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Does spinal function improve in low back pain patients who exercise?

PainSci » bibliography » Steiger et al 2011
Tags: treatment, self-treatment, back pain, exercise, pain problems, spine

One page on PainSci cites Steiger 2011: The Complete Guide to Low Back Pain

PainSci notes on Steiger 2011:

Does spinal function improve in low back pain patients who exercise? Does it improve in the way that it should? It ought to — that’s certainly one of the core assumptions of core training. This 2011 analysis of trials looked for correlations between clinical outcomes and spinal functional performance, but found little or none. Even when patients felt better, their backs didn’t work better … not even in terms of spinal functions that were allegedly specifically related to the type of back pain they had. If well-designed exercise plans for the right kind of patients actually improved spinal function as “advertised” by advocates, there should have been much clearer signs of that here. As back pain researcher Neil O’Connell put it, this data “suggests that if there are specific subgroups for whom exercise therapies have benefits, then the improvement in those subgroups was not likely due to the suggested ‘active ingredient’ of the exercises given.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

INTRODUCTION: The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy.

METHODS: We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria.

DATA EXTRACTION: one author extracted the data of the articles.

RESULTS: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively.

CONCLUSIONS: The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

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