Exercise and Advice for Low Back Pain

Back exercises and advice on managing pain both are widely recommended for low back pain. Researchers tested whether these interventions, delivered at seven physiotherapy clinics in Australia and New Zealand, had any effect on pain and physical function 6 weeks and 12 months later. Subjects were 259 adults with low back pain for 6 to 12 weeks; about one third had radiation of the pain to the leg. Statistical models accounted for potential confounding variables such as pain medication use, prior surgery, and clinical site.

Compared with sham advice (empathy but no back pain advice), three sessions of physiotherapist advice over 4 weeks — encouraging patients to return gradually to normal activities — decreased pain at 6 weeks (by 0.7 on a 0 to 10 scale) but not at 12 months. Results were similar for a 12-session, 6-week exercise program (aerobic, stretch, and strengthening) compared with sham ultrasonography and sham short wave diathermy. Advice, but not exercise, significantly improved ability to perform physical activity, with improvement of 0.7 and 0.6 (on a 0 to 10 scale) at 6 weeks and 12 months, respectively. Compared with no intervention, advice and exercise together were associated with improved function (increases of 1.1 at 6 weeks and 12 months) and less pain (–1.5 points at 6 weeks, and a nearly significant –0.8 points at 12 months).