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Exercise therapy for low back pain

 

Clinical bottom line

Specific exercises are not effective for the treatment of low back pain, but may be helpful for patients with chronic low back pain to increase return to normal daily activities and work.


Reference

M van Tulder et al. Exercise therapy for low back pain. Spine 2000 25: 2784-2796.

Review

The review considered only randomised trials with subjects ages 18-65 years who had been treated for non-specific low back pain in primary care or an occupational setting. Studies had to use one or more types of exercise therapy. Outcome measures looked for were pain, a global measure of improvement, an assessment of back-pain specific functional status and generic functional status.

A wide search strategy was used.

Results

There were 39 randomised trials for inclusion, of which 16 were considered high quality by the criteria of the reviewers. There were many different exercises, and comparisons, for acute and chronic low back pain, and different lengths of follow up. The analysis was necessarily descriptive.

The conclusion was that:

Comment

There are times when we can be grateful that someone has done a review that we could never contemplate. This is really difficult territory, because of all the complications. This is not like drug treatment, where perhaps the main issues are dose and duration. This is much, much more complicated. This review tells us that, without compelling new evidence, we can regard specific exercises as having no clinical effect in back pain.