Elsevier

Joint Bone Spine

Volume 75, Issue 5, October 2008, Pages 533-539
Joint Bone Spine

Review
Exercise and nonspecific low back pain: A literature review

https://doi.org/10.1016/j.jbspin.2008.03.003Get rights and content

Abstract

We reviewed the literature to clarify the effects of exercise in preventing and treating nonspecific low back pain. We evaluated several characteristics of exercise programs including specificity, individual tailoring, supervision, motivation enhancement, volume, and intensity. The results show that exercise is effective in the primary and secondary prevention of low back pain. When used for curative treatment, exercise diminishes disability and pain severity while improving fitness and occupational status in patients who have subacute, recurrent, or chronic low back pain. Patients with acute low back pain are usually advised to continue their everyday activities to the greatest extent possible rather than to start an exercise program. Supervision is crucial to the efficacy of exercise programs. Whether general or specific exercises are preferable is unclear, and neither is there clear evidence that one-on-one sessions are superior to group sessions. Further studies are needed to determine which patient subsets respond to specific characteristics of exercise programs and which exercise volumes and intensities are optimal.

Introduction

Low back pain has been a major public health burden for many years, generating substantial work disability and healthcare costs. Among adults in the general population, 70–85% are believed to experience at least one episode of low back pain at some time during their lives [1]. Nonspecific low back pain, defined as pain with no identifiable cause, accounts for about 85% of cases. Studies of the many treatment modalities available for low back pain have failed to determine which strategy is optimal. However, there is convincing evidence of the harmful effect of bed rest, which was long recommended for acute low back pain. Patients should continue their everyday activities to the greatest extent possible. Exercise is being increasingly used to treat low back pain, and data on the effect of exercise is accumulating. We reviewed these data to clarify the role for exercise in the treatment and prevention of low back pain.

Section snippets

Methods

To identify articles on the effect of exercise in low back pain, we searched the Medline database using the following keywords: exercise, low back pain, physical training, and rehabilitation. Further publications were identified by examining the reference list of each selected article. We used the widely accepted classification scheme for low back pain based on symptom duration, which distinguishes acute pain (<6 weeks), subacute pain (6–12 weeks), and chronic pain (more than 12 weeks). The level

Exercise for the prevention and treatment of low back pain

We identified 20 reviews and meta-analyses of the efficacy of exercise in preventing and treating low back pain published between 1997 and 2007 (Table 1). They are discussed below.

Conclusion

Exercise is effective for the primary and secondary prevention of low back pain. Exercise is more effective in decreasing pain and disability from low back pain than control treatments or physician consultation. The results are less consistent in subacute low back pain, and the usefulness of exercise in acute low back pain remains controversial. The volume and intensity of exercises and the methods used for muscle strengthening, aerobic training, and stretching are not described in sufficient

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