Exercises for the prevention of recurrences of episodes of low-back pain

Back pain is a common disorder that has a tendency to recur. We conducted this review to see if exercises, either as part of treatment or as a post-treatment programme could reduce back pain recurrences. We searched for studies that included persons with back pain experience, interventions consisting of only exercises and that measured recurrences of back pain.

There were nine studies with 1520 participants. There was moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting.

Adverse (side) effects of exercising were not mentioned in any of the studies. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

Authors' conclusions: 

There is moderate quality evidence that post-treatment exercise programmes can prevent recurrences of back pain but conflicting evidence was found for treatment exercise. Studies into the validity of measurement of recurrences and the effectiveness of post-treatment exercise are needed.

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Background: 

Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post-treatment programme, can reduce back pain recurrences.

Objectives: 

To investigate the effectiveness of exercises for preventing new episodes of low-back pain or low-back pain-associated disability.

Search strategy: 

We searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE and CINAHL up to July 2009.

Selection criteria: 

Inclusion criteria were: participants who had experienced back pain before, an intervention that consisted of exercises without additional specific treatment and outcomes that measured recurrence of back pain or time to recurrence.

Data collection and analysis: 

Two review authors independently judged if references met the inclusion criteria. The same review authors independently extracted data and judged the risk of bias of the studies. Studies were divided into post-treatment intervention programmes and treatment studies. Study results were pooled with meta-analyses if participants, interventions, controls and outcomes were judged to be sufficiently homogenous.

Main results: 

We included 13 articles reporting on nine studies with nine interventions. Four studies with 407 participants evaluated post-treatment programmes and five studies with 1113 participants evaluated exercise as a treatment modality. Four studies had a low risk of bias, one study a high risk and the remainder an unclear risk of bias.

We found moderate quality evidence that post-treatment exercises were more effective than no intervention for reducing the rate of recurrences at one year (Rate Ratio 0.50; 95% Confidence Interval 0.34 to 0.73). There was moderate quality evidence that the number of recurrences was significantly reduced in two studies (Mean Difference -0.35; 95% CI -0.60 to -0.10) at one-half to two years follow-up. There was very low quality evidence that the days on sick leave were reduced by post-treatment exercises (Mean Difference -4.37; 95% CI -7.74 to -0.99) at one-half to two years follow-up.

We found conflicting evidence for the effectiveness of exercise treatment in reducing the number of recurrences or the recurrence rate.

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