Exercises: which ones are worth trying, for which patients, and when?

STUDY
DESIGN: Criteria-based review. SUMMARY OF BACKGROUND DATA: Reviews based on trials published up to 1990 conclude that the efficacy of exercise therapy in patients with low back pain is questionable.
OBJECTIVES: To determine from recently published trials the efficacy of exercises in patients with acute, subacute, or chronic back pain.
METHODS: A Medline search for randomized trials concerning exercise therapy in 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 back pain. Three trials had method scores lower than 40 points. For acute back pain, two trials with high method scores (> 50 points) reported no efficacy of flexion or extension exercises; two trials of the McKenzie type of exercises reported positive results but had low method scores. For subacute pain, one trial (> 50 points) reported positive results of exercises with a graded activity program. For chronic back pain, three trials reported positive results with different types of exercises; two trials reported better results with intensive exercising compared with low grade exercising, but after 12 months, this effect had disappeared. In chronic pain, no relation between method score and conclusions could be found.
CONCLUSIONS: In acute back pain, exercise therapy is ineffective, whereas in subacute back pain, exercises with a graded activity program, and in chronic back pain, intensive exercising, deserve attention. More research on McKenzie therapy, on exercises with a graded activity program, and on different types of exercising in patients with chronic back pain is necessary.