Active exercises for acute low back pain

Evidence Summaries

Level of Evidence = B
In acute low-back pain, exercise therapy appears to be not more effective as either no treatment or other conservative treatments.

In a Cochrane review 1 on exercise therapy for non-specific low back pain, 11 trials involving 1,192 adults considered patients with acute low-back pain. Ten of the trials had non-exercise comparisons.

The trials provided conflicting evidence: one high quality trial conducted in an occupational setting found mobilizing home-exercises to be less effective than usual care and one low quality trial conducted in a healthcare setting found a therapist-delivered endurance program improved short-term functioning more than no treatment. Of the remaining eight low quality trials, six found no statistically significant or clinically important differences between exercise therapy and usual care or no treatment.

The pooled analysis of trials with adequate numeric data failed to show a difference in short-term pain relief between exercise therapy and no treatment (three trials), with an effect of -0.59 points/100 (95% CI: -12.69 to 11.51). There was no difference at earliest follow-up in pain relief when compared to other conservative treatments (seven trials): 0.31 points (95% CI: -0.10 to 0.72) [vs. all comparisons (10 trials) 0.03 points (95% CI: -1.34 to 1.40)]. Similarly, there was no significant positive effect of exercise on functional outcomes.

Comment: The quality of evidence is downgraded by inconsistency of results.


1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005 Jul 20;(3):CD000335.  [PMID:16034851]

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