What’s the best exercise for low back pain?

People who experience non-specific low back pain often say things like – ‘I have a weak back’, or ‘I need to strengthen my core’.

But working in the industry, you are quick to realise – it’s typically not as simple as that. Crunches, sit-ups, and back extensions tend not to be the top of the list when it comes to an effective rehabilitation program!

If it really were that simple, there wouldn’t be so many people who continue to suffer from low back pain. Data from the Australian Bureau of Statistics National Health Survey in 2017–2018 suggest that around 4 million Australians experience chronic low back pain – this is 16% of the population! (1)

There are many different therapeutic approaches to consider, but which type provides the best results? Yoga, pilates or Tai Chi? Core stability training or core endurance training? Stretching, cardio, or functional strengthening?

This week’s blog touches on the results of several meta-analysis research reviews which compare the effectiveness of various forms of exercise.

Article 1: A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

This article (2)*, published in 2012, analysed data from 5 different randomised control trials to compare ‘general exercise’ with ‘core stability’ exercise. General exercise included generalised trunk stretching and strengthening. Core stability exercises involved an element of stabilising the spine, such as the use of wobble boards, swiss balls or an air filled disc cushion.

They found that pain and disability were improved more in the short term with core stability specific exercises compared to ‘general exercise’, but that by 6 – 12 months after training, scores were no longer significantly different.

Given that chronic back pain tends to persist beyond 6 months in many people, these findings do not support long term effectiveness of core stability training over other forms of exercise.

Article 2: The effectiveness of walking versus other exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials

Of the 5 randomised controlled trials included within this study (3), published in 2017, there was no statistically significant difference identified between pain, disability, or quality of life, when comparing walking exercise with other forms of exercise. Fear-avoidance was also improved equally between the various forms of exercise!

It is interesting to note also that they did not identify a further improvement if walking was included as an addition to other forms of exercise.

Article 3: Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain

Our third article (4), published in 2005, compared results for different modes of program delivery. Their analysis identified superior results for exercise programs that were individually designed, individually supervised or supervised within a group setting, as compared to unsupervised home exercise programs. High doses of exercise sessions proved more effective than lower doses (no surprises there!). The most beneficial form of exercise was reported as stretching and strengthening exercises.

So… The Consensus?

The consensus is… That there is no consensus.

As is the case with most scientific research, it’s never easy to get a clear ‘black or white’, yes or no, pass or fail answer! What is clear, is that the approach that works for one person doesn’t always work for another person. That’s why it is important to evaluate a range of different approaches, in the context of that particular case, before deciding on an exercise plan.

As the third article suggests, what appears to be most important is ensuring that the exercise program is individualised, supervised, and actually being completed!

That is where exercise physiology comes in. Stay tuned for our article (coming next week) which will delve further into the role that exercise physiology plays in musculoskeletal rehabilitation, and how we can work hand-in-hand alongside physio!

*Note that this study reported a high risk of bias.

Author: Yolanda van Vugt

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