Exercise therapy for low back pain: a narrative review of the literature

Exercise therapy has become an expected modality in the treatment of low back pain but there are no clear evidence based guidelines available. The purpose of this review is to analyze the available literature in regard to demonstrated efficacy of various types of exercise therapy for low back pain.

A search was made on PubMed for exercise and low back pain that found 28 citations in English including 23 randomized controlled clinical trials published between 1993 and 2004 and 5 literature reviews published in 2000 through 2002.

Previous reviews have stated that the literature does not support the use of exercise therapy for acute low back pain but it does give qualified support to exercise therapy for chronic low back pain. More recent studies have divided subjects based on functional rather than temporal characteristics, specifically, taking into consideration the directional preference of the patient and addressing muscle groups that augment stabilization of the "neutral zone." Such approaches yield effective clinical response in both acute and chronic patients within 2 weeks with 6 visits and provide lasting benefit up to 3 years after intervention.

By identifying specific functional characteristics of individual patients, providers should be able to design exercise therapies that will provide more effective clinical intervention for low back pain patients.