During the recent past the most common treatment prescribed for longstanding lower back pain has become supervised exercise. There are many exercise programmes available to patients – with many therapists proclaiming that their particular exercise programme is the very best and the one that experts are recommending. In this commentary I would like to summarise what it is that we know about exercise, what we don’t know, and what we hope to learn in the future.

While there is abundant evidence that exercise is helpful for many lower back pain patients – both as a treatment as well as a preventative measure – it should not be considered as a “cure” – because it is not. Many patients experience excellent results from exercise while others do not. Some patients experience a worsening of their condition.

There is NO clear cut evidence that one programme is superior to any other – irrespective of what you may have been told by your therapist or fitness instructor. We do know that in order to be effective, exercise programmes should last for at least 12 weeks, that programmes should be carried out under professional supervision at least initially, that they must be intensive, that improvement can only be expected after approximately 6 weeks, and that initially you may feel a slight worsening of your symptoms. In order to maintain good results most patients will have to continue with their exercises for much longer periods of time.

Tailored programmes are a good way to begin because health professionals know exactly what to avoid and how to identify “yellow cards” relative to your condition. Fitness instructors – although skilled at designing programmes do not have a background in the many pathologies of the spine. So, if your problem is of sufficient significance, start off with a physiotherapist, chiropractor or other health professional. At our clinic, patients undergoing exercise are supervised by the physiotherapists often in consultation with the chiropractor about issues of importance to the individual patient.

Patients experiencing acute pain should NOT exercise. Several high quality studies have demonstrated that patients experiencing acute pain do worse than those that do not exercise. Wait a few days until the worst symptoms have subsided and then begin with careful stretching. When you symptoms have lessened you can re-start your exercises. Discuss warning signs with your health professional.

There are many studies underway which are attempting to identify patient sub-groups which will assist professionals in identifying which patients should be prescribed exercise and which should not. As this information becomes available I will update readers of this blog.