Which Exercise Treatment Is Best for Chronic Low Back Pain?

A randomized trial comparing an exercise-based treatment of person-specific motor skill training (MST) in performance of functional activities versus strength and flexibility exercise (SFE) in improving function in patients with chronic low back pain (LBP) found that the former was a more effective short- and long-term treatment option.

“Exercise is an effective, nonpharmacologic treatment for chronic LBP, and most clinical practice guidelines recommend exercise as first-line treatment for chronic LBP. However, there is limited evidence about (1) which exercise is best and (2) the long-term effects of different exercise-based treatments,” the researchers explained.

A total of 1,595 adults with chronic, nonspecific LBP were screened for eligibility for the trial; 154 patients were ultimately randomized to one of the interventions. All patients had at least 12 months of chronic, nonspecific LBP; were aged 18 to 60 years; and had a modified Oswestry Disability Questionnaire (MODQ) score of at least 20%. Patients were randomized to receive six weekly one-hour sessions of MST in functional activity performance or SFE of the trunk and lower limbs. Half of patients in each group also received up to three booster treatments six months after the initial treatment. The main outcome measure was the MODQ score, which ranged from 0% to 100%, immediately, six months, and 12 months after treatment.

Of the 149 patients included in the intention-to-treat analysis, 91 were women, and the mean age was 42.5 years (standard deviation, 11.7 years). The MST group had lower posttreatment MODQ scores than the SFE group, with a difference of 7.9 (95% confidence interval [CI], 4.7-11.0; P<0.001). The lower MODQ scores persisted at six and 12 months, with differences of 5.6 (95% CI, 2.1-9.1) and 5.7 (95% CI, 2.2-9.1), respectively. However, booster treatments did not impact MODQ scores in either cohort.

The study was published in JAMA Neurology.

“Use of MST appeared to (1) result in improved short-term but more importantly long-term outcomes with only 6 one-hour treatments, (2) promote better adherence to training for a prolonged period, and (3) enable a person to practice the activities across the day, thus providing a means of self-management. Such benefits could be key in a condition typically characterized by a clinical course of recurrent, fluctuating, or persistent functional limitation and pain,” the researchers concluded.