CHAPEL HILL, North Carolina—Exercise is underutilized for the treatment of chronic back and neck pain, finds a new study in the February issue of Arthritis Care & Research.¹

"Less than 50% of the subjects in our sample were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain," conclude researchers who were led by Janet K. Freburger, PT, PhD, of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

Stretching, strengthening may be most effective

Exactly what type of exercise program is most effective for back and neck pain is not fully understood, but recent evidence points toward individually-tailored, supervised exercise programs that include stretching and strengthening.

The researchers conducted a telephone survey of almost 700 chronic back or neck pain patients who saw a physician, chiropractor and/or physical therapist during the previous year. Patients were asked whether they were prescribed exercise, the amount of supervision received, and the type, duration and frequency of the prescribed exercise. They were also asked which specialist prescribed the exercise.

Only 14% get exercise Rx from physicians, despite indications

Overall, the type of provider played a major role in whether participants received a prescription for exercise. Fully 46% of back and neck pain patients received their exercise prescription from a physical therapist, but about one-third of patients who saw a physical therapist did not receive an exercise prescription. About 27% of back and neck pain patients received an exercise Rx from a physician, and 21% received one from a chiropractor. Chiropractors were more likely to prescribe exercise if they saw the patient on a more frequent basis, the study showed.

Although most of the 700 participants had seen a physician, only 14% were prescribed exercise. Some of those who were not prescribed exercise by a physician were likely referred to a physical therapist who did prescribe exercise. The type of provider seen determined the amount of supervision and, to some extent, the types of exercises prescribed for those who were prescribed exercise. For example, physical therapists were more likely to provide supervision and prescribe stretching and strengthening exercises.

"Although exercise prescription provided by physical therapists appears to be the most in line with current guidelines, there is much room for improvement by all types of providers who prescribe exercise for patients with chronic back and neck pain," the researchers conclude.

None of the hypothesized health-related characteristics, such as pain or weakness in the extremities, affected whether an individual was prescribed exercise, and providers' decisions to prescribe exercise did not appear to be influenced by the degree of impairment. Women, people with a higher education level, and those receiving worker's compensation were more likely to be prescribed exercise, the researchers report.

“Considering current evidence of the efficacy of exercise, these findings demonstrate that exercise is being underutilized as a treatment for chronic back and neck pain,” the study authors conclude.

References

1. Freburger JK, Carey TS, Holmes GM, et al. Exercise prescription for chronic back or neck pain: Who prescribes it? Who gets it? What is prescribed? Arth Care Res. 2009;61:192-200.