Exercise and work-oriented back pain management programs

Evidence Rating  
Some Evidence
Evidence rating: 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.

Health Factors  
Decision Makers

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)

  • Reduced absenteeism

Other Potential Beneficial Outcomes

  • 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 work1, 2, 3, 4, 5. 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 work3. Graded activity exercise programs in the workplace can reduce sick leave usage among employees suffering from sub-acute LBP1, and may increase the likelihood that individuals with chronic LBP return to work6. 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 included2. 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 LBP2. 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 effective7.

Exercise therapy can reduce the severity of back pain and related physical disability1, 4, 5. 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 interventions8. Exercise, alone or combined with education, appears to reduce the risk of LBP9.

Impact on Disparities

No impact on disparities likely

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1 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.

2 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.

3 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.

4 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.

5 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.

6 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.

7 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.

8 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.

9 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.

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