Evidence from the Cochrane Database
- E Schonstein, DT Kenny, J Keating, BW Koes
Physical conditioning programs that include a cognitive-behavioural approach
plus intensive physical training (specific to the job or not) that includes
aerobic capacity, muscle strength and endurance, and coordination; are in
some way work-related; and are given and supervised by a physiotherapist or
a multidisciplinary team, seem to be effective in reducing the number of
sick days for some workers with chronic back pain, when compared to usual
care. However, there is no evidence of their efficacy for acute back pain.
- JA Hayden, MW van Tulder, A Malmivaara, BW Koes
Exercise therapy appears to be slightly effective at decreasing pain and
improving function in adults with chronic low-back pain, particularly in
populations visiting a healthcare provider. In adults with subacute low-back
pain there is some evidence that a graded activity program improves
absenteeism outcomes, though evidence for other types of exercise is
unclear. For patients with acute low-back pain, exercise therapy is as
effective as either no treatment or other conservative treatments.
- SD French, M Cameron, BF Walker, JW Reggars, AJ Esterman
There is moderate evidence that heat wrap therapy reduces pain and
disability for patients with back pain that lasts for less than three
months. The relief has only been shown to occur for a short time and the
effect is relatively small. The addition of exercise to heat wrap therapy
appears to provide additional benefit. There is still not enough evidence
about the effect of the application of cold for low-back pain of any
duration, or for heat for back pain that lasts longer than three months.
Heat treatments include hot water bottles, soft heated packs filled with
grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat
pads, electric heat pads and infra-red heat lamps. Cold treatments include
ice, cold towels, cold gel packs, ice packs and ice
- WJJ Assendelft, SC Morton, I Yu Emily, MJ Suttorp, PG Shekelle
There was little or no difference in pain reduction or the ability to
perform everyday activities between people with low-back pain who received
spinal manipulation and those who received other advocated therapies.
This review of 39 trials found that spinal manipulation was more effective
in reducing pain and improving the ability to perform everyday activities
than sham (fake) therapy and therapies already known to be unhelpful.
However, it was no more or less effective than medication for pain, physical
therapy, exercises, back school or the care given by a general practitioner.
- MW Heymans, MW van Tulder, R Esmail, C Bombardier, BW Koes
There is moderate evidence suggesting that back schools are more effective
for pain and function than other conservative treatments if the patients
with chronic low-back pain (LBP) are from the general public, primary or
secondary care. There is conflicting evidence whether back schools are more
effective than placebo or waiting list controls for pain, function and
- There is moderate evidence suggesting that back schools, in an occupational
setting, reduce pain, and improve function and return-to-work status, in the
short and intermediate-term, compared to exercises, manipulation, myofascial
therapy or advice, placebo or waiting list controls, for patients with
- K Karjalainen, A Malmivaara, M van Tulder, R Roine, M Jauhiainen, H Hurri, B
Multidisciplinary biopsychosocial rehabilitation programs (including
workplace visits) seem to offer some benefit for adults with subacute low
back pain, but further research on effectiveness and cost-effectiveness is
- Prolonged low back pain can lead to a combination of physical,
psychological, occupational and social impairment. For that reason, physical
rehabilitation can also include psychological, behavioural and educational
interventions. This kind of "biopsychosocial multidisciplinary
rehabilitation" is available as outpatient rehabilitation, or in pain
clinics and rehabilitation centres. The review found moderate evidence of
effectiveness from trials of this type of rehabilitation for working age
adults. Although the trials showed some benefit from multidisciplinary
rehabilitation which includes workplace visits, more research on
effectiveness and cost-effectiveness is needed.
- H Dagfinrud, KB Hagen, TK Kvien
What is the bottom line?
- Physiotherapy or exercises are helpful to people with ankylosing
- There is "silver" level evidence that home exercises are better than no
exercises and improve movement in the spine and fitness. Group exercises are
better than home exercises and improve pain, stiffness, movement in the
spine and overall well-being. Adding a few weeks of exercising at a spa
resort to weekly group exercises is better than just weekly group exercises.
- We still need more information about the different types of physiotherapy
and exercise, and how long and how often physiotherapy should be done for
the most improvement.