Exercise interventions
for the treatment of chronic low back pain: A systematic review and
meta-analysis of randomized controlled trials

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.

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.

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?

by:  Danielle Schindler and Adam Rosen
by: Jeffrey Driban


Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials Clinical Rehabilitation DOI: 10.1177/0269215515570379