Activité physique et réentraînement à l’effort chez les patients lombalgiques

Low back pain (LBP) is a major public health problem in Western countries. The benign nature of LBP regularly contrasts with its impact on quality of life due to its readily recurrent nature and its potential progression to chronicity, a stage at which it is regularly accompanied by a restriction of social and professional participation. Regular physical activity (PA) and exercise (PE) are essential for the management of LBP and the prevention of recurrence. PA is therefore recommended for all stages of LBP. However, pain, mistaken beliefs and inappropriate pain-related behaviours regularly form obstacles to practicing PA. According to the biopsychosocial model, chronic LBP is linked to a set of factors that make its management complex. This observation has led to the establishment of multidisciplinary functional restoration programs including management of the physical, psycho-behavioural and socio-professional components of chronic LBP. The rehabilitation component of programs typically includes muscle strengthening and stretching exercises, aerobic activities and spinal stabilisation. Other aspects of care include improving psychosocial and behavioural parameters, notably through cognitive and behavioural therapies and therapeutic education of the patient. Lastly, most programs also offer socio-professional assessment and support with a view to improving return to work or job retention. The multidisciplinary approach to the management of chronic LBP has shown its effectiveness, particularly in terms of functional disability and pain intensity, while the effects concerning absenteeism and return to work are more heterogeneous. Promoting active behaviours and patient autonomy during the course of supervised care, over the long term, is a crucial issue. This therefore requires, on the one hand, to take into account the patient's preference for the choice of PA and PE, but also to focus on motivational strategies.