My brother and I are having a debate about back pain. We both seem to suffer from chronic low back pain. He maintains that we have gotten out of shape because we can't do anything with the pain. I think we got the back pain because we were so out of shape to begin with. Which is it?
This may be a bit like the chicken and the egg. Which came first: the pain or the deconditioning? Is there a link between the two before and/or after back pain develops?
These are all good questions and ones that researchers are taking a closer look at because so many back rehab programs are focused on exercise. Does exercise really work? Are we exercising for the reasons we think we are?
It makes sense that chronic back pain limits physical activity and exercise. But it has never been proven that a lack of daily activity and exercise contributes to the onset of back pain. And there isn't convincing evidence that people with chronic low back pain become deconditioned from a lack of physical activity and exercise.
As far as physical fitness goes, we know that laying around (either being a couch potato or immobilized by bed rest or paralysis) does lead to muscle atrophy and loss of strength. This type of muscle wasting affects all muscles (legs, arm, trunk, back) from large to small. But whether or not the loss of muscle mass is directly related to low back pain is also unclear.
There's plenty of room for debate and study on this topic. In general, it's clear that physical activity and exercise benefits us in more ways than one. Exercise has been shown to improve immune system function, heart and lung function, and prevent obesity, diabetes, and other illnesses and diseases linked with a sedentary lifestyle. So, whether for your back, your heart, your lungs, or your general health, the best adivce is to get active and stay active despite the back pain.