Exercise and work-oriented back pain management programs
Low back pain affects many working adults. Exercise interventions such as graded activity programs can involve specific exercises for increasing flexibility and strengthening back muscles, or exercises to improve overall strength and fitness. Physical conditioning programs, also called work conditioning, work hardening, or functional restoration/exercise programs, are generally designed by physical therapists.
Expected Beneficial Outcomes (Rated)
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Reduced absenteeism
Other Potential Beneficial Outcomes
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Reduced pain
Evidence of Effectiveness
There is some evidence that exercise programs targeting lower back pain (LBP), especially in the workplace, reduce sickness absence and promote return to work (Hayden J, Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005;(3):CD000335.
Link to original source (journal subscription may be required for access)Cochrane-Hayden 2005, Schaafsma FG, Whelan K, van der Beek AJ, et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Systematic Reviews. 2013;(8):CD001822.
Link to original source (journal subscription may be required for access)Cochrane-Schaafsma 2013, Oesch 2010, van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practice & Research Clinical Rheumatology. 2010;24(2):193-204.
Link to original source (journal subscription may be required for access)van Middelkoop 2010, Bell JA, Burnett A. Exercise for the primary, secondary, and tertiary prevention of low back pain in the workplace: A systematic review. Journal of Occupational Rehabilitation. 2009;19(1):8-24.
Link to original source (journal subscription may be required for access)Bell 2009). Additional evidence is needed to confirm effects.
Exercise programs can increase the likelihood that patients on work disability due to non-acute LBP return to work (Oesch 2010). Graded activity exercise programs in the workplace can reduce sick leave usage among employees suffering from sub-acute LBP (Hayden J, Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005;(3):CD000335.
Link to original source (journal subscription may be required for access)Cochrane-Hayden 2005), and may increase the likelihood that individuals with chronic LBP return to work (Magalhães MO, Muzi LH, Comachio J, et al. The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial. Manual Therapy. 2015;20(4):603-609.
Link to original source (journal subscription may be required for access)Magalhaes 2015). Intense physical conditioning programs (six or more sessions) may reduce sickness absence due to chronic back pain, and have also been shown to be effective for sub-acute pain when an explicit workplace component is included (Schaafsma FG, Whelan K, van der Beek AJ, et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Systematic Reviews. 2013;(8):CD001822.
Link to original source (journal subscription may be required for access)Cochrane-Schaafsma 2013). Light conditioning programs (five sessions or fewer) appear to have no effect on sub-acute or chronic LBP, and there is no evidence light or intense physical conditioning programs reduce sick leave duration for acute LBP (Schaafsma FG, Whelan K, van der Beek AJ, et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Systematic Reviews. 2013;(8):CD001822.
Link to original source (journal subscription may be required for access)Cochrane-Schaafsma 2013). Simple exercise programs appear to have similar effects to complex exercise programs for workers at work; for workers off work due to sub-acute LBP, some complex exercise programs may be more effective (White 2016).
Exercise therapy can reduce the severity of back pain and related physical disability (van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practice & Research Clinical Rheumatology. 2010;24(2):193-204.
Link to original source (journal subscription may be required for access)van Middelkoop 2010, Bell JA, Burnett A. Exercise for the primary, secondary, and tertiary prevention of low back pain in the workplace: A systematic review. Journal of Occupational Rehabilitation. 2009;19(1):8-24.
Link to original source (journal subscription may be required for access)Bell 2009, Hayden J, Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005;(3):CD000335.
Link to original source (journal subscription may be required for access)Cochrane-Hayden 2005). Exercise programs focused on building strength with resistance training or increasing coordination and stability appear to be more effective at reducing chronic LBP than other exercise interventions (Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. 2015;29(12):1155-1167.
Link to original source (journal subscription may be required for access)Searle 2015). Exercise, alone or combined with education, appears to reduce the risk of LBP (Steffens D, Maher CG, Pereira LSM, et al. Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine. 2016;176(2):199-208.
Link to original source (journal subscription may be required for access)Steffens 2016).
Impact on Disparities
No impact on disparities likely
Citations - Evidence
* Journal subscription may be required for access.
Bell 2009* - Bell JA, Burnett A. Exercise for the primary, secondary, and tertiary prevention of low back pain in the workplace: A systematic review. Journal of Occupational Rehabilitation. 2009;19(1):8-24.
Cochrane-Hayden 2005* - Hayden J, Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005;(3):CD000335.
van Middelkoop 2010* - van Middelkoop M, Rubinstein SM, Verhagen AP, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practice & Research Clinical Rheumatology. 2010;24(2):193-204.
Oesch 2010 - Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine. 2010;42(3):193-205.
Cochrane-Schaafsma 2013* - Schaafsma FG, Whelan K, van der Beek AJ, et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Systematic Reviews. 2013;(8):CD001822.
Magalhaes 2015* - Magalhães MO, Muzi LH, Comachio J, et al. The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial. Manual Therapy. 2015;20(4):603-609.
Searle 2015* - Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. 2015;29(12):1155-1167.
Steffens 2016* - Steffens D, Maher CG, Pereira LSM, et al. Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine. 2016;176(2):199-208.
White 2016 - White MI, Dionne CE, Wärje O, et al. Physical activity and exercise interventions in the workplace impacting work outcomes: A stakeholder-centered best evidence synthesis of systematic reviews. The International Journal of Occupational and Environmental Medicine. 2016;7(2):61-74.
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- Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
- Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
- Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
- Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
- Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
- Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.