Why is Exercise Prescribed for Low Back Pain Relief?

PainRelief.com Interview with:
Matthew Jones PhD, AEP

Department of Exercise Physiology, Faculty of Medicine

Dr. Jones

PainRelief.com:  What is the background for this review?

Response: Bck pain is the leading cause of disability worldwide and is associated with significant individual and societal costs. Low back pain can significantly impact an individual’s ability to carry out day to day tasks. Clinical guidelines consistently recommend that people with low back pain take exercise, and there does not appear to be a type of exercise (e.g., walking, Pilates, lifting weights) that is better than another for reducing pain and improving function. Despite hundreds of studies of exercise in people with low back pain, researchers do not have a good idea of how it works. This is important, because if we know how something works, we can design more effective interventions to reduce the burden of low back pain. The aim of this review was to summarise why researchers think exercise helps people with chronic low back pain (i.e., pain persisting for longer than 3 months).

PainRelief.com: What are the main findings?

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Response: There were 110 studies included in our review. There was no consensus on why researchers thought exercise helped low back pain, but 33 unique mechanisms were proposed which were grouped into five broad themes. The two most common themes were: ‘neuromuscular’, including improvements in muscle strength or the ability to control the muscles around the spine; and ‘psychosocial’, including improvements in mood or confidence around doing activities despite pain. In one third of studies, researchers did not propose a reason for why they thought exercise was beneficial for low back pain.

PainRelief.com: What should readers take away from your report?

Response: Arguably the most interesting finding is that, despite decades of research and hundreds of studies, there is no clear consensus on why researchers think exercise is beneficial for people with low back pain. However, our results do highlight a number of mechanisms/themes that were proposed more consistently by researchers, indicating some agreement.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: The results of this review have a few implications for future research. Firstly, our review provides a list of mechanisms that may be explored as ‘mediators’ (a variable that is affected by the intervention (exercise) and in turn affects the outcome (pain or disability)) in future studies of exercise for low back pain. Better understanding of these mediators may help us design more effective interventions to optimise the benefits of exercise.

No disclosures


Annika Wun, Paul Kollias, Harry Jeong, Rodrigo RN. Rizzo, Aidan G. Cashin, Matthew K. Bagg, James H. McAuley, Matthew D. Jones. Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists. Musculoskeletal Science and Practice, 2021; 51: 102307 DOI: 10.1016/j.msksp.2020.102307

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Last Updated on December 23, 2020 by PainRelief.com