The Fitness Fixer
The Fitness Fixer

Doctors Don't Prescribe Effective Back and Neck Pain Therapy - Exercise

Studies have confirmed that directed Studies have confirmed that directed exercise is beneficial for chronic low back and neck pain. Is it being used? In a survey reported in Arthritis Care & Research, of 684 patients with chronic low back or neck pain, only 14.4% were prescribed exercise by their physicians. By contrast, 63.8% of those seeing a physical therapist and 33.1% of those who saw a chiropractor were prescribed exercise.

Other significant predictors of an exercise prescription were being female, having greater than a high school education, and being on workers' compensation.

Primary source:
Freburger JK, et al "Exercise prescription for chronic back or neck pain: Who prescribes it? Who gets it? What is prescribed?" Arthritis Care Res 2009; 61(2): 192-200.

My colleague, family medicine physician Dr. Fabrice Czarnecki sent me this:

A study did a review "prospective controlled trials of interventions." These are studies that evaluated effectiveness of various interventions to prevent back pain (BP) in working age adults. In short, after all the math and big words were sifted through, they found that, "only exercise was found effective for preventing self-reported BPs in seven of eight trials. Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs."

Their conclusions: "Twenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals."

Bigos SJ, Holland J, Holland C, et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009 Feb;9(2):147-68. (Review) PMID: 19185272

Not all exercise fixes pain. Many exercises cause lower back pain, even those commonly used in rehab and PT programs. Prescribing random exercise is not effective.

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Dr. Bookspan is an award-winning scientist whose goal is to make exercise easier and healthier.