Individualized exercise programs can and do improve most types of chronic low-back pain, but not necessarily acute back pain, according to two meta-analyses published in the May 3 issue of Annals of Internal Medicine.1,2
"We found that exercise therapy was effective at treating adults with chronic low-back pain," says the lead author of both studies Jill A. Hayden, MD, of the Institute for Work and Health in Toronto, Canada. Specifically, "the most effective treatment strategy for chronic back pain was found to be individually-tailored programs delivered in a supervised format, performed over longer periods of time. Stretching and strengthening were the best types of exercises."
The authors performed a quantitative meta-analysis of 61 randomized controlled trials in adult nonspecific acute, subacute, and chronic low-back pain, comparing the effects of exercise against no treatment or other conservative treatments. They found that for pain lasting 6 to 12 weeks, exercise programs helped decrease pain by 10.2 points (on a scale of 100) when compared to no treatment, and 5.93 points when compared to conservative treatment. Exercise yielded more modest gains in function vs no treatment (3.00 points) and conservative treatment (2.37 points). For acute low back pain lasting less than 6 weeks, exercise therapy, conservative management and no treatment had similar effects.
"For acute low back pain there was no evidence in that exercise therapy is more effective than other treatments," Dr. Hayden says. "However, exercise is not the same as keeping active, which is strongly recommended for patients with acute low-back pain." she tells CIAOMed.
A separate meta-analysis of 43 trials evaluating 72 exercise treatments and 31 comparison groups was aimed at identifying particular exercise intervention characteristics that are effective in adults with nonspecific chronic low-back pain. The results indicate that exercise programs including stretching or strengthening and delivered with supervision may improve pain and function. Furthermore, the study suggests that strategies should be used to encourage adherence.
"For patients with long-standing chronic pain, clinicians should assess the patient and design an appropriate exercise program, work with or refer to a therapist, follow the patients periodically to ensure compliance, and adjust the exercise program as necessary," Dr. Hayden says.
The new study "confirms what we have been doing as clinicians," says Lewis G. Maharam, MD, a New York City sports medicine specialist and author of several books including, "A Healthy Back: A Sports Medicine Doctor's Back-Care Program for Everybody." "Motion is lotion and movement is key to improved status in all types of back pain," he tells CIAOMed.
"All clinical studies have shown that early movement is better than no movement in long term prognosis with back pain," Dr. Maharam asserts. "Rest just doesn't do it."
References:
- Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765-775.
- Hayden JA, vans Tulder MW, Tomlinson G. Systematic review for using exercise therapy to improve outcomes in chronic low back Pain. Ann Int Med. 2005;142:776-785.