Making exercise count: Considerations for the role of exercise in back pain treatment

Abstract

Introduction Chronic low back pain (CLBP) is pain that has persisted for greater than three months. It is common and burdensome and represents a significant proportion of primary health presentations. For the majority of people with CLBP, a specific nociceptive contributor cannot be reliably identified, and the pain is categorised as ‘non‐specific’. Exercise therapy is recommended by international clinical guidelines as a first‐line treatment for non‐specific CLBP. Aim This comprehensive review aims to synthesise and appraise the current research to provide practical, evidence‐based guidance concerning exercise prescription for non‐specific CLBP. We discuss detailed initial assessment and being informed by patient preferences, values, expectations, competencies and goals. Methods We searched the Cochrane Database of Systematic Reviews, PubMed and the Physiotherapy Evidence Database (PEDro) using broad search terms from January 2000 to March 2021, to identify the most recent clinical practice guidelines, systematic reviews and randomised controlled trials on exercise for CLBP. Results/Discussion Systematic reviews show exercise is effective for small, short‐term reductions in pain and disability, when compared with placebo, usual care, or waiting list control, and serious adverse events are rare. A range of individualised or group‐based exercise modalities have been demonstrated as effective in reducing pain and disability. Despite this consensus, controversies and significant challenges remain. Conclusion To promote recovery, sustainable outcomes and self‐management, exercise can be coupled with education strategies, as well as interventions that enhance adherence, motivation and patient self‐efficacy. Clinicians might benefit from intentionally considering their own knowledge and competencies, potential harms of exercise and costs to the patient. This comprehensive review provides evidence‐based practical guidance to health professionals who prescribe exercise for people with non‐specific CLBP.

Does a powerlifting inspired exercise programme better compliment pain education compared to bodyweight exercise for people with chronic low back pain? A multicentre, single-blind, randomised controlled trial

“…11 Indeed, some advancement has been made in this area with O’Sullivan et al 28 abandoning the classification-based exercise previously associated with cognitive functional therapy. Additionally, a recent summary of exercise for chronic pain includes broad general exercise such as resistance and aerobic modes, 29 which is in line with the work of O’Sullivan et al 28 The findings of this study, allow practitioners to implement exercise prescriptions paired with pain education, which do not originate from conflicting philosophies, such as contemporary pain education and biomedical exercise commonly observed in the literature. 4–6 Moreover, this study shows the efficacy for practitioners to use exercise modalities commonly prescribed for asymptomatic, general population clients, for people with chronic low back pain.…”

Evidenzbasiertes und individualisiertes Training für Schmerzpatient*innen

“…Ein patientenzentrierter Ansatz bedeutet, dass die Therapieziele auf die funktionelle Ausgangssituation der Patient*innen, deren Werte, Präferenzen und Wünsche abgestimmt werden 15 , 17 – 20 . Welche Bewegungs- und Trainingsform in der Therapie eingesetzt wird, ist also davon abhängig, welche funktionellen Einschränkungen ein Patient aufweist (z.…”

“…Unserem zeitgemäßen Verständnis entsprechend wird Schmerz nicht mehr eindimensional biomedizinisch erklärt, sondern als persönliche Erfahrung verstanden, die in unterschiedlichem Maße von biologischen, psychologischen und sozialen Faktoren beeinflusst wird 65 . Dementsprechend lassen sich das individuelle Assessment und die patientenzentrierte Behandlung der mehrdimensionalen Hintergrundfaktoren (Treiber) von Schmerz und Funktionsverlusten als kleinster gemeinsamer Nenner vieler vermeintlich unterschiedlicher Therapieansätze definieren 20 , 66 – 70 .…”

“…wird ein Schmerzpatient gewisse Übungen sicherlich nicht dauerhaft durchführen, solange er die dabei auftretenden Schmerzen als Indikator für eine schädigende Folge interpretiert. Demzufolge wird ein Training ohne das Verständnis eines Patienten für persistierende Schmerzen und den adäquaten Umgang mit ihnen kaum erfolgreich sein 20 . Dies unterstreicht einmal mehr die Wichtigkeit einer therapeutischen Schmerzedukation als „Sprungbrett“ für nachfolgende, aktive Interventionen – selbst dann, wenn die Wirkung einer alleinigen Edukation auf Schmerz und Funktion eher bescheiden ausfällt 7 , 19 , 20 , 64 , 71 – 73 .…”

The Effect of M-Health-Based Core Stability Exercise Combined with Self-Compassion Training for Patients with Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study

“…So CSE has become the first recommended treatment for NCLBP by Chinese therapists. However, patients with NCLBP have been observed to exhibit poor adherence to exercise training without supervision, leading to poor efficiency [12]. Exercise based on mobile-health (mhealth) is a novel approach to delivery of the exercise training using personal mobile phones [13] that grew rapidly during the COVID-19 outbreak [14].…”