Physiotherapy exercises for back pain
Clinical bottom line: Trials are of insufficient quality to draw a clear conclusion. It is not clear whether physiotherapy is better than other conservative treatments, or whether it is better than no treatment. It is not possible to establish which types of exercises are the most effective.
About 80% of the population will suffer from back pain during
their active lives. This is usually self-limiting, and will disappear within a
few months in 90% of patients. However, there is a lack of consensus on which
of the many treatments available is the best for chronic back pain.
Physiotherapy is widely used for back complaints, usually exercise therapy
given alone or in combination with other treatments (e.g. massage, heat,
traction, ultrasound or short wave diathermy).
Koes BW, Bouter LM, Beckerman H, van der Hiejden GJMG,
Knipschild PG. Physiotherapy exercises and back pain: a blinded review. 1991;
BMJ 302: 1572-6.
Date review completed: 1990
Number of trials included: 16
Control group: active/no intervention/placebo
Main outcomes: pain, mobility
Inclusion criteria were randomised controlled trials of
physiotherapy for back pain; physiotherapy given individually, not in groups;
physiotherapy given alone or with additional treatment; back pain present at
baseline; full journal publication.
Reviewers provided a descriptive summary of trials,
methodological assessment together with a 'positive' or 'negative' conclusion
for each trial as concluded in the original report.
Of the 16 trials included, most were of poor methodological
quality, and trials were generally not adequately designed to assess the
intervention - small group sizes, high rates of loss-to-follow-up, internal
sensitivity, poor statistical analysis. Type of exercise, control interventions
and length of intervention varied between trials. Ten trials had negative
conclusions and six had positive conclusions. Reviewers note that there is a
general trend for higher quality trials to have positive results. Blinding
status was unclear, but ten of sixteen appeared to be evaluator-blind.
Four trials compared exercise therapy with no therapy or
placebo therapy. One of four trials showed a benefit of exercise therapy for
pain and activity at four and 12 weeks, but this did not persist to three
months. The remaining trials showed no benefit for acute pain, sciatic symptoms
and chronic low back pain.
Seven trials compared exercise therapy with other
conservative treatments. Two of seven trials showed significant benefit
compared with hot packs and rest and with mini back school (i.e. one session).
The second study showed benefit was still present at one year. Five of seven
trials showed no benefit when compared with manual therapy, home care
instructions, non-steroidal anti-inflammatory drugs, manipulation, manipulation
and mobilisation or short wave diathermy.
Different exercise therapies compared
Eight trials compared different types of exercise therapy -
mainly isometric flexion exercises compared with extension exercises. Four of
eight trials showed no difference (although all were flawed). Four showed some
benefit - one favouring three months of intensive dynamic back extensor
exercises over a less intensive treatment plus massage and heat, one favoured
extension over flexion exercises, and two favoured flexion exercises over
mobilisation plus other exercises and, in one trial, massage and heat.
Reviewers did not report on adverse effects
- Identifier CP093-4465: Feb-2000