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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Exercise for Low Back Pain
3 May 2005 | Volume 142 Issue 9 | Page I-71
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain." It is in the 3 May 2005 issue of Annals of Internal Medicine (volume 142, pages 765-775). The authors are J.A. Hayden, M.W. van Tulder, A.V. Malmivaara, and B.W. Koes.
What is the problem and what is known about it so far?
Low back pain is a common problem that causes discomfort and disability. It may be acute (last less than 6 weeks), subacute (last 6 to 12 weeks), or chronic (last more than 12 weeks). Treatment includes decreasing pain and helping patients resume their normal activities through exercise therapy, patient education, and pain-relieving drugs (such as nonsteroidal anti-inflammatory drugs). Past reviews of studies suggested that exercise therapy might help chronic low back pain but not acute low back pain. Because several recent trials assess exercise therapy, an updated review of the evidence would be helpful.
Why did the researchers do this particular study?
To see whether exercise therapy reduces pain and improves physical function in adults with different durations of low back pain.
Who was studied?
6390 adults with low back pain who participated in 61 trials of exercise therapy.
How was the study done?
The researchers searched the medical literature up to October 2004 to find randomized, controlled trials that compared exercise therapy with placebo, no treatment, conservative management, or another exercise group. They subdivided trials into 3 groups according to whether participants had acute, subacute, or chronic low back pain. They then combined data from the trials to see whether exercise reduced pain, improved physical function, and reduced work absenteeism in the 3 groups.
What did the researchers find?
Exercise therapy slightly decreased pain and improved physical function in adults with chronic low back pain. In adults with acute low back pain, exercise therapy had effects on pain similar to those of no treatment. In adults with subacute back pain, trials conducted in occupational settings suggested that exercise programs that gradually increased activity (graded-activity programs) decreased absenteeism from work.
What were the limitations of the study?
The authors found it difficult to compare studies. Studies defined low back pain differently and also used different ways to measure pain intensity and function. Some studies were small and of low quality.
What are the implications of the study?
Exercise therapy probably improves pain and function outcomes better than no treatment in adults with chronic, but not acute, low back pain.
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  D. Chatzitheodorou, S. Mavromoustakos, and S. Milioti The effect of exercise on adrenocortical responsiveness of patients with chronic low back pain, controlled for psychological strain Clinical Rehabilitation, April 1, 2008; 22(4): 319 - 328. [Abstract] [PDF]
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 R. Chou and L. H. Huffman Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Ann Intern Med, October 2, 2007; 147(7): 492 - 504. [Abstract] [Full Text] [PDF]
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L. H.M. Pengel, K. M. Refshauge, C. G. Maher, M. K. Nicholas, R. D. Herbert, and P. McNair Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain: A Randomized Trial Ann Intern Med, June 5, 2007; 146(11): 787 - 796. [Abstract] [Full Text] [PDF]
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 D. Chatzitheodorou, C. Kabitsis, P. Malliou, and V. Mougios 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 Physical Therapy, March 1, 2007; 87(3): 304 - 312. [Abstract] [Full Text] [PDF]
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 F. H. Shen, D. Samartzis, and G. B.J. Andersson Nonsurgical Management of Acute and Chronic Low Back Pain J. Am. Acad. Ortho. Surg., August 1, 2006; 14(8): 477 - 487. [Abstract] [Full Text] [PDF]
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 K. H. Bridwell, P. A. Anderson, S. D. Boden, A. R. Vaccaro, and J. C. Wang What's New in Spine Surgery J. Bone Joint Surg. Am., August 1, 2006; 88(8): 1897 - 1907. [Full Text] [PDF]
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 Additional articles abstracted in ACP Journal Club Evid. Based Med., February 1, 2006; 11(1): 30 - 30. [Full Text] [PDF]
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K. J. Sherman, D. C. Cherkin, J. Erro, D. L. Miglioretti, and R. A. Deyo Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain: A Randomized, Controlled Trial Ann Intern Med, December 20, 2005; 143(12): 849 - 856. [Abstract] [Full Text] [PDF]
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 Evidence based journal watch Br. J. Sports Med., November 1, 2005; 39(11): 877 - 878. [Full Text] [PDF]
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 A. Tonks What's new in the other general journals BMJ, May 14, 2005; 330(7500): 1107 - 1108. [Full Text] [PDF]
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J. A. Hayden, M. W. van Tulder, and G. Tomlinson Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain Ann Intern Med, May 3, 2005; 142(9): 776 - 785. [Abstract] [Full Text] [PDF]
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