Therapeutic Exercise Progression in Patients with Nonspecific Low Back Pain: A Systematic Review
Agnese Tuninetti1, Valerio Barbari1, Lorenzo Storari1
1Department of Human Neurosciences, Sapienza University of Rome, Rome, 00185, Italy.
Journal of Pain Research
|December 8, 2025
Summary
Using specific criteria to advance therapeutic exercise for nonspecific low back pain (NSLBP) shows short-term benefits. However, more research is needed to confirm long-term effectiveness and clinical applicability for NSLBP rehabilitation.
Area of Science:
- Physical Therapy
- Rehabilitation Medicine
- Clinical Exercise Physiology
Background:
- Nonspecific low back pain (NSLBP) is a prevalent condition requiring effective rehabilitation strategies.
- Therapeutic exercise is a cornerstone of NSLBP management, but optimal progression remains debated.
- Current practices for exercise progression in NSLBP rehabilitation vary, lacking standardized criteria.
Purpose of the Study:
- To systematically review and synthesize objective and subjective criteria used for therapeutic exercise progression in adults with NSLBP.
- To evaluate whether defined progression criteria enhance the effectiveness of exercise interventions for NSLBP compared to protocols without specific criteria.
Main Methods:
- A comprehensive literature search was conducted across three electronic databases, supplemented by manual reference screening.
- Eligible studies included randomized controlled trials (RCTs) involving adults with NSLBP undergoing therapeutic exercise with defined progression criteria.
- Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for included RCTs.
Main Results:
- Forty-seven RCTs met the inclusion criteria, necessitating a qualitative synthesis due to study heterogeneity.
- Both subjective and objective progression criteria were identified in the reviewed literature.
- Intervention groups utilizing predefined progression criteria demonstrated superior short- and medium-term improvements in pain and function compared to control groups.
Conclusions:
- Exercise progression guided by specific criteria shows promise for short-term pain reduction and functional improvement in NSLBP.
- The direct clinical applicability of current findings is limited by study heterogeneity and the need for standardized methodologies.
- Future research should focus on establishing measurable, clearly defined progression criteria for exercise-based NSLBP interventions to enhance clinical practice and long-term outcomes.
