Exercise therapy : a treatment for low back pain and stiffness compared to rest

Abstract

Low back pain is reported to be the leading cause of disability worldwide, and features a very high lifetime prevalence and recurrency rate. Exercise therapy is currently the leading conservative treatment for all non-sinister presentations of this condition. This PICO review aims to study the effect of exercise therapy on low back pain and stiffness versus rest. The included studies were conducted on adults (>18 years of age), lower limb referral and neurological symptoms were also considered, and no limits were set regarding the duration of symptoms. Exclusion criteria included underlying pathologies such as central nervous system conditions, vertebral fractures, direct trauma, spinal stenosis, post-operative pain, pregnancy, osteoporosis, malignancy, benign tumours and infection or inflammatory conditions. The initial literature search resulted in the identification of 81 records, 17 of which were discarded from the study (n = 64). The Critical Appraisal Skills Programme (CASP) was used to appraise each study in order to ensure a high degree of consistency between analyses. The research highlights how exercise therapy is currently the leading conservative treatment for low back pain and stiffness in terms of reduction of pain and stiffness scores, although the research discussing efficacy, different exercise types or prescription parameters is highly conflicting. In conclusion, exercise therapy can be used to conservatively treat acute, sub-acute or longstanding low back pain and stiffness, especially when combined with patient education focusing on the psychological and cognitive aspects of the condition. The main recommendations for practice include actively attempting to deconstruct the patient’s maladaptive beliefs and misconceptions regarding the back and low back pain, encouraging the restoration of movement and the adoption of healthy lifestyle habits, and empowering the patient to make sense of their symptoms, whilst remaining mindful that no two patients should be treated in an identical manner