Analysis of current approaches and a practical guide to prescription of exercise.

Based on current information, aerobic exercises offer the greatest benefit to patients with back pain. Evidence supports the use of abdominal and extension exercises in a selected group of patients, but indications are limited, as are the useful types of exercises in both of these approaches. No support exists for the use of preprinted handouts, which assume that every patient with back pain, regardless of clinical presentation, requires the same six or eight exercises. Rather, selectivity of exercises based on a thorough clinical evaluation is recommended. Use of a specific exercise should be governed by the sound scientific principles presented in this paper. Many other types of therapeutic exercises not mentioned in the present paper are currently utilized in the care of patients with back pain.