Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists

Annika Wun; Paul Kollias; Harry Jeong; Rodrigo Rn Rizzo; Aidan G Cashin; Matthew K Bagg; James H McAuley; Matthew D Jones

doi:10.1016/j.msksp.2020.102307

Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists

Musculoskelet Sci Pract. 2021 Feb:51:102307. doi: 10.1016/j.msksp.2020.102307. Epub 2020 Nov 24.

Authors

Annika Wun¹, Paul Kollias¹, Harry Jeong¹, Rodrigo Rn Rizzo², Aidan G Cashin³, Matthew K Bagg⁴, James H McAuley², Matthew D Jones⁵

Affiliations

¹ School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.
² School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.
³ Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁴ Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; New College Village, University of New South Wales, Sydney, Australia.
⁵ School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia. Electronic address: matthew.jones@unsw.edu.au.

PMID: 33254007
DOI: 10.1016/j.msksp.2020.102307

Abstract

Background: Exercise is recommended for the management of chronic low back pain (CLBP). Trialists have proposed numerous mechanisms to explain why exercise improves pain and function in people with CLBP, but these are yet to be synthesised.

Objective: To synthesise the proposed mechanisms of benefit for exercise in people with CLBP.

Design: Review.

Methods: The Physiotherapy Evidence Database (PEDro) was searched from inception to July 2019. Randomised controlled trials of adults with CLBP, indexed in PEDro as 'fitness training', were included. Two reviewers independently screened and extracted data from each study. Data were analysed quantitatively and qualitatively using thematic analysis.

Results: 186 studies were identified and 110 were included in the analysis. Thirty-six studies (33%) did not provide a mechanism of benefit for exercise in people with CLBP. Of the remaining studies, most provided more than one mechanism, from which 33 unique mechanisms were identified. These were grouped into five themes which, from most to least common, were: neuromuscular (n = 105 (44%)); psychosocial (n = 87 (36%)); neurophysiological (n = 22 (9%)); cardiometabolic (n = 15 (6%)); and tissue healing (n = 12 (5%)). The effects of these proposed mechanisms on outcomes for people with CLBP were seldom examined.

Conclusions: This review identified a variety of mechanisms proposed in clinical trials to explain why 'fitness training' works for people with CLBP, but these mechanisms were seldom tested. Randomised controlled trials investigating the mediating effects of these mechanisms may be warranted to better understand why exercise works for CLBP.

Keywords: Chronic low back pain; Exercise; Mechanism; Rationale.

Publication types

Review

MeSH terms

Adult
Exercise
Humans
Low Back Pain* / therapy
Physical Therapy Modalities