Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomized controlled trials
Searle A, Spink M, Ho A, Chuter V. (2015). Clinical Rehabilitation.
Take Home Message: Exercise reduces pain in patients with nonspecific low back pain. Exercise protocols involving strength training and stabilization with a whole-body approach appear to provide the greatest relief.
Chronic low back pain affects up to 70% of adults and a majority do not know the underlying cause of this pain. There is some evidence in the literature that exercise can help improve low back pain. However, there is little about which specific exercises or exercise protocols are most effective at reducing pain. Therefore the purpose of this meta-analysis was to determine specific exercises that are more effective than other interventions or control protocols to reduce pain. The authors searched electronic databases for randomized control trials related to low back pain and exercise interventions. Studies were only included if the patients had low back pain from a non-specific origin. The authors performed a meta-analysis on the extracted articles to determine if exercise interventions were effective when compared with other treatment methods to reduce back pain. An exploratory subgroup analysis was performed on four separate groups of trials: 1) coordination/stability exercises, 2) strength/resistance exercises, 3) cardiorespiratory exercises, and 4) combined trials. The exploratory analyses enabled the authors to determine the exercise intervention with the greatest benefits. Ultimately, 39 studies with 4109 participants were included in the meta-analysis. 30 of 39 studies demonstrated exercises positively influenced back pain. The results showed that exercise has a small but significant benefit for the treatment of nonspecific chronic low back pain and is more effective than conservative treatment. Based on the subgroup analysis, strength/resistance and coordination/stabilization exercise interventions proved to have a small but significant effect. The authors found the largest effect sizes for studies that used strength/resistance exercises with a focus on the whole body and trunk.
Determining effective protocols to treat low back pain is compromised by not knowing the specific underlying mechanism. This study demonstrates exercise interventions can improve low back pain even when the exact source of pain is unknown. The results of the study are encouraging for clinical settings because strength/resistance and coordination/stability training can be useful interventions to alleviate low back pain. Weakness and altered muscle activation firing patterns may contribute to non-specific low back pain. Increasing core strength and stability through implementing whole-body resistance and coordination programs may assist in improving these deficiencies and reduce pain. This study only sought to assess the effect of clinical interventions on pain. Further research needs to be completed to determine if exercise interventions improved specific measurable outcomes such as strength, stiffness, balance, etc. In addition a follow-up study is necessary to determine the length of time, frequency of interventions, number of exercises, and intensity of exercises it takes for interventions to reduce the pain to meaningful levels, as this was not reported and not an aim of the current study. In the meantime, sports medicine clinicians should continue to provide therapeutic exercises to patients with nonspecific low back pain, especially coordination/stabilization exercises and strength/resistance (for example, whole body and trunk exercises).
Questions for Discussion: What programs do you use for chronic, non-specific low back pain? Besides clinical interventions, what advice do you give patients with low back problems to assist in pain reduction?
Written by: Danielle Schindler and Adam Rosen
Reviewed by: Jeffrey Driban