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Exercise and Advice for Low Back Pain

These commonly recommended interventions provided small but statistically significant benefits.

Back exercises and advice on managing pain both are widely recommended for low back pain. Researchers tested whether these interventions, delivered at seven physiotherapy clinics in Australia and New Zealand, had any effect on pain and physical function 6 weeks and 12 months later. Subjects were 259 adults with low back pain for 6 to 12 weeks; about one third had radiation of the pain to the leg. Statistical models accounted for potential confounding variables such as pain medication use, prior surgery, and clinical site.

Compared with sham advice (empathy but no back pain advice), three sessions of physiotherapist advice over 4 weeks — encouraging patients to return gradually to normal activities — decreased pain at 6 weeks (by 0.7 on a 0 to 10 scale) but not at 12 months. Results were similar for a 12-session, 6-week exercise program (aerobic, stretch, and strengthening) compared with sham ultrasonography and sham short wave diathermy. Advice, but not exercise, significantly improved ability to perform physical activity, with improvement of 0.7 and 0.6 (on a 0 to 10 scale) at 6 weeks and 12 months, respectively. Compared with no intervention, advice and exercise together were associated with improved function (increases of 1.1 at 6 weeks and 12 months) and less pain (–1.5 points at 6 weeks, and a nearly significant –0.8 points at 12 months).

Comment: The evidence from this trial should inform the management of low back pain. Although the benefits of these interventions appear to be small and short-lived, these data support advice and exercise for low back pain.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine July 10, 2007

Citation(s):

Pengel LHM et al. Physiotherapist-directed exercise, advice, or both for subacute low back pain: A randomized trial. Ann Intern Med 2007 Jun 5; 146:787-96.

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