional disease. To understand this concept, consider that in some cases, as the spine abnormally curves, the involved vertebrae are forced to rotate. At the thoracic level, vertebral turning impacts the rib cage and may result in rib prominence on the opposite side of the curve. Deformity is the primary complaint. Back pain from scoliosis is uncommon. Spinal Infections (Osteomyelitis) Osteomyelitis is a bone infection usually caused by bacteria. In the spine it is commonly found in the vertebrae, although the infection can spread into the epidural and/or intervertebral disc spaces. Typically, symptoms include persistent and severe back pain exacerbated by movement, swelling, fever, sweating, weight loss, and malaise. DETERMINING THE CAUSE Back pain is not always indicative of a spinal problem. Rarely is back pain an emergency or serious medical condition. A proper diagnosis is paramount to determine the best course of treatment. A thorough physical and neurologic assessment may reveal the cause of the pain.The examination begins with the patient's current condition and medical history. The oral segment of the examination often includes many questions such as "when did the pain start?" - "what activities preceded the pain?" - "previous treatment" - "does the pain radiate or travel into another part of the body?" - "what makes the pain less or greater?" - and so on. This examination includes observation of the patient's posture, range of motion, and physical condition. Any movement generating pain is noted. The physician will palpate or feel the curvature of the spine, vertebral alignment, detect muscle and tender points. Abdominal palpation may be performed to determine if the cause of low back pain is possibly internal organ related (e.g. pancreas). The neurological examination tests the patient's reflexes, muscle strength, detects sensory and/or motor changes, and determines pain distribution. If nerve damage is suspected, the physician may order special tests to measure the rate at which nerves conduct impulses. These tests are termed Nerve Conduction Velocity (NCV) and Electromyography (EMG). Typically these studies are not performed immediately because it may take several weeks for nerve impairment to become apparent. If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis. Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or disc disease is suspected, or to evaluate neurologic dysfunction. An MRI represents the gold

standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging method of choice to study the bony elements in the spine. NONSURGICAL - CONSERVATIVE TREATMENT Seldom does back pain require surgical intervention. A conservative treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient's medical condition, age, other drugs the patient currently takes, and safety.The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to reduce the risk of stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers may be prescribed for use during the acute phase. A cervical collar may be recommended to help a patient with neck pain. Cervical collars limit movement and support the head taking the load off the neck. Lying down has a similar affect. Limiting neck movement and reducing pressure (weight) gives muscles needed rest while healing. Cervical traction may be prescribed for home use. This form of traction gently pulls the head, stretching neck muscles, while increasing the size of the neural passageways (foramen).Physical Therapy (PT) may be incorporated into the patient's treatment plan once activity can be tolerated. PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise.Therapeutic exercise can help build strength, increase range of motion, coordination, stability, balance, and promotes relaxation. Therapists educate their patients about their condition and teach posture correction and relaxation techniques. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes back maintenance through a home exercise program developed for the patient by the physical therapist. RECOVERY and PREVENTION First and foremost, follow the treatment plan outlined by the physician and physical therapist. Patients, who undergo a surgical procedure, may find the road to recovery a bit longer. However, that is not reason to become discouraged. It is normal to feel tired and emotionally down following surgery. During stress such as surgery, the body cranks out extra hormones after surgery the level drops, which may result in a 'down' period. To enhance recovery from surgery, an episode of back pain, or to help minimize future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight. Moreover, people who suffer from lower back pain are encouraged to help with their own recovery by exercising and getting physical therapy, but are seldom given the knowledge and tools needed to accomplish this. This discussion will provide a basic understanding of the causes of lower back pain, and discuss appropriate steps to exercise and rehabilitate a painful back.Of course, getting better is only the beginning, since further episodes of back pain are quite common as time passes. Whether suffering from the first bout of low back pain or following extensive treatments or even surgery, the best way for patients to avoid or minimize the severity of recurrences is to rehabilitate the back through appropriate back exercises.

Other Causes of the Back Pain There are other several structures in the back that can cause and/or contribute to low back pain. These include: Intervertebral Discs A Although the intervertebral disc is a remarkably versatile and strong structure, essentially acting as a shock absorber during everyday activities, sometimes the disc fails when there is a sudden, unexpected force (such as a fall, lifting or other trauma), or due to ordinary wear and tear over time. And when the disc does get injured it cannot repair itself very well, which is one of the major reasons recurrent back pain is so common.
Making matters worse, the pain often interferes with a patients ability to exercise, which adversely affects disc nutrition. Nutrition for the disc is achieved when physical activities and exercise cause the disc to swell up with water and then squeeze it outmuch like a sponge. When pain affects our physical activity, the injured disc is deprived of its nutrition and begins to degenerate. Activity is also needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material.

One of the keys to recovering from an episode of back pain or surgery, and to help avoid future recurrences of back pain, is to pursue appropriate rehabilitation and exercise. A comprehensive exercise regimen should include a combination of stretching, strengthening and aerobic conditioning of the back and body. This requires a basic understanding of the types of muscles that need to be conditioned There are three types of muscles that support the spine:

Extensors (back and gluteal muscles), which are used to straighten the back (stand), lift and extend, and move the thighs out away from the body. Flexors (abdominal and iliopsoas muscles), which are used to bend and support the spine from the front; they also control the arch of the lumbar (lower) spine and flex and move the thigh in toward the body. Obliques or Rotators (side muscles), which are used to stabilize the spine when upright; they rotate the spine and help maintain proper posture and spinal curvature.

While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.
For all forms of exercise, it is advisable to see a trained and licensed physical therapist, occupational therapist, chiropractic physician or physical medicine and rehabilitation physician (also called a physiatrist). Depending on the specific diagnosis and level of pain, the exercise program will be very different, and these specialists are trained to develop an appropriate exercise program and provide instruction on correct form and technique.

Stretching Any form of inactivity, especially if an injured back is involved, is usually associated with some progressive stiffness. Therefore, it is necessary to push the range of motion as far as can

be tolerated (in a controlled manner). Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain. Stretching exercise should focus on achieving flexibility and elasticity in the disc, muscles, ligaments, and tendons. Additionally, it is important to activate and strengthen muscles not directly involved with the injured area, such as the arms and legs. For example, hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back, so hamstring stretching is an important part of alleviating low back pain. Specialized equipment is available that helps repetitions to be done in the same manner so that progress can be identified and the level of exercise regulated. Strengthening It is thought that future episodes of back pain are less likely to occur if back strengthening is accomplished than if mere pain relief is achieved with just stretching. An episode of back pain that lasts for more than two weeks should be treated with proper strengthening exercise to prevent a recurring cycle of pain and weakness. There are two primary forms of exercise for strengthening and/or pain relief that tend to be used for specific conditions. When appropriate, the two forms of physical therapy may also be combined.

McKenzie exercise, in general focuses on extending the spine to reduce pain generated from a collapsed disc space (e.g. from degenerative disc disease). Theoretically, extension may also help reduce a herniated disc and reduce pressure on a nerve root. For patients who are suffering from leg pain due to a herniated disc (e.g. sciatica), extending the spine may help reduce the leg pain by "centralizing" the pain (moving the pain from the leg to the lower back). For most people, back pain is usually more tolerable than leg pain. Sometimes, based on the structured evaluation, flexion exercises are appropriate. Lumbar stabilization exercise focus on finding the patient's "neutral" spine, that is, the position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. Performed on an ongoing basis, these exercises can help keep the back strong and well-positioned. Special attention is paid to the extensor muscles of the lower back with resistance exercise.

Additionally, a strengthening program that involves progressive loading and unloading of the lumbar spine by means of flexion/extension exercise can reduce pain and increase the perception of improved back strength. This training, called facilitation, is best accomplished when the muscles to be facilitated are isolated in some way so that other muscles cannot take over the job. Often specific equipment is required to achieve that goal.

Low-Impact Aerobic Conditioning Conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to

perform everyday activities.Examples of low impact aerobic exercise that many people with back pain can tolerate include: Water therapy (also called pool therapy). For people with a great deal of pain, water therapy provides a gentle form of conditioning as the water counteracts gravity making many stretching movements easier and provides buoyancy as well as mild resistance. Some of the basic techniques for pool therapy exercises are as follows (they can be modified for varying degrees of difficulty):

Knee-to-chest exercise. This movement is performed while standing on one leg, which is slightly bent, and one leg outstretched in front while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip and lower back. Leg raise exercise. This movement is performed with one leg outstretched and the supporting leg slightly bent while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip and lower back. Wall-facing leg stretch exercise. In this stretching exercise individuals assume a Superman position with hands resting on side of pool and the body and legs outstretched into and supported by water. This extends all regions of the back and the joints in the back, as well as stretching shoulder muscles. Pool walking exercise. Walking both forward and backward in chest-high water works the leg muscles while exerting no impact of the knees or hips, which is particularly important for people who have arthritis in those joints. The walking exercise can be made more demanding with the addition of hand floats or light weights, so a stroll in the pool becomes an aquatic version of power walking. Quadruped activity and exercise. This exercise works legs and arms and is performed while floating on ones back (sometimes achieved with a therapist supporting the trunk or using a flotation jacket). The individual makes paddling motions with his or her arms and legs.

Spa treatments complementing water therapy for back pain typically involve relaxing in warm, agitated water such as that found in whirlpool baths. This form of hydrotherapy relaxes muscles, improves muscle blood flow and increases general blood circulation, which make the body more flexible and can prepare it for water therapy or land-based exercise.So,here are some examples of spa treatments: Massage The key to a healthy body is good circulation and massage is a great way to increase the flow of blood throughout the body. Massage has become a popular way to relieve muscle tension and spasm, inflammation, fluid retention, aches, stiffness, and pain. Other benefits include improved circulation, flexibility and greater range of motion, and tissue elasticity. Massage therapists use their hands or special tools to knead, rub, and stroke muscles. Sometimes lotion or oil is applied to the skin to reduce friction. If you have mild back pain or occasional stiffness, a massage may be just what you need. The use of massage for the treatment of low back pain is popular and has a long history of use across a range of cultures. Massage is manipulation of soft tissue (i.e. muscles and fascia) using the hands or a mechanical device, to promote circulation and relaxation of muscle spasm or tension. (1) There are many styles of massage and massage may be provided as a stand-alone treatment or as part of a comprehensive treatment plan. (2) Despite a lack of

methodologically sound trials, it has been accepted that this non-invasive therapy offers several potential benefits: massage therapy affords patients relief without overriding their desire to limit their of use drugs, massage therapy is non-addictive compared to pharmaceuticals taken for pain, massage therapy is low in cost compared to many prescription drugs. A trial testing the effectiveness of massage for chronic low back pain (LBP) showed that massage significantly reduced pain and improved functioning compared to sham laser post-treatment and after one month. Massage combined with exercise and education was significantly better than sham laser on both pain and function. Acupuncture Ac upuncture is the 5000-year-old Chinese art of healing that involves the insertion of very fine, sterile needles into specific parts of the body called Meridian points. This therapy stimulates and activates the body's immune and healing systems. Acupuncture is used to treat many disorders, including chronic pain, headaches, back, neck, or muscle pain, stress, and arthritis. Be sure to find an acupuncturist who is certified and experienced. A recent study published in 2005, reviewed 33 articles of acupuncture trials, and concluded that acupuncture is more effective than sham acupuncture and no additional treatment was required for providing short-term relief of chronic low back pain. This short-term relief seems to be sustained long-term; however, a sustained effect has not been established, as long-term follow up data is not yet available. More research is needed to evaluate acupuncture's effect on acute low back pain, and the evidence comparing acupuncture to other active treatments is inconclusive. At this time current estimates of acupuncture's effects on chronic low back pain are preliminary as several large studies are currently ongoing. However, anecdotal evidence supports acupuncture to be a viable adjunct to traditional medicine Hot Stone Massage It has to be one of the most enjoyable and relaxing therapeutic massages available. For hundreds of years, hot stone massage has been used by many different cultures and modernday therapists apply the same techniques for a wonderfully relaxing massage designed to work on muscle tension at the deepest level.During the hot stone massage treatment, smooth, basaltic (volcanic) rocks that have been heated in water are used in two ways; some stones are wrapped in towels and placed on specific energy centres, known as chakras, along the body to align and re-balance the bodys natural energy flow, whilst other stones are used by the therapist to perform the body massage.The heat of the stones penetrates deep into the muscle tissue allowing the muscles to relax 4-5 times quicker than in a standard body massage, easing muscle tension and revitalising the muscle tissue by increasing blood circulation.The deep relaxation and increased blood flow to the areas being worked not only accelerates any healing processes but also creates a state of deep mental relaxation.

Walking Many Many people think that walking as part of their daily routine (e.g. at work or while shopping) is enough. However, this stop-and-start type of walking is not adequate for aerobic conditioning. Instead, continuous walking at a sustained pace for a minimum of twenty to thirty minutes is required to provide aerobic conditioning.

Stationary biking Riding Riding a stationary bicycle provides aerobic conditioning with minimal impact on the spine. This is also a good exercise option for people who are more comfortable positioned leaning forward. Yoga Yoga is an ancient series of exercises and poses that integrate mind, body, and spirit. Yoga is founded on its teachings of concentration, relaxation, flexibility, and positive thinking.Each session typically contains a routine of physical poses that vary in difficulty. Participants use concentration to hold each pose. But you don't simply strengthen your concentration the longer you hold a pose. You also build flexibility. Muscles that are lean, flexible, and strong combat stress. Strong muscles also support your body and bones better, which may help prevent back pain.A special awareness of breathing is also integral to yoga. Deep breathing is thought to foster healthy energy, while relaxing the body.Choosing the most appropriate form of exercise depends upon the nature of the injury and an individuals exercise preferences. It may be helpful to discuss options with a physical therapist, or physician to identify which form of aerobic exercise is best to incorporate into an exercise routine.In addition to stretching, strengthening and aerobic exercises, there are several lifestyle guidelines that can help in the healing and rehabilitation process. Manage Anxiety About Low Back Pain Controlling anxiety and fear of re-injury and low back pain is very important to regain normal muscle function. The basis for these psychological reactions to low back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically tells the muscles to improve their function can overcome this neurological barrier to normal muscle function. Eat Properly to Help the Back Heal The healing process can be aided with appropriate nutrition, which includes adequate calorie intake in a balanced manner. If all calories consumed are in the form of sugars (such as breads, pasta, and sweets), any calories not immediately needed for energy are converted into fat. Extra weight can slow the healing process. A balanced diet includes adequate protein as a source of the building blocks of soft tissue healing. Additionally, fresh fruit and vegetables supply the vitamins and trace elements necessary for effective healing. A vitamin supplement may also be helpful.

Stop Smoking to Improve Oxygen Flow to the Spine Studies have shown that the development of lower back pain was significantly associated with smoking. The underlying theory for this is that smoking deprives the spine structures of nutrients, particularly oxygen in the blood supply (because smokers lungs do not intake or distribute oxygen as effectively as non-smokers) and thereby interferes with the spines

attempts to repair itself. Stopping smoking can improve oxygen flow and improve rehabilitation outcomes.

Get Adequate Sleep to Support the Healing Process One of the best ways to encourage sleep is to induce physical weariness through active exercise. Chronic inactivity does not create a need for the deep sleep that is so helpful for physical and emotional healing. Clearly, stimulants such as caffeine or nicotine should be avoided at bedtime. Smoking should also be avoided because it diminishes the available blood supply and makes the nervous system more sensitive. Control Medication Use for Back Pain While medications are often important for low back pain relief, one should also be careful about the use of medications. For example, use of narcotic medications and muscle relaxants over time may cause depression and should be used as little as possible. Also, while antiinflammatory medications may provide low back pain relief, there is no evidence that they do anything to speed the process of healing. The use of heat therapy or cold therapy, or liniment or massage therapy, as mechanisms for pain control are very safe and positive alternatives for low back pain management. Exercise Properly for Back Fitness
Exercising in a controlled, gradual, and progressive manner is the one signal the body responds to so that it knows to heal. Injections and medications can provide low back pain relief but cannot stimulate the healing process. If a pain problem has persisted for many weeks, the body is demonstrating that there are barriers to the healing process that need to be eliminated. The natural stimulus for the healing process is active exercise. Active exercise means using the nervous system to tell the muscles what to do, and includes dedication to an appropriate, comprehensive exercise and rehabilitation program.

Work With a Professional for Low Back Pain Finally, seeking the assistance of an appropriately trained and licensed health professional for back rehabilitation and exercise is highly recommended. The back is a complicated structure, and specialists have a defined protocol to identify the cause of back pain. And its always important to see a physician if the lower back pain lasts for more than a few weeks or a month or if there are any symptoms that cause concern, as the continued pain and/or symptoms may signify a serious medical condition. Ultimately, participating in developing and maintaining an active rehabilitation and exercise program for low back pain should help patients heal faster and have fewer recurrences of back pain.

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