4Exercise therapy for chronic nonspecific low-back pain
Section snippets
Exercises for prevention of LBP
Nine reviews have been published that evaluated different types of physical exercise interventions in the prevention of LBP. The reviews are essentially based on the same studies, although the most recent reviews also included some recent trials. Eight reviews concluded that there is some evidence of effect of exercise, but effect sizes were reported to be small to moderate [7], [8], [9], [10], [11], [12], [13], [14]. One review concluded that there was contradictory evidence that various
Acute LBP
The Cochrane review by Hayden et al [16]. included 11 trials (1192 subjects) on exercise therapy for acute LBP. None of the randomised controlled trials (RCTs) found exercise therapy in health-care settings to be effective for acute LBP. The meta-analysis showed no difference in short-term pain relief between exercise therapy and no treatment (three trials), with an effect of−0.59 points on a 100-point scale (95% confidence interval (CI),−12.69–11.51), and between exercise and other
Chronic LBP
Since the publication of the Cochrane review by Hayden et al. in 2005 [16], many additional trials have been published on exercise therapy for chronic LBP. In this section, we describe the results of all randomised trials on exercise therapy for chronic LBP. We included all trials of the Cochrane review and updated the search in MEDLINE, EMBASE, CINAHL, CENTRAL and PEDro up to 22 December 2008. The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The following
The effectiveness of the different treatment strategies
No significant treatment effects of exercise therapy compared to no treatment/waiting list controls were found on pain intensity and disability. Compared to usual care, pain intensity and disability were significantly reduced by exercise therapy at short-term follow-up. Adverse events were not reported in any of the included studies.
The Cochrane review, published in 2005, on the effectiveness of exercise for LBP found evidence for the effectiveness on pain and function in chronic patients [16].
Implications for practice
Exercise therapy seems to be effective for the prevention of LBP, but only few recent trials are conducted. This therapy is not effective for acute LBP, whereas it is effective for chronic LBP; however, there is no evidence that any type of exercise is clearly more effective than others. Subgroups of patients with LBP might respond differently to various types of exercise therapy, but it is still unclear which patients benefit most from what type of exercises. Adherence to exercise prescription
References (62)
Epidemiological features of chronic low-back pain
Lancet
(1999)- et al.
High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults
Spine J
(2009) A systematic review of workplace interventions to prevent low back pain
Aust J Physiother
(2000)- et al.
Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial
Pain
(2007) - et al.
Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial
Arch Phys Med Rehabil
(2007) - et al.
Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial
Pain
(2005) - et al.
Effect of Iyengar yoga therapy for chronic low back pain
Pain
(2005) - et al.
A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy
Physiotherapy
(2008) - et al.
A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial
Aust J Physiother
(2008) - et al.
Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial
Pain
(2008)
What can the history and physical examination tell us about low back pain?
Jama
Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies
Spine (Phila Pa 1976)
Evidence-based medicine and the challenge of low back pain: where are we now?
Pain Pract
The Cochrane Collaboration back review group for spinal disorders
Spine (Phila Pa 1976)
Editorial Board of the Back Review G. Cochrane back review group
Spine (Phila Pa 1976)
Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review
J Occup Rehabil
Effectiveness of training to prevent job-related back pain: a meta-analysis
Br J Clin Psychol
The effectiveness of four interventions for the prevention of low back pain
Jama
Preventive interventions for back and neck pain problems: what is the evidence?
Spine (Phila Pa 1976)
Low back pain interventions at the workplace: a systematic literature review
Occup Med (Lond)
A systematic review of controlled clinical trials on the prevention of back pain in industry
Occup Environ Med
Occupational health guidelines for the management of low back pain at work: evidence review
Occup Med (Lond)
Exercise therapy for treatment of non-specific low back pain
Cochrane Database Syst Rev
Clinical guidelines for the management of low back pain in primary care: an international comparison
Spine (Phila Pa 1976)
Quality of low back pain guidelines improved
Spine (Phila Pa 1976)
Evaluation of a program to reduce back pain in nursing personnel
Rev Saude Publica
Andersen. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study
Eur Spine J
A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain
Phys Ther
Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation
Spine
A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain
N Engl J Med
Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial
Eura Medicophys
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- 1
EMGO-Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, room D518, 1081 BT, Amsterdam, The Netherlands Tel: +31 20 4449813; Fax: +31 20 4446775. [email protected].
- 2
Department of Health Sciences & EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, U 452, 1081 HV Amsterdam. Tel: +31 20 5986587. [email protected]