Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis
Neto MG, Lopes JM, Conceição CS, Araujo A, Brasileiro A, Sousa C, Carvalho VO, & Archanjo FL. Physical Therapy in Sport. 2016; Epub ahead of print Accepted August 9, 2016. doi: 10.1016/j.ptsp.2016.08.004
Take Home Message: Stabilization exercises are better than general exercises for people with chronic non-specific low back pain and possibly as effective as manual therapy.
Supervised exercise is often recommended for people with chronic non-specific low back pain. A common type of exercise is stabilization exercises, which try to enable a person to better control and coordinate their spine and pelvis. Unfortunately, there is conflicting research as to whether it is successful in reducing pain and disability. The authors of this systematic review aimed to compare the effectiveness of stabilization exercises to general exercises or manual therapy in people with chronic non-specific low back pain. The authors conducted a systematic review and meta-analysis of randomized clinical trials among people without leg pain and with low back symptoms for > 3 months. They evaluated the quality and outcomes of 11 trials, which had 413 participants with stabilization exercises, 297 with general exercises, and 185 with manual therapy. The quality of the articles was relatively low, with scores ranging from 5 to 8 out of a possible score of 10. The stabilization exercise programs ranged from 4 to 12 weeks with sessions 20 to 60 minutes per session that occurred 1 to 3 times/week. Overall, the authors found that participants who completed stabilization exercises had greater pain and disability improvements in comparison to general exercises. However, there were no differences in function reported. The authors also reported no significant differences in pain or disability when comparing stabilization exercises to manual therapy.
The findings of this research reinforce that stabilization exercises or manual therapy may be a better choice for chronic non-specific low back pain than general exercises for improving outcomes. The difficulty with this is that most rehabilitation programs are varied and make it difficult to replicate. This is a similar issue with manual therapy. Programs and treatment times were wide-ranging and this could result in diverse results. It would be interesting to see if there is a relationship between outcomes and rehabilitation program frequency or duration. Manual therapy is also a very broad term, and it would be interesting to see if specific techniques such as joint mobilizations or massage techniques were more successful than others. Manual therapy and stabilization exercises resulted in similar outcomes. However, it would be interesting to see if a combination of the two approaches would be superior to just one of them. Ultimately, clinicians should consider stabilization exercises or manual therapy for patients with chronic non-specific low back pain.
Questions for Discussion: What exercises do you think are successful in treating low back pain? What manual therapy techniques have you found to help in low back pain cases?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban