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Exercise-based therapy for low back pain

Exercise-based therapy for low back pain
Literature review current through: Jan 2024.
This topic last updated: Oct 25, 2021.

INTRODUCTION — Low back pain (LBP) is the most common musculoskeletal complaint worldwide, with up to 85 percent of all people experiencing LBP during their lifetimes [1]. Exercise is often recommended to patients with LBP because it reduces pain and helps maintain or restore flexibility, strength, and endurance [2]. This topic will address the rationale and evidence pertaining to exercise in the treatment of nonspecific LBP.

Exercise-based therapy for LBP with lumbar radiculopathy and LBP due to spinal stenosis are discussed separately. (See "Acute lumbosacral radiculopathy: Treatment and prognosis", section on 'Physical therapy' and "Lumbar spinal stenosis: Treatment and prognosis", section on 'Physical therapy'.)

The evaluation of LBP and other treatment modalities for LBP are discussed elsewhere. As examples:

(See "Evaluation of low back pain in adults".)

(See "Treatment of acute low back pain".)

(See "Subacute and chronic low back pain: Nonpharmacologic and pharmacologic treatment".)

(See "Subacute and chronic low back pain: Nonsurgical interventional treatment".)

(See "Subacute and chronic low back pain: Surgical treatment".)

SUBACUTE AND CHRONIC LOW BACK PAIN: EXERCISE IS BENEFICIAL — Low back pain (LBP) is defined as acute (less than 4 weeks), subacute (4 to 12 weeks) or chronic (more than 12 weeks) according to the duration of symptoms. The role of exercise- or movement-based therapy in the management of LBP varies according to the duration of back pain symptoms.

Prescribe exercise — We advise exercise for all patients with subacute and chronic LBP [3,4]. LBP is associated with decreased strength, endurance, lumbar muscle atrophy, and fatigability [5].

In several systematic reviews, exercise modestly improved pain and function in patients with subacute and chronic LBP [3,6,7]. In addition, patients with chronic LBP who regularly participate in moderate to vigorous leisure-time activities have less pain and better function compared with those who are less physically active [8].

Proposed mechanisms of benefit — Exercise therapy improves pain and function in patients with chronic LBP [3,6,7,9,10], although a single mechanism by which exercise improves symptoms is not clear. There are likely several mechanisms contributing to the derived benefit, including neurologic, musculoskeletal, and psychological.

Tissue injury causes complex changes within the peripheral and central nervous system. Injury-induced cell proliferation and neurotrophic factors may amplify the processing of pain from the originally injured tissue or body area and result in the perpetuation of pain symptoms [11,12].

In animal studies, exercise reverses some of these injury-induced neurologic changes in the sensory ganglia, spinal cord, and brain [13-16]. Exercise also improves behavioral markers of pain in the exercising animal [13-23]. In animals, the effects of exercise on pain appear to be generalized; various exercises, even exercise that excludes the injured body part, reduce evidence of pain in the affected region [24].

Indirect evidence based upon these animal studies suggests that exercise would induce similar changes in the peripheral and central nervous systems that contribute to the production, maintenance, and resolution of pain, including LBP. Additionally, human studies have found that elevated pro-inflammatory cytokines and oxidative stress accompany LBP, and exercise attenuates these inflammatory processes [25].

Exercise has positive effects on human muscle, joint, and intervertebral disc metabolism [26-28]. These tissues require periodic loading in order to maintain their normal metabolism and repair microtrauma. The intervertebral disc does not receive a blood supply and obtains nutrients and metabolism by imbibition (the direct absorption of fluid by the disc), which is optimized by motion and impact.

Exercise provides psychological benefits, including reductions in stress, anxiety, and depression [29-31]. There is a strong association between chronic LBP and depression, and exercise may help to improve the mood of chronic LBP patients which in turn may lead to an increase in their level of physical activity [32,33]. Some patients are anxious about reinjuring their back and exhibit fear of movement (kinesophobia); exercise can be a means by which these patients learn to confront and overcome their fear [34]. In addition, physical activity interventions can improve the perception of exercise self-efficacy in activity-restricted individuals [35].

Counseling and evaluation prior to starting exercise — Counseling patients regarding their expectations is essential prior to recommending and initiating an exercise- or movement-based therapy program for LBP. In addition, addressing patient fears and concerns and assessing fitness level, interests, prior participation in exercise, and availability of resources are necessary in formulating an appropriate exercise plan.

Motivational interviewing and motivational enhancement therapy techniques can improve exercise motivation and compliance in patients with chronic LBP [36]. Health coaching for people with LBP with low recovery expectations can result in goal setting and action planning [37]. Individuals with neuromusculoskeletal conditions including LBP report complex barriers, demotivators, and motivators to performing exercise [38]. Demotivators to exercise include lack of interest, inaccessibility, high cost, self-consciousness, embarrassment, anxiety, frustration, and anger. Motivators to exercise include goal setting and achieving, enjoyment, feeling good and “normal,” optimism, self-redefinition, and "escape from everyday boundaries."

Patients with LBP wish to have clear and consistent advice from their health care providers regarding treatment options including self-management, as well as information on prognosis and impact on their occupation [39].

Addressing patient fears — Educational efforts that address excessive fears about perceived physical vulnerability, pain neurophysiology, and obstacles to exercise and that promote the benefits of exercise can increase physical activities in this population [40-42].

We educate patients regarding incorrect assumptions about the role of structural back "abnormalities" as the cause of their back pain. Patients who have had prior imaging may misunderstand the importance of the anatomic variations that have been identified, such as desiccated, narrow, degenerating, bulging, or herniated discs; facet joint arthritis; ligamentum flavum hypertrophy; Schmorl's nodes; spinal stenosis; and hemangiomas. We educate patients that these anatomic findings are not necessarily associated with their pain, do not necessarily require intervention, and can be found in the asymptomatic population [43,44]. Patients are educated that although these anatomic variations may persist, the pain can be well managed and resolve over time. (See "Evaluation of low back pain in adults", section on 'Limited utility of imaging' and "Treatment of acute low back pain", section on 'Patient education'.)

Patients may believe or have previously received advice that certain activities (eg, bending from the waist, twisting, lifting heavy items, exercise, and sports activities that stress the spine) are unsafe, particularly if those activities provoke discomfort. Providing education by offering a neurologic explanation for provoked pain as an abnormally low pain stimulus threshold may be helpful for some patients. It may also be helpful to challenge patient concerns such as having been told that they have an "unstable" spine; "misaligned" vertebrae, hips, and/or sacroiliac joints; or a leg length discrepancy. These “diagnoses” are usually incorrect and are not generally accepted as contributory to symptoms.

Possible temporary increase in low back pain with initiation of exercise — Among patients with LBP, a temporary exacerbation of symptoms may occur during or after therapeutic exercise. Counseling the patient that there may be an initial exacerbation of symptoms before there is an improvement can be reassuring and reduce kinesiophobia [42]. Increased LBP following exercise is common, usually benign, and simply indicates that the pain-producing tissues have been stimulated. Overall, when compared with non-exercising control populations, exercise does not appear to increase the risk of LBP exacerbations [2,45].

Evaluating exercise options — All patients with subacute and chronic LBP will likely derive benefit from physical activity, but there is significant variability in exercise ability and tolerance among patients, which should be considered when making exercise program recommendations. Some patients may never have been regularly physically active, while others may have stopped or greatly diminished physical activities and exercise because of their pain. Patients who have never been active should be encouraged to begin exercise but may benefit from a supervised graded program with more support. Patients who are already active and exercising should be encouraged to continue.

Exploration of the exercise options available within the patient's community, while taking into consideration their preferences, circumstances, fitness level, and exercise experiences, will help to determine the most appropriate exercise program [46]. Referral to physical therapy for formal exercise instruction and education may be reasonable for some patients who might benefit from a more structured, guided approach such as those with subacute or chronic LBP and significant functional impairment, deconditioning, and fear-avoidance of movement. (See "Subacute and chronic low back pain: Nonpharmacologic and pharmacologic treatment", section on 'Exercise therapy'.)

Possible risks of exercise — As with any movement-based program, there are risks of injury and other adverse events which may occur with exercise.

Patients may be at risk for musculoskeletal injuries to the hips, knees, and ankles. Other risks of exercise, including rare serious medical events (eg, arrhythmia, sudden cardiac death, and myocardial infarction), are discussed separately. The medical evaluation prior to recommending any exercise program for a patient is also reviewed elsewhere. (See "The benefits and risks of aerobic exercise", section on 'Risks of exercise' and "Exercise for adults: Terminology, patient assessment, and medical clearance", section on 'Medical assessment and clearance for exercise'.)

Older or frail patients may be at greater risk of injury due to impaired proprioception and balance, as well as osteoporosis and other medical comorbidities. Regardless of age, supervision of exercise by an athletic trainer or physical therapist may help to mitigate the risk of injury by ensuring that the patient maintains good physical form and proper movement patterns. (See "Physical activity and exercise in older adults", section on 'Developing an activity plan'.)

Choice of exercise: All programs are beneficial — No single exercise technique has superiority over others for patients with subacute and chronic LBP [47]. This may be because exercise in all forms has similar generalized effects on the abnormal neurologic and inflammatory processes associated with subacute and chronic LBP. (See 'Proposed mechanisms of benefit' above.)

Comparisons between exercise modalities have been made. In a 2021 network meta-analysis of 217 trials evaluating specific exercises recommended by clinicians to address chronic LBP in over 20,000 patients, three exercise modalities (Pilates, McKenzie therapy, functional restoration) had greater benefit in improving pain intensity and functional limitations compared with other exercise treatments [48]. However, results were reported with moderate certainty, and limitations included within-study risk of bias and heterogeneity.

All of the exercise approaches listed have demonstrated modest effects for reducing the pain and disability associated with LBP. However, no single approach has been shown to be more effective than any of the other approaches for all patients. Many physiotherapists anecdotally report that certain subgroups of LBP patients are more responsive to specific exercise programs, leading to the belief that proper subgrouping of LBP patients with “matched” exercises leads to better clinical outcomes. The literature provides conflicting evidence about subgrouping patients, and we do not support this approach. Thus, in the absence of strong evidence for the superiority of any particular exercise program or approach, the decision for which specific type of exercise to recommend should be a matter of patient preference and clinician experience.

In order of increasing complexity, some of the more popular and widely available exercise approaches for LBP are reviewed here.

Walking – Walking, the simplest and most readily available form of exercise, may be effective in decreasing symptoms of different types of chronic musculoskeletal pain, including LBP.

In a 2015 meta-analysis of 26 studies (five studies included patients with only chronic LBP; other studies included patients with chronic LBP, knee osteoarthritis, and fibromyalgia), walking improved pain and function at 12 months [49].

In a subsequent 2017 meta-analysis, walking was similar to other types of exercise for improvement in pain and disability, but there was no further improvement with the addition of walking to a different exercise program [50].

Aerobic exercise – Aerobic exercise is effective in decreasing symptoms of LBP. In a 2015 meta-analysis of eight cohort studies evaluating a variety of aerobic exercises (including bicycling, swimming, treadmill walking, and elliptical trainers), aerobic exercise decreased pain intensity and improved physical functioning over time in patients with chronic LBP [51].

In a subsequent 2018 meta-analysis of six studies comparing progressive aerobic exercise with progressive resistance exercise in patients with chronic LBP, the two different exercise programs were equally effective in reducing back pain [52].

Stretching exercises – There are a wide range of stretching exercises and programs available, both independent and guided, for patients with LBP. Participation in a variety of different stretching programs may be beneficial in reducing symptoms in patients with chronic LBP as demonstrated in two studies incorporating common leg and trunk stretches [53,54].

In addition, in a randomized controlled trial of office workers with neck, shoulder, and LBP, group exercise sessions consisting of back and general stretching combined with ergonomic worksite modifications were superior to worksite modifications alone in pain reduction at six months [55].

Pilates – Pilates is a technique of exercise that focuses on performing controlled movements of the whole body that start with the core (back and abdomen) and flow outward towards the limbs. Proponents report health benefits including body alignment, improved breathing, strength, coordination, and balance. Pilates can be adapted to patients with varying levels of fitness, with techniques that have been adapted to treat LBP.

Pilates may be similar in efficacy to other exercise regimens for the treatment of LBP [56,57]. In a 2015 systematic review including 29 studies, Pilates was no more effective than any other exercise for the treatment of chronic LBP [56]. In another randomized trial of patients with LBP, participating in Pilates sessions two and three times per week resulted in greater reduction of pain and disability than participating in once weekly Pilates sessions [58].

Yoga – Yoga is a mind-body practice with three main components: physical poses/postures, breathing control, and meditation/relaxation. Yoga can be adapted for patients of different fitness levels and skills and is beneficial in managing symptoms in patients with chronic LBP. As an example, in a 2022 meta-analysis of 21 trials, yoga produced small improvements in pain and function compared with non-exercise controls [59]. Yoga also was associated with small improvements in pain, although the effect did not reach the threshold for clinically meaningful improvement. Yoga was not more effective compared with other non-yoga exercises for improvement in function in patients with chronic LBP. (See "Overview of yoga".)

Tai Chi – Tai Chi is a mind-body exercise characterized by flowing movements that emphasizes balance, focus, fitness, and breathing, and it can be helpful in the management of LBP. Tai Chi can be practiced by individuals of varying fitness levels and skills; for this reason, it may be less likely to result in injury among older patients with LBP.

In a 2016 systematic review of randomized trials of patients with chronic pain, two of the three studies done on patients with LBP showed that Tai Chi plus physical therapy was modestly more effective than physical therapy alone [60]. In a 2019 meta-analysis of randomized trials evaluating the effects of yoga, Qigong, and Tai Chi on chronic LBP, all forms of exercise were beneficial in symptom management, while those participating in Tai Chi experienced the greatest reduction in pain intensity [61].

Alexander Technique – The Alexander Technique involves providing individualized, hands-on instruction to improve balance, posture, and coordination; education about harmful habits; and muscle use education to avoid painful movements.

In a randomized trial of 479 patients with chronic or recurrent LBP, participation in 24 sessions of the Alexander Technique was moderately effective in improving pain and disability at 12 months [62]. Receiving six sessions alone without any other treatment was ineffective, but the combination of home-based exercise and six Alexander Technique sessions resulted in moderate reduction in pain and disability and was more cost-effective compared with usual care or massage therapy.

Directional preference – Directional preference is an approach to the treatment of LBP based upon the theory that, in many patients with LBP, movement in a certain direction is the primary pain generator. Directional movement that causes pain to increase or radiate away from the midline should be avoided in favor of movement that lessens or "centralizes" (moving towards the midline) pain. Exercise is then prescribed based upon these observations. Directional preference techniques rely upon the assessment of a physical therapist or other trained provider and emphasize instruction in self-care. In a randomized trial of LBP patients who exhibited a directional preference, exercises matching this directional preference were more clinically effective than exercises in the opposite direction [63].

For patients with chronic LBP, directional preference exercise may be marginally better compared with advice to stay active but not compared with other forms of exercise [64-68].

Core exercise and spine stabilization – Core exercise and spine stabilization exercise (also referred to as motor or movement control exercise) describe exercises that aim to activate, control, and coordinate the deep muscles of the spine, abdomen, and pelvis. The exercises are initially performed at rest, then at rest in different positions, followed by adding movement, activity, and more complex functional tasks. Core exercises may be more beneficial compared with no exercise for LBP but not compared with other exercise types [69-73].

There are variations of core exercise which attempt to fine-tune this approach (low-load motor control versus high-load lifting [74,75]; stabilizing exercise in the prone, supine, or combined prone and supine position [76]; stabilization combined with precise motor control of the trunk [77]; or stabilization combined with greater hip strengthening [78]). The results of these variations of core exercise programs in patients with LBP are mixed. As examples, a 2016 systematic review concluded that motor control exercise was not superior to other forms of exercise for management of chronic LBP [79]; however, in a 2018 meta-analyses, movement control exercise (a variation of core strengthening and spine stabilization) was more effective than other interventions for improving short- and long-term disability, but it only reduced pain in the short term [80].

Graded activities exercise/back boot camp/functional restoration – These methods refer to exercise that begins with low-resistance strengthening with progressive increases in resistance at each session. Resistive equipment includes focused machines (back and leg) as well as whole body equipment. Aerobic and stretching exercises are also introduced in a progressive fashion. This technique is also known as progressive-resisted or quota-based strengthening. The progression of exercise and resistance proceeds even in the setting of pain, including pain flare-ups, as long as the pain is tolerable. Pain during and after a session is to be expected and should decrease as exercise desensitizes the pain-producing processes [4]. Treatment is usually delivered in 8 to 12 physical therapy sessions over four to six weeks [81,82].

This type of exercise intervention is typically delivered using a cognitive behavioral approach, which includes education regarding the safety of performing exercise while experiencing pain symptoms; support and praise for successful participation; and challenge and encouragement to achieve desired functional, recreational, and life goals.

This intervention focuses on restoring optimal back and life function and may be used for injured workers. (See "Occupational low back pain: Evaluation and management", section on 'Functional restoration'.)

In a systematic review comparing graded therapies (progressive resistance training and progressive aerobic training) in patients with chronic LBP, both therapies were superior to usual care for pain reduction, but neither was superior to the other [52]. In addition, in one trial, graded exercise was no more effective than physical therapy-based exercise in pain reduction at three or six months [83]. Though endurance, flexibility, and strength may improve with this type of treatment, the degree of back pain improvement shows weak or no correlation with changes in any of these physiological parameters [84]. Thus, it is likely that pain improvement resulted from more generalized benefits of exercise. (See 'Proposed mechanisms of benefit' above.)

Multidisciplinary (interdisciplinary) rehabilitation – Multidisciplinary, or interdisciplinary, rehabilitation combines (at a minimum) an exercise and a behavioral component provided by different health care professionals. The intensity and content of interdisciplinary therapy varies widely. These programs combine graded exercise therapy with a psychosocial approach, generally involving a psychologist. Multidisciplinary therapy can be similar to functional restoration programs but emphasizes multiple providers and behavioral interventions. This is discussed separately. (See "Subacute and chronic low back pain: Nonpharmacologic and pharmacologic treatment", section on 'Exercise therapy'.)

The exercise components of spine stabilization, functional restoration, and multidisciplinary rehabilitation are similar.

ACUTE LOW BACK PAIN: NO BENEFIT FROM EXERCISE THERAPY — Acute low back pain (LBP; duration of symptoms less than four weeks) has a good prognosis. Exercise treatment has not been shown to be more beneficial for acute LBP when compared with other acute treatments [3,6,85]. (See "Treatment of acute low back pain", section on 'Exercise and physical therapy'.)

Patients with acute LBP should be advised to avoid bedrest and stay as active as possible [86]. Patients who wish to exercise may continue to perform their usual exercise regimen or try home-based exercises as tolerated.

EXERCISE MAY HELP PREVENT LOW BACK PAIN — Participation in exercise may prevent incident episodes of low back pain (LBP) as well as recurrence of LBP [87].

Primary prevention of low back pain — Among individuals without previous back pain, exercise may reduce the risk of developing LBP. Representative studies include:

In a 2017 meta-analysis of 36 prospective cohort studies including over 158,000 participants, involvement in sport or other leisure physical activity was associated with a reduced risk of frequent or chronic LBP in moderately or highly active individuals compared with inactive persons (risk ratio 0.89; 95% CI 0.82-0.97) [88]. However, participating in physical activity was not associated with a lower risk of having short episodes of LBP.

In a 2018 meta-analysis including 13 randomized controlled trials and three non-randomized controlled trials, exercise was found to reduce the risk of developing LBP by 33 percent (risk ratio 0.67, 95% CI 0.53-0.85), with both the severity of pain and back related disability also lower in the exercise group [89]. Strengthening combined with stretching or aerobic exercises performed two to three times per week was felt to be an effective regimen in preventing LBP. The addition of an education component to exercise did not improve outcomes.

Preventing recurrent episodes of low back pain — Exercise therapy may have a role in secondary prevention, particularly for those with recurrent LBP. As examples:

In a meta-analysis including nine observational studies, post-treatment exercises were more effective than no intervention for reducing the rate of LBP recurrence at one year (rate ratio 0.50, 95% CI 0.34-0.73) [45]. The most promising approaches involved back flexibility and strengthening exercises.

A subsequent meta-analysis including 23 studies and 31,000 participants examined the effects of exercise and exercise plus education in those with a history of LBP (but without significant LBP at baseline) [90]. Compared with no exercise, both exercise (relative risk 0.65; 95% CI 0.50-0.86) and exercise plus education (relative risk 0.55, 95% CI 0.41-0.74) decreased the risk of recurrent LBP. A variety of exercise programs were included in the studies; leisure-time physical activity also appears to be effective in preventing LBP.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Lower spine disorders".)

SUMMARY AND RECOMMENDATIONS

Exercise recommended for subacute and chronic low back pain – The role of exercise- or movement-based therapy in the management of low back pain (LBP) varies according to the duration of back pain symptoms. For all patients with subacute (4 to 12 weeks) and chronic (more than 12) LBP, we recommend exercise therapy rather than no exercise (Grade 1B). (See 'Subacute and chronic low back pain: Exercise is beneficial' above and 'Prescribe exercise' above.)

Exercise improves pain and function – Exercise therapy improves pain and function in patients with chronic LBP, although a single mechanism by which exercise improves symptoms is not clear. There are likely several mechanisms contributing to the derived benefit, including neurologic, musculoskeletal, and psychological. (See 'Proposed mechanisms of benefit' above.)

Counseling, evaluation, and education are essential – Counseling patients regarding their expectations is essential prior to recommending and initiating an exercise- or movement-based therapy program for LBP. In addition, addressing patient fears and concerns and assessing fitness level, interests, prior participation in exercise, and availability of resources are necessary in formulating an appropriate exercise plan. (See 'Counseling and evaluation prior to starting exercise' above.)

Potential risks – As with any movement-based program, there are risks of injury and other adverse events that may occur with exercise. Patients may be at risk for musculoskeletal injuries to the hips, knees, and ankles. Other risks of exercise, including rare serious medical events (eg, arrhythmia, sudden cardiac death, and myocardial infarction), are discussed separately. (See 'Possible risks of exercise' above and "Exercise for adults: Terminology, patient assessment, and medical clearance", section on 'Benefits and risks associated with exercise' and "The benefits and risks of aerobic exercise", section on 'Risks of exercise'.)

All exercise programs are beneficial – No single exercise technique has superiority over others for patients with subacute and chronic LBP. This may be because exercise in all forms has similar generalized effects on the abnormal neurologic and inflammatory processes associated with subacute and chronic LBP. (See 'Choice of exercise: All programs are beneficial' above.)

Examples of exercise programs that are beneficial for patients with subacute and chronic LBP include:

Walking

Aerobic exercise

Stretching

Pilates

Yoga

Tai Chi

Alexander Technique

Directional preference

Core exercise/spine stabilization

Graded activities exercise/back boot camp/functional restoration

Multidisciplinary (interdisciplinary) rehabilitation

Exercise not harmful, but of no benefit in acute low back pain – Acute LBP (symptom duration less than four weeks) has a good prognosis. Exercise treatment has not been shown to be more beneficial for acute LBP when compared with other acute treatments. Patients with acute LBP should be advised to avoid bedrest and stay as active as possible. Patients who do wish to exercise, however, may continue to perform their usual exercise regimen, as they can tolerate, or try home-based exercises. (See 'Acute low back pain: No benefit from exercise therapy' above.)

Exercise helpful for primary and secondary prevention of low back pain – Exercise may prevent incident LBP among those with no prior history of back pain as well as recurrent back pain episodes among those with a history of previous LBP. (See 'Exercise may help prevent low back pain' above.)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges James Rainville, MD, and Kevin Bernard, MD, who contributed to an earlier version of this topic review.

  1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81:646.
  2. Rainville J, Hartigan C, Jouve C, Martinez E. The influence of intense exercise-based physical therapy program on back pain anticipated before and induced by physical activities. Spine J 2004; 4:176.
  3. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005; :CD000335.
  4. Rainville J, Hartigan C, Martinez E, et al. Exercise as a treatment for chronic low back pain. Spine J 2004; 4:106.
  5. Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin 2014; 30:865.
  6. Chou R, Huffman LH, American Pain Society, American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007; 147:492.
  7. Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015; 29:1155.
  8. Pinto RZ, Ferreira PH, Kongsted A, et al. Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain. Eur J Pain 2014; 18:1190.
  9. van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 2010; 24:193.
  10. Payne C, Wiffen PJ, Martin S. WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness. Cochrane Database Syst Rev 2017; 4:CD008427.
  11. Woolf CJ. What is this thing called pain? J Clin Invest 2010; 120:3742.
  12. Nijs J, Clark J, Malfliet A, et al. In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clin Exp Rheumatol 2017; 35 Suppl 107:108.
  13. Cobianchi S, Casals-Diaz L, Jaramillo J, Navarro X. Differential effects of activity dependent treatments on axonal regeneration and neuropathic pain after peripheral nerve injury. Exp Neurol 2013; 240:157.
  14. Chen YW, Lin MF, Chen YC, et al. Exercise training attenuates postoperative pain and expression of cytokines and N-methyl-D-aspartate receptor subunit 1 in rats. Reg Anesth Pain Med 2013; 38:282.
  15. Detloff MR, Smith EJ, Quiros Molina D, et al. Acute exercise prevents the development of neuropathic pain and the sprouting of non-peptidergic (GDNF- and artemin-responsive) c-fibers after spinal cord injury. Exp Neurol 2014; 255:38.
  16. Almeida C, DeMaman A, Kusuda R, et al. Exercise therapy normalizes BDNF upregulation and glial hyperactivity in a mouse model of neuropathic pain. Pain 2015; 156:504.
  17. Kuphal KE, Fibuch EE, Taylor BK. Extended swimming exercise reduces inflammatory and peripheral neuropathic pain in rodents. J Pain 2007; 8:989.
  18. Mazzardo-Martins L, Martins DF, Marcon R, et al. High-intensity extended swimming exercise reduces pain-related behavior in mice: involvement of endogenous opioids and the serotonergic system. J Pain 2010; 11:1384.
  19. Stagg NJ, Mata HP, Ibrahim MM, et al. Regular exercise reverses sensory hypersensitivity in a rat neuropathic pain model: role of endogenous opioids. Anesthesiology 2011; 114:940.
  20. Chen YW, Li YT, Chen YC, et al. Exercise training attenuates neuropathic pain and cytokine expression after chronic constriction injury of rat sciatic nerve. Anesth Analg 2012; 114:1330.
  21. Martins DF, Mazzardo-Martins L, Soldi F, et al. High-intensity swimming exercise reduces neuropathic pain in an animal model of complex regional pain syndrome type I: evidence for a role of the adenosinergic system. Neuroscience 2013; 234:69.
  22. Luan S, Wan Q, Luo H, et al. Running exercise alleviates pain and promotes cell proliferation in a rat model of intervertebral disc degeneration. Int J Mol Sci 2015; 16:2130.
  23. Kim YJ, Byun JH, Choi IS. Effect of Exercise on µ-Opioid Receptor Expression in the Rostral Ventromedial Medulla in Neuropathic Pain Rat Model. Ann Rehabil Med 2015; 39:331.
  24. Chuganji S, Nakano J, Sekino Y, et al. Hyperalgesia in an immobilized rat hindlimb: effect of treadmill exercise using non-immobilized limbs. Neurosci Lett 2015; 584:66.
  25. Cheng YY, Kao CL, Ma HI, et al. SIRT1-related inhibition of pro-inflammatory responses and oxidative stress are involved in the mechanism of nonspecific low back pain relief after exercise through modulation of Toll-like receptor 4. J Biochem 2015; 158:299.
  26. Powers SK, Jackson MJ. Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiol Rev 2008; 88:1243.
  27. McArdle A, Jackson MJ. Exercise, oxidative stress and ageing. J Anat 2000; 197 Pt 4:539.
  28. Belavý DL, Quittner MJ, Ridgers N, et al. Running exercise strengthens the intervertebral disc. Sci Rep 2017; 7:45975.
  29. Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA 2018; 320:2020.
  30. Herring MP, O'Connor PJ, Dishman RK. The effect of exercise training on anxiety symptoms among patients: a systematic review. Arch Intern Med 2010; 170:321.
  31. Schuch FB, Vancampfort D, Firth J, et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry 2018; 175:631.
  32. Rainville J, Sobel JB, Hartigan C, Wright A. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine (Phila Pa 1976) 1997; 22:2016.
  33. Wegner M, Helmich I, Machado S, et al. Effects of exercise on anxiety and depression disorders: review of meta- analyses and neurobiological mechanisms. CNS Neurol Disord Drug Targets 2014; 13:1002.
  34. Marshall PWM, Schabrun S, Knox MF. Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS One 2017; 12:e0180788.
  35. Lee LL, Arthur A, Avis M. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Int J Nurs Stud 2008; 45:1690.
  36. Vong SK, Cheing GL, Chan F, et al. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial. Arch Phys Med Rehabil 2011; 92:176.
  37. Iles RA, Taylor NF, Davidson M, O'Halloran P. An effective coaching intervention for people with low recovery expectations and low back pain: a content analysis. J Back Musculoskelet Rehabil 2014; 27:93.
  38. Newitt R, Barnett F, Crowe M. Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies. Disabil Rehabil 2016; 38:1.
  39. Lim YZ, Chou L, Au RT, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother 2019; 65:124.
  40. Bodes Pardo G, Lluch Girbés E, Roussel NA, et al. Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:338.
  41. Ben-Ami N, Chodick G, Mirovsky Y, et al. Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial. J Orthop Sports Phys Ther 2017; 47:57.
  42. Kernan T, Rainville J. Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain. J Orthop Sports Phys Ther 2007; 37:679.
  43. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015; 36:811.
  44. Ishimoto Y, Yoshimura N, Muraki S, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage 2013; 21:783.
  45. Choi BK, Verbeek JH, Tam WW, Jiang JY. Exercises for prevention of recurrences of low-back pain. Cochrane Database Syst Rev 2010; :CD006555.
  46. Slade SC, Patel S, Underwood M, Keating JL. What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies. Clin J Pain 2014; 30:995.
  47. Ferreira ML, Smeets RJ, Kamper SJ, et al. Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Phys Ther 2010; 90:1383.
  48. Hayden JA, Ellis J, Ogilvie R, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother 2021; 67:252.
  49. O'Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil 2015; 96:724.
  50. Vanti C, Andreatta S, Borghi S, et al. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil 2019; 41:622.
  51. Meng XG, Yue SW. Efficacy of aerobic exercise for treatment of chronic low back pain: a meta-analysis. Am J Phys Med Rehabil 2015; 94:358.
  52. Wewege MA, Booth J, Parmenter BJ. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2018; 31:889.
  53. Lawand P, Lombardi Júnior I, Jones A, et al. Effect of a muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized controlled trial. Joint Bone Spine 2015; 82:272.
  54. Keane LG. Comparing AquaStretch with supervised land based stretching for Chronic Lower Back Pain. J Bodyw Mov Ther 2017; 21:297.
  55. Shariat A, Cleland JA, Danaee M, et al. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther 2018; 22:144.
  56. Patti A, Bianco A, Paoli A, et al. Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine (Baltimore) 2015; 94:e383.
  57. Mostagi FQ, Dias JM, Pereira LM, et al. Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. J Bodyw Mov Ther 2015; 19:636.
  58. Miyamoto GC, Franco KFM, van Dongen JM, et al. Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation. Br J Sports Med 2018; 52:859.
  59. Wieland LS, Skoetz N, Pilkington K, et al. Yoga for chronic non-specific low back pain. Cochrane Database Syst Rev 2022; 11:CD010671.
  60. Kong LJ, Lauche R, Klose P, et al. Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sci Rep 2016; 6:25325.
  61. Zou L, Zhang Y, Yang L, et al. Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2019; 8.
  62. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ 2008; 337:a884.
  63. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila Pa 1976) 2004; 29:2593.
  64. Paatelma M, Kilpikoski S, Simonen R, et al. Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up. J Rehabil Med 2008; 40:858.
  65. Garcia AN, Costa Lda C, da Silva TM, et al. Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther 2013; 93:729.
  66. Petersen T, Kryger P, Ekdahl C, et al. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial. Spine (Phila Pa 1976) 2002; 27:1702.
  67. Hosseinifar M, Akbari M, Behtash H, et al. The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain. J Phys Ther Sci 2013; 25:1541.
  68. Halliday MH, Pappas E, Hancock MJ, et al. A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference. J Orthop Sports Phys Ther 2016; 46:514.
  69. Cho HY, Kim EH, Kim J. Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain. J Phys Ther Sci 2014; 26:1237.
  70. Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine (Phila Pa 1976) 2006; 31:E670.
  71. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther 2005; 85:209.
  72. Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 2014; 15:416.
  73. Nabavi N, Mohseni Bandpei MA, Mosallanezhad Z, et al. The Effect of 2 Different Exercise Programs on Pain Intensity and Muscle Dimensions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. J Manipulative Physiol Ther 2018; 41:102.
  74. Aasa B, Berglund L, Michaelson P, Aasa U. Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. J Orthop Sports Phys Ther 2015; 45:77.
  75. Michaelson P, Holmberg D, Aasa B, Aasa U. High load lifting exercise and low load motor control exercises as interventions for patients with mechanical low back pain: A randomized controlled trial with 24-month follow-up. J Rehabil Med 2016; 48:456.
  76. Ojoawo AO, Hassan MA, Olaogun MOB, et al. Comparative effectiveness of two stabilization exercise positions on pain and functional disability of patients with low back pain. J Exerc Rehabil 2017; 13:363.
  77. Saner J, Kool J, Sieben JM, et al. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up. Man Ther 2015; 20:672.
  78. Kendall KD, Emery CA, Wiley JP, Ferber R. The effect of the addition of hip strengthening exercises to a lumbopelvic exercise programme for the treatment of non-specific low back pain: A randomized controlled trial. J Sci Med Sport 2015; 18:626.
  79. Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016; :CD012004.
  80. Luomajoki HA, Bonet Beltran MB, Careddu S, Bauer CM. Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis. Musculoskelet Sci Pract 2018; 36:1.
  81. Roche G, Ponthieux A, Parot-Shinkel E, et al. Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88:1229.
  82. Rainville J, Jouve CA, Hartigan C, et al. Comparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per week. Spine J 2002; 2:402.
  83. Magalhães MO, Comachio J, Ferreira PH, et al. Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial. Braz J Phys Ther 2018; 22:82.
  84. Steiger F, Wirth B, de Bruin ED, Mannion AF. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. Eur Spine J 2012; 21:575.
  85. Machado LA, Maher CG, Herbert RD, et al. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC Med 2010; 8:10.
  86. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev 2010; :CD007612.
  87. de Campos TF, Maher CG, Fuller JT, et al. Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis. Br J Sports Med 2021; 55:468.
  88. Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med 2017; 51:1410.
  89. Shiri R, Coggon D, Falah-Hassani K. Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. Am J Epidemiol 2018; 187:1093.
  90. Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2016; 176:199.
Topic 7774 Version 48.0

References

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