Nonspecific chronic lower back pain: can exercise in nature and thermal balneotherapy reduce symptoms?
A team of researchers from Austria have studied the following therapy concept for treating patients with nonspecific lower back pain: Exercise in nature combined with thermal balneotherapy (the therapeutic use of baths and the active ingredients they contain). The study was carried out with 80 patients (35 men and 45 women) aged 19 to 65 years. The prerequisite for being included in the study was “chronic nonspecific lower back pain” and the associated repeated medical treatment over the past three years. Exclusion criteria included previous lumbar spine surgery, malign diseases, suspected prolapse, acute pain, osteoporosis, contra indications for balneotherapy – such as uncontrolled high blood pressure – and hernia or pregnancy. The researchers subdivided participants into three groups. One group of 26 exercised in nature – in this case mountain hiking in a moderately alpine region for five hours daily – over a period of six days and was additionally subjected to balneotherapy in the form of a 20-minute bath in magnesium and calcium sulphate followed by a resting phase. The second group of 27 participants did the hiking without a thermal bath. Over the six days the hiking groups climbed a total of 3,407 metres covering a distance of 61 kilometres in total. The third group – also encompassing 27 participants served as a control group without any type of therapy; they stayed at home maintaining their standard lifestyle. The study subjects were given a medical examination at the beginning of the study, after the exercise activities on the eighth day and after four months (on day 120). Functional mobility of the vertebral column and trunk rotation were measured and pain behaviour, impairments in everyday activities and physical as well as mental impairments were documented, to name but a few indicators. The patients kept a “pain diary” for the entire duration of the study documenting the use of pain killers. Furthermore, the number of days of patients’ inability to work was documented as well as the number of doctor appointments. The study showed that moderate mountain hiking in combination with balneotherapy as part of a multi-modal treatment including the education of patients with chronic nonspecific back pain had a positive impact on pain intensity, the functional mobility of the spine, health-related quality of life and depressions. Balneotherapy seems to promote regeneration after the physical strains of mountain hiking. Based on the study results exercising in nature such as hiking in moderately alpine regions in combination with balneotherapy are recommended as a form of therapy. However, more studies are still needed to examine the sustainability of this “nature therapy”.
FIBO Report // Olesja Kehler 12 August 2019
Source: Huber D, et al. 2019. Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of nonspecific chronic low back pain: a randomized controlled clinical trial. BMC Musculoskelet. Disord. 20, 1:221 Full text free Link to abstract: www.ncbi.nlm.nih.gov/pmc/articles/PMC6524239
This contribution is based on: Röder J. et al. 2019. Evidenz Update 8 2019. Z. f. Physiotherapeuten 71;8:89 www.physiotherapeuten.de