From the Guidelines
Individuals who exercise exhibit less pain, as evidenced by a systematic review that found exercise to be associated with decreased pain intensity and improved function compared to minimal intervention or usual care 1. The relationship between spinal abnormalities and pain is complex, and exercise has been shown to have a positive impact on pain levels, regardless of the presence of spinal abnormalities.
- A systematic review found that exercise decreased pain intensity and improved function in individuals with low back pain, with a weighted mean difference of −12.48 on a 0- to 100-point scale for pain and −9.00 on a 0- to 100-point scale for function 1.
- Another systematic review found that exercise was associated with a lower likelihood of work disability at long-term follow-up, with an odds ratio of 0.66 1.
- The evidence suggests that exercise, including specific types such as motor control exercises (MCE), can be effective in reducing pain and improving function in individuals with low back pain, regardless of the presence of spinal abnormalities.
- The benefits of exercise on pain levels are thought to be due to a combination of psychological, neurological, and biomechanical factors, rather than simply the presence or absence of spinal abnormalities.
- Overall, the evidence supports the use of exercise as a nonpharmacologic therapy for low back pain, and individuals who exercise can expect to exhibit less pain, regardless of the presence of spinal abnormalities.
From the Research
Relationship Between Spinal Abnormalities and Pain
- Studies have investigated the relationship between spinal abnormalities and pain, with a focus on the effects of exercise on pain perception 2, 3, 4, 5, 6.
- Research suggests that exercise, including yoga and physical therapy, can be beneficial for patients with chronic low back pain, improving pain outcomes and functional limitations 2, 3, 4.
Effects of Exercise on Pain
- A study published in 2015 found that yoga therapy can be safe and beneficial for patients with non-specific low back pain or sciatica, accompanied by disc extrusions and bulges 2.
- Another study published in 2024 found that yoga, physical therapy, and home exercise can improve pain perception, function, stress, and quality of life in patients with chronic low back pain 3.
- A systematic review published in 2021 found moderate-certainty evidence that exercise treatment is more effective for treating chronic low back pain compared to no treatment, usual care, or placebo 4.
Spinal Manipulation and Exercise
- A randomized controlled trial published in 2023 found that spinal manipulation added to exercise was more effective than exercise alone for improving pain and quality of life in patients with thoracic spinal pain, at least in the short term 5.
- Another study published in 2022 found that a stretch and strength-based yoga exercise program can improve neuropathic pain, low back pain, disability, and function in patients with lumbar disc herniation 6.
Key Findings
- Exercise, including yoga and physical therapy, can be beneficial for patients with chronic low back pain, improving pain outcomes and functional limitations 2, 3, 4.
- Spinal manipulation added to exercise may be more effective than exercise alone for improving pain and quality of life in patients with thoracic spinal pain, at least in the short term 5.
- A stretch and strength-based yoga exercise program can improve neuropathic pain, low back pain, disability, and function in patients with lumbar disc herniation 6.