The support for exercise interventions as treatment for chronic lower back pain goes back decades at this point. Whether it is walking, strengthening exercises, stretching or pilates, it has been demonstrated ad nauseum that exercise is better than passive treatments for chronic nonspecific lower back pain. 

The difference demonstrated in the literature, however, is not as great as many people (including us) would probably like to believe. Probably the best systematic review to date on this topic was done by Dr. Jill Hayden and colleagues in 2018 (updated in 2021). They looked at 249 studies from all around the world comparing exercise interventions to placebo, usual care or no treatment for lower back pain. 

They showed that exercise was superior to non-exercise interventions for pain and functional limitation. The difference for function did not however, reach their pre-designated level for clinical significance (which they set at a higher than usual 15 out of 100 points).  This means that in the real world it may not be a meaningful improvement for a patient.

There are a few reasons why the results of large studies like this might not end up showing a large difference when comparing exercise to other interventions:

Poor exercise prescription 

This is based on experience after having read several hundred research articles and working in the field for more than 5 years. Physiotherapists are typically under dosing exercise, or just giving ineffective exercise altogether. 

This is not meant to condemn necessarily, it is just what they have been taught. But giving a clamshell exercise to an otherwise relatively healthy adult with lower back pain is unlikely to do much for their pain level, let alone improve physical performance. Chiropractors are often not even giving exercise at all, but when they do, the same problems are prevalent.

Pooling of multiple exercise types together

Combining strength training and stretching together really muddies the waters. They are so different that it is hard to see how they would have similar effects on pain or disability broadly. With large review studies they typically combine all different exercise types together to make it easier to analyze. This is great for just getting a quick, general answer, but it is at the cost of detailed information. 

When exercise types have been looked at individually, it is clear that some are better than others. Hayden and colleagues have done the most comprehensive study on this topic to date also. They found in their 2021 systematic review that McKenzie exercises and Pilates were superior to other types studied for pain and functional limitation. (5)

The LBPfix program was designed with the current best evidence in mind. It utilizes techniques from both McKenzie Method and Pilates to reduce pain and increase function. Check it out now!

Pooling of comparison groups together

No treatment is definitely not the same as ‘usual care’. Usual care would typically be consultation with a family doctor, which would include education, advice and probably some sort of medication like an NSAID. Education and advice are very important for chronic pain as we will soon discuss. Pooling these together makes the ‘no treatment’ condition appear better, and thus decrease the difference when compared to exercise. 

Here’s the thing though, even if exercise was not superior to other therapies, you  still need to exercise to be healthy and reduce injury risk in the future anyway. Exercise is also the only way to get better at physical tasks or activities (aside from practice, of course). So not only is it better than other interventions for decreasing pain, but it is also beneficial for countless other reasons.

The LBPfix program guides you through an exercise progression that is tailored to you based on the results of your self assessment.