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Is Exercise Helpful For Low Back Pain?

Many experts agree that exercise is an important part of treating low back pain. But studies so far only show that the effects of exercise on pain and function are small and don't last. Why is that? Is it the type of exercise being used? The type of patients in the studies? Or some other factor?

In this report, a group of experts at a panel discussion and interactive workshop summarize their thoughts and suggestions on this topic. The forum met in Amsterdam, The Netherlands in June of 2006. They discussed a wide range of concerns about how exercise trials are conducted and reported. There is general agreement that many studies are of low quality.

Some of the factors considered in reviewing exercise-based research included the fact that exercise varies so much in type, frequency, intensity, and duration. There are land-based programs versus water or pool-based programs. Some studies focuse on trunk exercises while others measure walking distance.

Not all patients are alike. Some are afraid of movement while others simply don't like to exercise. Are the results different for these patients compared to those who like to exercise and who do their exercises every day?

And what about measuring the results of exercise programs? Should it be based on change in symptoms, function, quality of life, or some other measure? There isn't a consistent way to measure and report on results from study to study.

The panel also pointed out that the way some research is carried out just isn't sound or unbiased. Sometimes it's difficult to keep the groups from knowing who's getting what kind of treatment. This is called blinding. It's a necessary part of scientific research to avoid influencing responses to treatment.

It's difficult to tell when the exercise was helpful and when it was the effects of concern, encouragement, and contact with the physical therapist who was guiding the exercise program. This factor is referred to as the patient-provider interaction. There are ways to measure the patient-provider interaction but many times this isn't included in the study.

The panel made several suggestions for ways to improve research efforts. Stronger evidence is needed regarding exercises before recommending specific programs for patients with low back pain. Here are some of the ideas presented:

  • Include sham interventions so there isn't a group who knows they aren't receiving any therapy. Make the sham exercise similar but at a level below what's needed to make a difference.
  • All researchers should use the same measuring tools to identify results. This way data from studies can be combined and analyzed to allow for systematic reviews and meta-analysis.
  • Use exercise guidelines already in place to start. This type of baseline or benchmark helps define the most appropriate exercise program for a research study.
  • Use a limited number of experienced and/or certified providers of exercise. Results can be biased just based on different providers carrying out the program differently from patient to patient or from one study to the next.
  • Include an evaluation of the patient-provider interaction.
  • Be specific in reporting information on patients in the study, type of exercises used, measure of patient cooperation, and results.

    If every study on exercise treatment for low back pain could follow these guidelines, it may be easier and faster to identify successful exercise protocols. Improved research design and methodology could reduce bias. Better evidence is needed to prove the many claims that exercise is the answer to the problem of low back pain.

    Pieter H. Helmhout, MSc, et al. Exercise Therapy and Low Back Pain. In Spine. July 15, 2008. Vol. 33. No. 16. Pp. 1782-1788.


    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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