Which exercise is best for adults with chronic low back pain?

Chronic low back pain is a very common and multi-factorial problem which is often treated with exercise. A new systematic review was found, which looked at which type of exercise is best at reducing pain compared to other treatments.

Here’s what they did

The authors searched MEDLINE, CINAHL, EMBASE, SPORTDiscus, PsycINFO, and The Cochrane Library, looking for published randomised controlled trials in any language, which studied the treatment of chronic low back pain with exercise. They also looked at reference lists, clinical guidelines and review articles.

Here’s what they found

Forty five trials were found with a total of 4462 participants with chronic low back pain, which compared an exercise group to another intervention (electrotherapy or manipulative therapy) or control (waiting list, GP care, usual activities).
In order to determine the most effective exercise intervention the studies were divided into 4 groups according to the type of exercise used: coordination / stabilisation, strength / resistance, cardiorespiratory and a group with multiple components of exercise.
The majority of the studies used supervised exercise programmes (n=40). Trials were between 1.5 – 18 weeks in duration
The combined results of the trials show that exercise is more effective for chronic low back pain than other interventions used or the control groups, showing a small but significant benefit. Programmes consisting of strength / resistance, coordination / stabilisation and combined exercise show a significant effect, while the cardiorespiratory group showed no effect.

The authors concluded

Exercise therapy has a pain reducing effect in patients with chronic low back pain, especially exercise that includes muscle strengthening and coordination or stabilisation work.

Muscle strengthening & coordination or stabilisation work reduce pain in patients with chronic low back pain

The Musculoskeletal Elf’s view

The authors of this study did a thorough search of the literature, looking at a wide range of databases and looking for studies in all languages.

Details of the studies included in this review were not presented in the article which means that the reader is not provided with detailed information on, for example, information on study populations, the randomisation methods used, the frequency of interventions for each study, what outcome measures were used and at what stage of the study, and the length of studies. This makes it difficult for the clinician reading this review to know how relevant the results are to other patient populations and to know how long-term the effects of the exercise programmes were.

It would have been interesting if the authors had also included a measure of patients’ function or activity levels, rather than just pain.

What do you think?

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Do you know that there is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses? This is called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses or PRISMA statement and can be accessed through the website of the EQUATOR Network. The Elves use the PRISMA statement for critical appraisal of systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review.

Links

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, [Abstract]