How Graded Exercise & Graded Exposure Can Help With Low Back Pain

Both graded exercises and graded exposure are helpful ways to reduce low back pain (LBP). While graded exercises work to improve exercise and activity tolerance, graded exposure improves tolerance to activities that are difficult and avoided out of fear. Both have been shown to provide good benefits for LBP.

Graded Exercises vs Graded Exposure

Graded Exercise	Graded Exposure
Improve exercise and activity tolerance	Improve tolerance to once fearful activities
Good benefit for LBP	Good benefit for LBP

When addressing low back pain, it's important to not only consider the physical, but also the psychological factors, which have been shown to be large component of chronic low back pain. Anxiety and fears on pain and injury can lead to fear avoidance behavior affecting daily function, which can compound loss of function even further.

To help with fear avoidance, it can be helpful to learn about the common misconceptions surrounding low back pain. This includes:

• Abnormal findings on imaging (xray, MRI) are common in people without back pain. They do not always indicate serious damage or illness.

• Pain does not necessarily mean serious damage nor is it permanent pain.

• The spine is not fragile; it is strong and resilient.

Next, comes the treatment which can involve a combination of graded exercises such upper and lower body strengthening and graded exposure, which will depend on the fearful activity. For example, if there's fear and pain involved with walking, it can be started at a low level distance and duration. Then as strength and tolerance builds, fear is decreased, the level can be gradually increased. Effort, positive thinking, and continued progression will be required.