Only Exercise Found to Prevent Low-Back Problems

Exercise in workplace and community environments is excellent in halting low-back problems, while a variety of other popular interventions have little if any beneficial effect, according to a recent review of a number of high-scientific-quality clinical trials.

“Strong and consistent evidence finds many popular prevention methods to fail, while exercise has a significant impact, both in terms of preventing symptoms and reducing back-pain-related work loss,” said Stanley J. Bigos, a University of Washington professor emeritus of orthopedic surgery and environmental health.
   
Bigos and his fellow researchers, who published their results in The Spine Journal, examined an array of clinical trials on back-pain prevention, weighing their scientific quality using criteria set by the prestigious Cochrane Collaboration Back Review Group. They found 20 controlled trials that were very high-quality in their methodology and objectivity. Eight of these dealt with exercise as a back-pain preventive, and seven of the eight found exercise to be effective in halting back-pain problems.

The other trials, however, found several other approaches to back pain to be ineffective, including reduced-lifting programs, back or ergonomic educational interventions, lumbar supports, shoe inserts and stress management.
   
“Passive interventions such as lumbar belts and shoe inserts do not appear to work,” Bigos said. “And eight trials found ergonomic interventions, of either reducing lifting, or back or ergonomic training sessions, to be ineffective in preventing back problems.”
   
The Bigos review, however, doesn’t mean that ergonomic educational programs shouldn’t be pursued – only that they’re not effective against back pain. They may have other benefits, said John Holland, a co-author and a University of Washington clinical professor of environmental and occupational health sciences. “Ergonomic interventions may increase productivity, product quality and work comfort,” he said. “There are many reasons why such research should continue.”
   
The scientists declared that the results of their review suggest that resources for the prevention of back pain should be applied to interventions that really work – namely, exercise programs – not to popular but ineffective methods.
   
“The new review also supports one additional important conclusion,” said Bigos. “Ten years ago, some critics suggested we rely upon lower level studies. They maintained that it was not possible to perform high-quality clinical trials on preventive interventions for low-back problems in the workplace. However, our review demonstrates the viability of the growing number of high-quality trials providing more reliable evidence to guide back-problem prevention efforts.”