Conservative management of low back pain

With the apparent indefinite postponement of the release of chymopapain for lumbar disk disorders, it seems appropriate to review critically the proliferation of proposed methods of management of this common complaint, particularly the numerous exercise regimens which have been set forth as helpful. A critical review of these regimens quickly reveals that the majority are propounded with considerably more confidence than statistical proof of their efficacy. The following is a delineation of the results of a critical review of the literature, with emphasis on those few studies which have been statistically validated. The physician has an obligation to attempt conservative management of discogenic disease with methods of demonstrated efficacy before recommending invasive procedures such as laminectomy or chemonucleolysis.