Regular exercise can help reduce the risk of developing low back pain significantly, particularly when the exercise is combined with educational instruction on how to prevent back pain, according to a meta-analysis published Monday in the journal JAMA Internal Medicine.

In fact, the meta-analysis, which was conducted by researchers from Australia and Brazil, found that exercise-plus-education cuts the risk of low back pain almost in half.

That’s a remarkable finding. For, as an editorial accompanying the study points out, “If a medication or injection were available that reduced [low back pain] recurrence by such an amount, we would be reading the marketing materials in our journals and viewing them on television.”

The meta-analysis found no evidence to support the use of three other commonly prescribed self-help measures for low back pain: strap-on back belts, shoe inserts and ergonomic adjustments (such as modifying a work station).

Acute low back pain is an extremely frequent health complaint, affecting about 80 percent of American adults at some point in their lifetime, according to the National Institute of Neurological Disorders and Stroke. It is also one of the most common causes of work-related disability and sick leave.

In surveys, about one quarter of American adults report that they have had an episode of low back pain within the past three months. Among people who have experienced such an episode, most (estimates range from 24 percent to 80 percent) will go on to have a recurrent episode within a year.

Study details

For the meta-analysis, the researchers crunched data from 23 randomized clinical trials involving almost 31,000 mostly working-age people from around the world. The trials had investigated various ways of preventing and treating low back pain. In most of the studies, people in the treatment group participated in two or three exercise sessions a week at a clinic or other facility. They were also instructed to exercise at home. The length of the clinical trials ranged from two to 18 months.

The analysis revealed that people assigned to exercise programs were 35 percent less likely to develop a recurrent episode of low back pain and 78 percent less likely to use sick leave than people who had not participated in such programs.

It didn’t matter what type of exercise was prescribed. Whether the programs focused on aerobic conditioning, flexibility (stretching) or strengthening core and back muscles, the results on reducing back pain were similar.

The analysis also found that when educational instruction on preventing back pain was combined with an exercise program, the effects were even greater: The risk of developing a recurrent episode of low back pain fell by 45 percent.

The researchers uncovered no good quality evidence, however, to support the use of education alone (without exercise) for the prevention of back pain. Nor did they find that back straps, shoe inserts and ergonomic desks or work stations offered significant protection. 

Requires an ongoing effort

Of course, as the authors of the editorial note, “although exercise appears to be effective in reducing the risk of future [low back pain] episodes, it will not eliminate one’s risk of recurrence.”

That’s particularly true if you don’t keep exercising. For the meta-analysis also revealed that the positive effects of an exercise program on reducing the risk of low back pain lasts for only about a year after the program ends. 

For exercise to be effective, it must be ongoing, say the researchers, and that requires people to engage in some long-term behavioral change.

FMI: You can download and read the meta-analysis in full at the JAMA Internal Medicine website.