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Back Pain – Exercise..?

Evidence Based Medicine involves randomised controlled trials (RCTs) as a standard of evidence that Doctors can hang their reputation upon. When several RCTs are published about a similar aspect of health they can be combined together to improve the powerfulness of the results. Much as was recently published in the British Journal of Sports Medicine combining 27 RCTs about exercise decreasing pain levels and improving functional ability. The publication was a Meta-analysis that looked into who was suited to exercise as a way of predicting who would get the most benefit.

An interesting aspect to the study was the effect of giving exercise to people already exercising, some got worse and some improved suggesting exercise, exercise, exercise is not the panacea of a solution it might be touted as. When I mention exercise I mean the activity you partake in over and above movement. Movement variety is the basic minimum for us all to incorporate into our lives.

Those people who had persistent back ache / pain who according to 27 RCTs seemed to have a global improvement would be those persons who can find relief from OTC medication on an ongoing basis. Those persons who experienced a functional improvement had lower fear avoidance beliefs in their thinking. For those persons looking for a decreased pain experience then they would have a lower BMI, have a supportive work environment with no heavy physical demands who gained relief with medication yet had a low grade chronicity where their pain experience was a regular 5/10 (intensity).

The meta-analysis didn’t mention which types of exercise are best yet this subject has been covered in another meta-analysis recently published. Hopefully as clinicians we can begin to identify those persons who might fare best with exercise as a strategy for improvement in their muscle and joint aches and pains.

What was mentioned was that exercise did not prove to be better than manual therapy. I’d suggest that some people will be better off with manual therapy and no exercise. Opinions aside, as more RCTs are completed the evidence mounts to identify for healthcare professionals who is likely to be best suited to a particular approach to their persistent back pain experience.


Hayden JA et al (2019) Exercise Treatment Effect Modifiers in Persistent Low Back Pain An Individual Participant Data Meta Analysis of 3514 Participants from 27 RCTS. Brit J Sports Med DOI:10.1136/brjsports-2019-101205

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