Abstract
Background context
Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated
effectiveness for improving function and work.
Purpose
The goal of this article is to review several key aspects about the safety and efficacy
of exercise that may help clinicians understand its utility in treating chronic back
pain.
Study design/setting
A computerized literature search of MEDLINE was conducted using “exercise,” “fitness,”
“back pain,” “backache” and “rehabilitation” as search words. Identified abstracts
were scanned, and useful articles were acquired for further review. Additional references
were acquired through the personal collections of research papers possessed by the
authors and by reviewing prior review articles on this subject. These final papers
were scrutinized for data relevant to the key aspects about exercise covered in this
article.
Results
For people with acute, subacute or chronic low back pain, there is no evidence that
exercise increases the risk of additional back problems or work disability. To the
contrary, current medical literature suggests that exercise has either a neutral effect
or may slightly reduce risk of future back injuries. Exercise can be prescribed for
patients with chronic low back pain with three distinct goals. The first and most
obvious goal is to improve or eliminate impairments in back flexibility and strength,
and improve performance of endurance activities. There is a large body of evidence
confirming that this goal can be accomplished for a majority of patients with chronic
low back pain. The second goal of exercise is to reduce the intensity of back pain.
Most studies of exercise have noted overall reduction in back pain intensity that
ranges from 10% to 50% after exercise treatment. The third goal of exercise is to
reduce back pain–related disability through a process of desensitization of fears
and concerns, altering pain attitudes and beliefs and improving affect. The mechanisms
through which exercise can accomplish this goal have been the subject of substantial
research.
Conclusions
Exercise is safe for individuals with back pain, because it does not increase the
risk of future back injuries or work absence. Substantial evidence exists supporting
the use of exercise as a therapeutic tool to improve impairments in back flexibility
and strength. Most studies have observed improvements in global pain ratings after
exercise programs, and many have observed that exercise can lessen the behavioral,
cognitive, affect and disability aspects of back pain syndromes.
Keywords
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Article info
Publication history
Accepted:
June 2,
2003
Received:
February 12,
2003
Footnotes
☆FDA device/drug status: not applicable.
☆Nothing of value received from a commercial entity related to this research.
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
