From the Guidelines
According to Haldeman, a negative correlation between exercise and Low Back Pain (LBP) is not an expected relationship. Patients with LBP typically demonstrate reduced cardiovascular fitness, decreased muscle strength, and limited mobility as common associations with their condition. These physical limitations often develop as a result of pain-related movement restrictions, deconditioning from reduced activity levels, and compensatory movement patterns that emerge to avoid discomfort. However, the evidence suggests that exercise is associated with less pain intensity and better function in patients with LBP, as shown in a systematic review that found exercise therapy was associated with less pain intensity (3 trials: WMD, −9.23 [CI, −16.02 to −2.43]) and better function (3 randomized, controlled trials: WMD, −12.35 on a 0- to 100-point scale [CI, −23.0 to −1.69]) versus usual care at treatment end 1. Another systematic review found that compared with minimal intervention, MCE decreased pain intensity (2 trials: WMD, −12.48 on a 0- to 100-point scale [CI, −19.04 to −5.93] short term and 13.32 [CI, −19.75 to −6.90] long term) and improved function (3 trials: WMD, −9.00 on a 0- to 100-point scale [CI, −15.28 to −2.73] short term; 2 trials: WMD, −6.64 [CI, −11.72 to −1.57] long term) 1. While the exact nature of the relationship between exercise and LBP is complex and influenced by various factors, the current evidence supports the use of exercise as a therapeutic intervention for managing LBP, rather than a negative correlation between the two. Some key points to consider include:
- Exercise is associated with less pain intensity and better function in patients with LBP 1
- MCE is associated with decreased pain intensity and improved function in patients with LBP 1
- The effects of exercise on LBP are smaller at long-term follow-up, but still statistically significant 1
- Exercise is a recommended therapeutic intervention for managing LBP, rather than a negative correlation between the two 1
From the Research
Relationship Between Exercise and Low Back Pain
According to the provided studies, the expected relationship between exercise and Low Back Pain (LBP) is complex and can vary depending on the type and intensity of exercise.
- The study by 2 suggests that the relation between physical activity and chronic low back pain may be U-shaped, with both inactivity and excessive activity presenting an increased risk for back pain.
- The study by 3 found that the physical activity advice ought to be different for LBP prevention and rehabilitation to reduce long-term sickness absence risk, and specified by domain and activity intensity.
- The study by 4 found that physical activity seems to be associated with lower prevalence of LBP.
- The study by 5 found that tai chi, yoga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients.
- The study by 6 found that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes.
Not an Expected Relationship
However, there is no study by Haldeman in the provided evidence, but based on the available studies, an unexpected relationship between exercise and LBP would be:
- A direct positive correlation between high-intensity exercise and reduced LBP, as most studies suggest a U-shaped relationship or specify the type and intensity of exercise that is beneficial for LBP.
- A lack of differentiation between the type and intensity of exercise in the prevention and rehabilitation of LBP, as most studies emphasize the importance of tailoring exercise advice to the specific context.