Exercise interventions for CLBP

What does the research say about therapeutic exercise interventions for chronic low back pain?

as at 11 March 2025

Introduction

Chronic low back pain (CLBP) is a prevalent condition that poses significant health and economic challenges globally. Exercise interventions have been widely studied as a treatment option due to their low cost and minimal side effects. This summary reviews the therapeutic quality of various exercise interventions for CLBP based on recent research findings.

Effectiveness of Exercise Interventions

General Efficacy: Exercise interventions have been shown to significantly reduce pain in patients with chronic low back pain compared to control groups or other treatments. Strength/resistance and coordination/stabilization exercises are particularly effective. 1, 2
Specific Exercise Modalities: Different types of exercises, such as Pilates, yoga, and motor control exercises, have been identified as effective in improving pain and physical function. Pilates and stabilization exercises, in particular, have shown significant improvements in pain and function compared to minimal treatment. 5, 7, 8
Combination Therapies: Combining therapeutic exercise with pain neurophysiology education (PNE) has been found to yield better outcomes than exercise alone, indicating the importance of addressing both physical and psychosocial aspects of CLBP. 3, 9
Group-Based vs. Individual Exercise: Group-based exercise programs have been compared with other non-pharmacological interventions, showing no significant difference in outcomes. However, group exercises may offer additional benefits such as increased motivation and reduced costs. 6
Motor Control Exercises: These exercises focus on the activation and coordination of deep trunk muscles and have been shown to be effective, although not superior to other exercise forms. The choice of exercise may depend on patient preferences and therapist expertise. 4

Limitations and Recommendations
Despite the positive findings, there are limitations in the current research, including variability in study quality and outcome measures. More high-quality randomized controlled trials are needed to better understand the long-term effects and optimal exercise regimens for CLBP. 2, 10

Conclusion
Exercise interventions, particularly those involving strength, stabilization, and motor control, are effective in managing chronic low back pain. Combining exercise with educational components may enhance treatment outcomes. While group-based exercises offer practical benefits, individual preferences and specific clinical contexts should guide the choice of exercise modality. Further research is necessary to refine these interventions and confirm their long-term efficacy.

References

1. Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation, 29, 1155 - 1167. https://doi.org/10.1177/0269215515570379

Summary: Strength/resistance and coordination/stabilisation exercise programs are most effective in reducing chronic low back pain, while cardiorespiratory and combined exercise programs are ineffective.

Meta-Analysis      Very Rigorous Journal              Highly Cited

2. Liddle, S., Baxter, G., & Gracey, J. (2004). Exercise and chronic low back pain: what works? Pain, 107, 176-190. https://doi.org/10.1016/j.pain.2003.10.017

Summary: Exercise positively affects chronic low back pain patients, with strengthening exercise being a common component, and results are generally maintained at follow-up.

Systematic Review            Highly Cited

3. Pardo, G., Girbes, E., Roussel, N., Izquierdo, T., Penick, V., & Martín, D. (2017). Pain Neurophysiology Education and Therapeutic Exercise for Patients with Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial. Archives of physical medicine and rehabilitation, 99 2, 338-347. https://doi.org/10.1016/j.apmr.2017.10.016

Summary: Combining pain neurophysiology education and therapeutic exercise significantly improves pain intensity and disability in chronic low back pain patients compared to exercise alone.

RCT             Highly Cited

4. Saragiotto, B., Maher, C., Yamato, T., Costa, L., Costa, L., Ostelo, R., & Macedo, L. (2016). Motor control exercise for chronic non-specific low-back pain. The Cochrane database of systematic reviews, 1, CD012004. https://doi.org/10.1002/14651858.CD012004

Summary: Motor control exercise (MCE) is not clinically more effective than other treatments for chronic non-specific low-back pain.

Systematic Review           Very Rigorous Journal              Highly Cited

5. Li, Y., Yan, L., Hou, L., Zhang, X., Zhao, H., Yan, C., Li, X., Li, Y., Chen, X., & Ding, X. (2023). Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1155225

Summary: Tai chi, yoga, Pilates, sling exercise, and core or stabilization exercises significantly improved chronic low back pain and physical function in patients compared to conventional rehabilitation and no intervention.

Meta-Analysis

6. Lemieux, J., Armani, N., Powelske, B., & Kawchuk, G. (2020). Comparing the effectiveness of group-based exercise to other non-pharmacological interventions for chronic low back pain: A systematic review. PloS one, 15 12, e0244588. https://doi.org/10.1371/journal.pone.0244588

Summary: Group-based exercise shows no significant difference in disability level and pain scores compared to other non-pharmacological interventions for chronic low back pain.

Systematic Review           Rigorous Journal

7. Owen, P., Miller, C., Mundell, N., Verswijveren, S., Tagliaferri, S., Brisby, H., Bowe, S., & Belavy, D. (2019). Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine, 54, 1279 - 1287. https://doi.org/10.1136/bjsports-2019-100886

Summary: Pilates, stabilisation/motor control, resistance training, and aerobic exercise training are the most effective treatments for adults with non-specific chronic low back pain, potentially being more effective than therapist hands-on treatment.

Meta-Analysis      Rigorous Journal         Highly Cited

8. Hayden, J., Ellis, J., Ogilvie, R., Stewart, S., Bagg, M., Stanojevic, S., Yamato, T., & Saragiotto, B. (2021). Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. Journal of physiotherapy. https://doi.org/10.1016/j.jphys.2021.09.004

Summary: Pilates, McKenzie therapy, and functional restoration are more effective than other types of exercise for reducing pain intensity and functional limitations in adults with chronic low back pain.

Meta-Analysis      Highly Cited

9. Jones, K., Tocco, E., Marshall, A., McLeod, T., & Bacon, C. (2020). Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic. Journal of sport rehabilitation, 1-6. https://doi.org/10.1123/jsr.2019-0345

Summary: Pain education combined with therapeutic exercise may effectively reduce pain and disability in patients with chronic nonspecific low back pain.

Systematic Review

10. Hayden, J., Van Tulder, M., Malmivaara, A., & Koes, B. (2005). Exercise therapy for treatment of non-specific low back pain. The Cochrane database of systematic reviews, 3, CD000335. https://doi.org/10.1002/14651858.CD000335.PUB2

Summary: Exercise therapy is slightly effective in decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations, and is as effective as no treatment or conservative treatments in acute low-back pain.

Systematic Review           Highly Cited