|
|
The Role of Exercise in the Management of Low Back Pain |
|
Exercise has long been considered a front-line approach in the treatment of patients experiencing low back pain (LBP). 1,2,4,6 However, literature tends to be less clear as to the exact role of exercise on low back pain management. Most of the research has centered on the role of therapeutic exercise in the management of chronic and non-specific low back pain, and on its short-term effects on pain and disability.1,2,3,6 It is even less clear about the role of therapeutic exercise in the management of acute low back pain.3,7 Furthermore, questions remain about the types of exercise that work best and if specific exercise approaches, such as lumbar stabilization training and motor control training, offer any further benefit over general exercise, such as walking, or approaches such as Pilates or Tai Chi.1,3,4,5, 8,10 Finally, the exact role of exercise on patients with low back pain is an area that needs to be explored further to determine its overall effect on patient outcomes.2,3,11 In summary, utilizing exercise in the management of patients with low back pain is generally supported by the literature, with low to moderate certainty of eliciting a positive effect. There is a trend that suggests that more specific approaches, like Pilates, and motor control exercises with lumbar stabilization may be slightly more beneficial than general exercise programs in the short term.1,8,10 However, questions still remain as to which exercise approaches work best for specific populations, as well as parameters such as dosage, volume, frequency, and specificity. |
|
|
1. “Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis.” Fernandez-Rodriguez R, et al. 2022.This article attempted to determine which type of exercise is best for reducing pain and disability in patients with chronic LBP. The most beneficial programs included exercises like Pilates or strength exercises at least 1-2 times per week, or core or mind-body exercise sessions of less than 60 minutes, for a minimum of 3 to 9 weeks in duration. 2. “Individualized Exercise in Chronic Non-Specific Low Back Pain: A Systematic Review with Meta-Analysis on the Effects of Exercise Alone or in Combination with Psychological Interventions on Pain and Disability.” Fleckenstein J, et al. 2022 .This paper investigated the effects of individualized interventions, based on exercise alone, or combined with psychological treatment, on pain intensity and disability in patients with chronic LBP. Active interventions did result in better outcomes than passive interventions in the short-term, and overall, individualized interventions like motor-control exercise with behavioral therapy boosted effects further. 3. “Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021.” George SZ, et al. 2021. This clinical practice guideline examined all types of therapeutic interventions currently used to treat LBP. It found that exercise for those with chronic LBP had Grade A evidence. Exercise for acute LBP with leg pain had Grade B evidence to support its use. However, exercise for patients with acute LBP had only Grade C evidence to date. 4. “A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain.” Gordon R, et al. 2016 This systematic review found that general exercise programs that combine muscular strength, flexibility and aerobic fitness are beneficial for rehabilitation of those suffering from chronic LBP. 5. “Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain - A Systematic Review of Systematic Reviews.” Grooten WJA, et al. 2022. This systematic reviews found that the effects of various exercise types on chronic LBP pain and disability varies with no major difference between the exercise types chosen. 6. “Exercise Therapy for Chronic Low Back Pain” Hayden JA, et al. 2021. This Cochrane review found moderate-certainty evidence that exercise is effective for the treatment of chronic LBP compared to no treatment or usual care approaches for pain reduction. The literature was less clear with regard to disability. Sub group analysis suggests exercise is also better than electrotherapy, but no observed differences in outcomes compared to manual therapy treatments. 7. “Effects of Exercise Therapy in Patients with Acute Low Back Pain: A Systematic Review of Systematic Reviews.” Karlsson M, et al. 2020. This article examined the effect of several different exercise approaches on treating patients with acute LBP. It found no difference between any exercise type on pain and disability when compared to sham ultrasound, usual care, spinal manipulation, or advice to stay active. 8. “Which Specific Modes of Exercise Training are Most Effective for Treating Low Back Pain? Network Meta-Analysis.” Owen PJ, et al., 2020. This article attempted to determine which modes of exercise were best for a variety of parameters, including pain, physical function, mental health, and muscular strength. A total of 89 studies were included that examined 131 exercise interventions. There was low quality evidence that Pilates, stabilization/motor control training, resistance training, and aerobic exercise were the most effective treatment approaches for non-specific chronic LBP patients.
9. “Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis.” Tataryn N, et al, 2021.This study attempted to determine if a posterior chain resistance training program (PCRT) was more effective than a general exercise (GE) program for improving pain and disability, strength, and number of adverse events in both recreationally active and sedentary individuals with chronic LBP. The authors found that 12-16 weeks of PCRT had a statistically significantly greater effect on pain and disability compared to GE, but no difference was observed in the number of adverse events in either group. 10. “Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain: A Randomized Clinical Trial.” Van Dillen LR, et al, 2021. The purpose of this study was to determine if exercise-based treatment of person-specific motor skill training (MST) during functional activities or strength and flexibility exercises (SFE) are more effective in improving function. Those receiving MST had greater short-term and long-term improvements than those who received SFE. 11. “The Impact of Contextual Effects in Exercise Therapy for Low Back Pain: a Systematic Review and Meta-Analysis.” De Roode, A. et al, 2024. Contextual factors, such as the patient-therapist relationship and patient expectation, has been shown to have considerable influence on treatment outcomes. These effects are often under-appreciated in analyzing clinical trials, often leading to an “efficacy paradox”. This means that the treatment effects observed in clinical practice are often greater than those reported in clinical trials. |
|
This video demonstrates exercises recommended by McGill to be used in the treatment of LBP. |
|
McGill, S. Low Back Disorders: Evidence based prevention and rehabilitation. 3rd ed. 2016. Champaign: Human Kinetics. Liebenson, C. (ed.): Rehabilitation of the Spine: A Patient-Centered Approach. 3rd ed. Baltimore: Lippincott, Williams & Wilkins. 2019.
|
|
This content was developed in part by Kenneth T. Cieslak, DC, LAT, ATC, CSCS, PSP; Nickolas Unger, BA, PTA, CSCS; Leslie Rippon PhD, ATC, and the NATA Foundation Educational Resources Committee. |
|
View all past Research to Clinical Practice issues HERE. |
|
|
|
|
