A new literature review published online by JAMA Internal Medicine hints that exercise may reduce the risk of low back pain (LBP). The work was led by Daniel Steffens, Ph.D., of the University of Sydney, Australia.
New Study: Exercise Prevents Back Pain
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Dr. Steffens and his co-authors identified 23 published reports (on 21 different randomized clinical trials including 30, 850 participants). As indicated in the January 11, 2016 news release, “Although our review found evidence for both exercise alone (35% risk reduction for an LBP episode and 78% risk reduction for sick leave) and for exercise and education (45% risk reduction for an LBP episode) for the prevention of LBP up to one year, we also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year). This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required.”
Dr. Steffens told OTW, “Back pain is a leading cause of disease burden globally. At present, a variety of interventions, such as exercise, education, back belts and shoe insoles, are commonly prescribed to prevent an episode of low back pain. Guidelines lack clear recommendations for prevention of low back pain and the effectiveness of the range of possible prevention strategies for low back pain is not clear. Our study aimed to investigate the effectiveness of these interventions for prevention of low back pain. We found that exercise alone, or in combination with education, is effective for preventing back pain. In contrast, we also found that education alone, back belts, shoe insoles and ergonomic interventions do not prevent back pain or sick leave due to back pain.”
“It is important that surgeons understand the approach to exercise that was used in the trials so they can best advise their patients. There was some variation but in general trials included exercises to improve strength, flexibility, skill and aerobic fitness. The exercises did not just focus on the spine but included upper and lower limb exercises as well. Typically participants did 2-3 sessions per week at the clinic and agreed to do home exercise as well. The program duration ranged from 12 weeks to 18 months.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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