back pain

Exercise Prescription for Back Pain


Eugene K. Wai, MD, MSc, CIP, FRCSC1
R. Michael Galbraith, DO, CCFP (SEM), Dip Sport Med2
Denise C. Lawrence Wai BScPT3
Susan Yungblut, PT, MBA4
Ted Findlay, DO, CCFP, FCFP5

1 is an orthopedic surgeon who specializes in the care of adult spinal disorders. He is also an Associate Professor in the Department of Surgery at the University of Ottawa. In addition he is the Research Chair for the Canadian Spine Society.
2Private practice Elite Sports Medicine in Lethbridge, AB.. Head Team Physician, Lethbridge Hurricanes (WHL). Clinical Lecturer, Dept of Family Medicine, University of Calgary School of Medicine.
3 is a Physical Therapist in Ottawa and a Research Assistant at The Ottawa Hospital.
4 Physiotherapist, Liquidgym, Ottawa; Nordic Walking Instructor and Urban Poling Master Trainer, OttawaNordicWalks; Past Director, Exercise is Medicine Canada
5 is a Clinical Assistant Professor in the Department of Medicine at the University of Calgary. He is also in a Private Family Medicine practice. In addition he is on Medical Staff at Alberta Health Services, Calgary Zone in Calgary, Alberta.


Abstract: Exercise is one of the most effective and simplest evidence-based recommendations to manage acute and chronic back pain. This paper discusses the physiology and evidence to support exercise as effective treatment. We will provide guidance on how to assess and prescribe exercise and offer methods to educate and encourage physical activity for patients with back pain.
Key Words: Back Pain, Physical Activity, Exercise Prescription, Motivational Interviewing.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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1. Exercise is one of the most effective and simplest evidence-based recommendations to manage acute and chronic back pain.
2. For chronic back pain the most important exercise is the one the patient will actually do.
3. For acute back pain the exercise prescriptions should take into account the patient's directional preference of exercise (Pattern of Pain) and the patient's unique situation.
4. Exercise Prescriptions should include the F.I.T.T. principle (Frequency, Intensity, Time and Type).
Simply asking the patient about exercise has been shown to be effective in improving health outcomes. Consistent messaging about the positive role of physical activity is important.
Most forms of physical activity are usually beneficial. The exercise prescription should take in to account what the patient is actually prepared to do.
Patients often require reassurance that pain associated with exercising does not lead to physical harm.
Motivational interviewing is a structured, empathetic method to engage resistant patients.
Walking is free.
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We've got your back: HealthPlexus and the Canadian Spine Society Announce the Launch of the Back Health CME Resource

The Canadian Spine Society, as part of its educational mandate, is partnering with and the Journal of Current Clinical Care…
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For immediate release:
January 7th 2014

The Canadian Spine Society (CSS), as part of its educational mandate, is partnering with (HealthPlexus) and the Journal of Current Clinical Care (JCCC) to promote best practices and knowledge translation for fast and effective diagnosis and management of back pain.

As part of the multi-faceted collaboration, CSS and HealthPlexus will work on a comprehensive continuing education program aimed at healthcare professionals that will be delivered via and the Journal of Current Clinical Care.

Dr. Hamilton Hall is a well-recognized key opinion leader both nationally and internationally on the subject of back pain. He has taken on the position of Editor-in-Chief for the Back Health Resource Center @HealthPlexus.

Dr. Hall and his colleagues from the CSS will present an ongoing series of Clinical Reviews and Case Studies, which will be available through the HealthPlexus channels. Their goal is to provide those healthcare professionals who are managing patients with back health issues with deeper knowledge and increased ability to address their patients' needs.

"Numerous population wide surveys have confirmed that arthritic disorders that limit mobility are the most important factors in impairing quality of life for older adults. Back pain is one of the key issues limiting mobility, and I applaud HealthPlexus for addressing this very important topic."

-Barry J. Goldlist, MD, FRCPC, FACP, AGSF, senior member of the advisory board for [Geriatrics and Dementia] and the Journal of Current Clinical Care. Dr. Goldlist is a nationally recognized geriatrician with a long standing interest in medical education and medical journalism.

“For practitioners who look after the adult population, especially those in the middle and later years, disorders of musculo-skeletal mobility and acute and chronic pain is one of the most common challenges they face with their patients. There is enormous suffering and impairment of full function and ability to participate in normal activities much less those of a recreational nature when someone experiences back pain that is unrelieved by simple and safe methods. Having an additional means to learn about and find methods to address the issues of back pain with all its complexities of diagnosis and treatment, is an important addition to the HealthPlexus spectrum of clinical support for practicing physicians.”

-Michael Gordon, MD, MSc, FRCPC, FACP, the Editor-in-Chief of the Dementia Educational Resource. Dr. Gordon is the Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System

"As a medical professional who has trained as both a Radiologist and a Family physician, I have seen many patients who suffer from the entire spectrum of lower back pain. I don't think that medical school and residency prepares you enough to adequately to deal with the complexity of this condition. A dedicated CME resource focusing on back health is a much needed tool for both students and practicing physicians who wish to acquire skills and keep their skills up to date on this subject. Dr. Hall is eminently qualified for such an endeavor. I still recall his teachings, some years ago now, in my medical school class at the University of Toronto vividly. As medical editor of the Journal of Current clinical Care, I encourage you to take advantage of this learning opportunity."

-D’Arcy Little, MD, CCFP, FRCPC, the editorial director of and its sister publication, the Journal of Current Clinical Care. Dr. Little is a family physician, diagnostic radiologist and medical writer. He completed fellowships in Care of the Elderly and Academic Medicine

About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Back Health Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.

About The Canadian Spine Society:

The CSS is a collaborative body of Canadian neurosurgical and orthopaedic spine surgeons and other spine care professionals with a primary interest in advancing excellence in spine patient care, research and education.

Contact Person:
Mark Varnovitski


Back Pain Should Be A Priority in the Overall Treatment of the Elderly

Back Pain Should Be A Priority in the Overall Treatment of the Elderly


Sharron Ladd, BSc
Managing Editor

"It is clear that the study of back pain has been overlooked in the geriatric community, perhaps relegated to second-class status behind health conditions like diabetes, heart disease and cognitive impairment," says Dr. Hart Bressler, the primary author of the landmark study entitled "The Prevalence of Low Back Pain in the Elderly." The study, co-authored by Dr. Warren Keyes, Dr. Paula Rochon and Dr. Elizabeth Badley appeared in the September 1st issue of the journal Spine. Several reasons are cited for the under-representation of elderly in back pain studies. One of the main reasons is the economic burden of maintaining worker's compensation programs; these programs are necessarily directed at the younger working population. Other reasons are listed in Table 1.

Using the key words low back pain, back pain, elderly, geriatrics and aged for their literature analysis, the researchers found only twelve studies on low back pain in the elderly, between 1966 and the present, that met their final selection criteria! The methodologies underlying some of these studies are dubious. "Many studies have grouped younger and older patients together, such as a 40 year old with an 82 year old.