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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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"Active Exercises for Acute Low Back Pain." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/456456/all/Active_exercises_for_acute_low_back_pain.
Active exercises for acute low back pain. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/456456/all/Active_exercises_for_acute_low_back_pain. Accessed April 24, 2019.
Active exercises for acute low back pain. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/456456/all/Active_exercises_for_acute_low_back_pain
Active Exercises for Acute Low Back Pain [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 April 24]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/456456/all/Active_exercises_for_acute_low_back_pain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Active exercises for acute low back pain ID - 456456 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/456456/all/Active_exercises_for_acute_low_back_pain PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -