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Exercise programs that focus on coordination/stabilization or strength/resistance can improve chronic low back pain

Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29:1155-67.

Review question

In people with chronic low back pain, which types of exercise are best for reducing pain?

Background

Low back pain is very common and may be due to individual characteristics (e.g., injury), psychological/sociological factors (e.g., stress), or work-related factors (e.g., heavy lifting). However, the cause of low back pain for an individual is often unknown.

Treatment of low back pain is difficult and often not very effective.

How the review was done

The researchers did a systematic review based on studies available up to October 2014.

They found 45 randomized controlled trials with 4,462 people.

The key features of the studies were:

• people were 30 to 63 years of age;
• trials were 1.5 to 18 weeks long;
• exercise programs were categorized as coordination/stabilization (e.g., balance and agility), strength/resistance (strengthening major muscle groups), aerobic “cardioâ€� exercise (exercise through continuous motion of major muscle groups), and exercises that combine various components (e.g., yoga); and
• exercise was compared with usual activities, care by family doctors, ultrasound or laser therapy, or manipulative therapies such as physiotherapy and massage.

What the researchers found

Compared with control, low back pain was improved by:

• exercise that focused on coordination/stabilization;
• exercise that focused on strength/resistance; and
• exercises that combined various components.

Compared with control, low back pain was not improved by aerobic “cardio� exercise.

Conclusion

In people with chronic low back pain, exercise programs that focus on coordination/stabilization or strength/resistance can improve low back pain.

Exercise for chronic low back pain

*Based on standard mean differences (SMD); very small = less than 0.2 SMD, small = 0.2 to 0.49 SMD, medium = 0.5 to 0.79 SMD, large = 0.8 or more SMD.