EXERCISES - WHICH ONES ARE WORTH TRYING, FOR WHICH PATIENTS, AND WHEN

Study Design. Criteria-based review. Summary of Background Data. Revie ws based on trials published up to 1990 conclude that the efficacy of exercise therapy in patients with low back pain is questionable. Objec tives. To determine from recently published trials the efficacy of exe rcises in patients with acute, subacute, or chronic back pain. Methods . A Medline search for randomized trials concerning exercise therapy i n patients with back pain published from 1991 until the first quarter of 1995 was conducted. All studies were given a method score (maximum, 100 points). Results. Eleven randomized trials were included: four in acute back pain, one in subacute, and six in patients with chronic ba ck pain. Three trials had method scores lower than 40 points. For acut e back pain, two trials with high method scores (> 50 points) reported no efficacy of flexion or extension exercises; two trials of the McKe nzie type of exercises reported positive results but had low method sc ores. For subacute pain, one trial (> 50 points) reported positive res ults of exercises with a graded activity program. For chronic back pai n, three trials reported positive results with different types of exer cises; two trials reported better results with intensive exercising co mpared with low grade exercising, but after 12 months, this effect had disappeared. In chronic pain, no relation between method score and co nclusions could be found. Conclusions. In acute back pain, exercise th erapy is ineffective, whereas in subacute back pain, exercises with a graded activity program, and in chronic back pain, intensive exercisin g, deserve attention. More research on McKenzie therapy, on exercises with a graded activity program, and on different types of exercising i n patients with chronic back pain is necessary.