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Supervised Exercise for Chronic Low Back Pain: Is It Really Needed?

Many research studies have been focused on patients with chronic low back pain (CLBP). It's clear that exercise is the first treatment choice. But what kind of exercise? And should it be used alone or after some other treatment?

In this study, changes in pain and disability are measured in patients with CLBP. Two groups are compared. The first group received Swiss ball exercises supervised by a physical therapist. The second group received advise about exercise.

All patients in both groups received manipulative or non-manipulative treatment first for four weeks. Then they continued their rehab program either with the supervised Swiss Ball exercises or the extra exercise advice.

The basic advice was to stay active and exercise. Pictures of exercises known to help with LBB were provided. Patients in the exercise advice group were told to do two sets of 10 repetitions of the exercises every day. They kept a journal and recorded how often and how many exercises were done.

The main measure used to compare the groups was self-report measures of LBP disability. Several patient surveys (e.g., McGill Pain Questionnaire, Oswestry Disability Index) were used to determine disability. Disability was also measured in terms of pain intensity and muscular strength and endurance. Electromyography (EMG) measured muscle fatigue.

The Swiss ball exercise group reported a faster reduction in disability in the first eight weeks of the program. Pain intensity also decreased more in the exercise group during the first eight weeks. Patients in the exercise group had a higher sense of well-being compared to the advice-only group.

Long-term results were not different between the two groups. But this may be related to the tools used to measure the results and not a true reflection of the changes observed in the patients. It's likely that the Oswestry Disability Index can't accurately measure long-term post-treatment effects.

The authors conclude that an exercise program for patients with CLBP can speed up their recovery and get them back to work or sports play faster. The reason for this appears to be an increase in their sense of well-being. The supervision was more important than the actual type of training.


Paul Marshall, PhD, and Bernadette Murphy, PhD. Self-Report Measures Best Explain Changes in Disability Compared with Physical Measures After Exercise Rehabilitation for Chronic Low Back Pain. In Spine. February 1, 2008. Vol. 33. No. 3. Pp. 326-338.


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