Exercise therapy probably helps chronic low back pain

Wednesday 10 November 2021

Vanessa Jordan

PEARLS No.

688

Clinical question

What is the effect of exercise treatment on pain and functional limitations in adults with chronic non‐specific low back pain compared with no treatment, usual care, placebo and other conservative treatment?

Bottom line

This review found moderate evidence that exercise therapy probably provides a small benefit for pain outcomes in treatment of chronic low back pain compared with no treatment (including usual care and placebo). Overall reduction in disability was smaller and not considered clinically important.

Types of exercise included were core strengthening, Pilates, general strengthening, and stretching.

Exercise treatment was found to improve pain and functional limitations outcomes compared with other conservative treatments. However, these effects were small and not considered clinically important. Conservative treatments consisted of physical and manual therapy, electrotherapy and/or psychological therapy.

Caveat

This review included numerous studies across geographic locations and settings. Most studies were conducted in healthcare settings where exercise treatments are often delivered, making this evidence applicable to clinical practice. However, fewer studies were available in community settings.

Overall, there was moderate‐quality evidence for the effectiveness of exercise treatment compared with no treatment, usual care or placebo, and low to moderate-quality evidence when compared with other conservative treatments.

Context

Low back pain has been the leading cause of disability globally for at least the past 3 decades, and it results in enormous direct healthcare and lost productivity costs. Many of the social and economic costs associated with low back pain are attributable to people who have prolonged disability – experiencing chronic and/or recurrent low back pain. Despite a large amount of research in the field, there remains uncertainty about the best treatment approach for this population.

Cochrane Systematic Review

Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev 2021;9:CD009790. This review contains 249 trials with a total of 24,486 participants.

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