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Exercise therapy for treatment of non-specific low back pain
Editorial Group: Cochrane Back Group
Published Online: 17 FEB 2010
Assessed as up-to-date: 30 SEP 2004
DOI: 10.1002/14651858.CD000335.pub2
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.pub2.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 17 FEB 2010
References
References to studies included in this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Alexandre 2001 {published data only}
- , , , . Evaluation of a program to reduce back pain in nursing personnel. Revista de Saude Publica 2001;35:356-61.
Aure (ex2) {published data only}
Aure 2003 {published data only}
- , , . Manual therapy and exercise therapy in patients with chronic low back pain. A randomized, controlled trial with 1-year follow-up. Spine 2003;28(6):525-532.
Bendix_a (ex2) {published data only}
Bendix_a 2000 {published data only}
- , , , , . Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 2000;25:2494-500.
Bendix_b (ex2) {published data only}
Bendix_b 1995 {published data only}
- , , , . Functional restoration for chronic low back pain: Two-year follow-up of two randomized clinical trials. Spine 1998;23:717-25.
- , , , , , . Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow-up. Scand J Rehab Med 1997;29:81-9.
- , , , , . Active treatment programs for patients with chronic low back pain: a prospective randomized, observer-blinded study. Eur Spine J 1995;4:148-52.
Bentsen (ex2) {published data only}
Bentsen 1997 {published data only}
- , , . The effect of dynamic strength back exercise and/or a home training program in 57-year old women with chronic low back pain: results of a prospective randomized study with a 3-year follow-up period. Spine 1997;22:1494-500.
Bronfort (ex2) {published data only}
Bronfort 1996 {published data only}
Buswell (ex2) {published data only}
Buswell 1982 {published data only}
- . Low back pain: a comparison of two treatment programmes. NZ J Physiotherapy 1982;10:13-7.
Calmels (ex2) {published data only}
Calmels 2004 {published data only}
Cherkin 1998 {published data only}
- , , , , . A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med 1998;339:1021-9.
Chok 1999 {published data only}
- , , , . Endurance training of the trunk extensor muscles in people with subacute low back pain. Phys Ther 1999;79:1032-42.
Dalichau (ex2) {published data only}
Dalichau 2000 {published data only}
- , . [Effects of elastic lumbar belts on the effect of a muscle training program for patients with chronic back pain]. [German]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2000;138:8-16.
Davies (ex2) {published data only}
Davies 1979 {published data only}
- , , . The value of exercises in the treatment of low back pain. Rheumatol Rehabil 1979;18:243-7.
Delitto (ex2) {published data only}
Delitto 1993 {published data only}
- , , , , . Evidence for use of an extension-mobilization category in acute low back syndrome: a prescriptive validation pilot study. Phys Ther 1993;73:216-28.
Descarreaux (ex2) {published data only}
Descarreaux 2002 {published data only}
- , , , . Evaluation of a specific home exercise program for low back pain.. J Manipulative Physiol Ther 2002;25(8):497-503.
Deyo 1990 {published data only}
- , , , , . A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990;322:1627-34.
Elnaggar (ex2) {published data only}
Elnaggar 1991 {published data only}
- , , , , . Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients. Spine 1991;16:967-72.
Faas 1993 {published data only}
- , , , . A randomized placebo-controlled trial of exercise therapy in patients with acute low back pain. Spine 1993;18:1388-95.
- , , , . A randomized trial of exercise therapy in patients with acute low back pain. Spine 1995;20:941-7.
Farrell 1982 {published data only}
- , . Acute low back pain: comparison of two conservative treatment approaches. Med J Aus 1982;1:160-4.
Frost 1995 {published data only}
- , , , . Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain. Br Med J 1995;310:151-4.
- , , , , . A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial. Pain 1998;75:273-9.
Frost 2004 {published data only}
- , , , , . Randomized controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708-11.
Galantino 2004 {published data only}
- , , , , , , et al. The impact of modified hatha yoga on chronic low back pain: A pilot study. Alternative Therapies in Health & Medicine 2004;10:56-9.
Gilbert (ex2) {published data only}
Gilbert 1985 {published data only}
- , , , . A randomized controlled trial of flexion exercises, education, and bed rest for patients with acute low back pain. Physiother Can 1987;39:96-101.
- , , , . Clinical practice of common treatments for low-back pain. Br Med J 1985;291:789-92.
Gur (ex2) {published data only}
Gur 2003 {published data only}
- , , , , , . Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers in Surgery & Medicine 2003;32:233-8. Direct Link:
Hansen 1993 {published data only}
- , , , , , , et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low back pain. Spine 1993;18:98-107.
Hemmila 1997 {published data only}
- , , , . Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: A randomized controlled trial. J Manip Phys Therapeutics 2002;25:99-104.
- , , , . Does folk medicine work? A randomized clinical trial on patients with prolonged back pain. Arch Phys Med Rehabil 1997;78:571-7.
Hides 1996 {published data only}
- , , . Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001;26:E243-8.
- , , . Multifidus muscle recovery is not automatic after resolution of acute first-episode low back pain. Spine 1996;21:2763-9.
Hildebrandt 2000 {published data only}
Johanssen (ex2) {published data only}
Johanssen 1995 {published data only}
- , , , , , , et al. Exercises for chronic low back pain: a clinical trial. J Orthop Sports Phys Ther 1995;22:52-9.
Jousset (ex2) {published data only}
Jousset 2004 {published data only}
- , , , , , , et al. Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study. Spine 2004;29:487-93.
Kankaanpaa 1999 {published data only}
- , , , . The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self-experienced disability, and lumbar fatigability. Spine 1999;24:1034-42.
Kendall (ex2) {published data only}
Kendall (ex3) {published data only}
Kendall 1968 {published data only}
- , . Exercises for backache: a double-blind controlled trial. Physiother 1968;54:154-7.
Kuukkanen 2000 {published data only}
- , . An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain. Clinical Rehabilitation 2000;14:192-202.
Lidström 1970 {published data only}
Lie (ex2) {published data only}
Lie 1999 {published data only}
Lindstrom 1992 {published data only}
- . A successful intervention program for patients with subacute low back pain. (Academic Thesis). Göteborg: Göteborg University, 1994.
- , , , , , , et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioural approach. Physical Therapy 1992a;72:279-93.
- , , , , , . Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioural therapy approach. Spine 1992b;17:641-52.
Ljunggren (ex2) {published data only}
Ljunggren 1997 {published data only}
- , , , , . Effect of exercise on sick leave due to low back pain: a randomized, comparative, long-term study. Spine 1997;22:1610-7.
Malmivaara 1995 {published data only}
- , , , , , , et al. The treatment of acute low back pain - bed rest, exercises or ordinary activity?. N Engl J Med 1995;332:351-5.
Manniche (ex2) {published data only}
Manniche (ex3) {published data only}
Manniche 1988 {published data only}
- , , , , . Clinical trial of intensive muscle training for chronic low back pain. Lancet 1988;ii:1473-6.
- , , , , . Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain 1991;47:53-63.
Mannion (ex2) {published data only}
Mannion (ex3) {published data only}
Mannion 1999 {published data only}
- , , , . A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24:2435-48.
- , , , . Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-up. Rheum 2001;40:772-8.
- , , , . Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength. Spine 2001;26:897-908.
Moffett 1999 {published data only}
- , , , , , , et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 1999;319:279-83.
Moseley 2002 {published data only}
- . Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother 2002;48:297-302.
Niemisto 2003 {published data only}
- , , , , , . A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 2003;28:2185-91.
Petersen (ex2) {published data only}
Petersen 2002 {published data only}
- , , , , . The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial.. Spine 2002;27:1702-9.
Preyde (ex2) {published data only}
Preyde 2000 {published data only}
- . Effectiveness of massage therapy for subacute low-back pain: A randomized controlled trial. Can Med Assoc J 2000;162:1815-20.
Rasmussen-Barr 2003 {published data only}
- , , . Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Manual Therapy 2003;8:233-41.
Risch 1993 {published data only}
- , , , , , , et al. Lumbar strengthening in chronic low back pain patients: physiologic and psychological benefits. Spine 1993;18:232-8.
Rittweger (ex2) {published data only}
Rittweger 2002 {published data only}
- , , , , . Treatment of chronic lower back pain with lumbar extension and whole-body vibration exercise: a randomized controlled trial. Spine 2002;27:1829-34.
Seferlis 1998 {published data only}
Soukup (ex2) {published data only}
Soukup 1999 {published data only}
- , , , , . 'Active back school', prophylactic management for low back pain: Three-year follow-up of a randomized, controlled trial. J Rehab Med 2001;33:26-30.
- , , , , . Active back school: Prophylactic management for low back pain. A randomized controlled, 1-year follow-up study. Spine 1999;24:865-71.
- , , , , . Exercises and education as secondary prevention for recurrent low back pain. Phys Res Int 2001;6:27-39. Direct Link:
- , , , , , . The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain: A randomized, controlled trial with 12-month follow-up. Spine 1999;24:1585-92.
Staal 2004 {published data only}
- , , , , , . Graded activity for low back pain in occupational health care: a randomized, controlled trial.[see comment]. Ann Intern Med 2004;140:77-84.
Stankovic 1990 {published data only}
- , . Conservative treatment of acute low-back pain: a 5-year follow-up study of two methods of treatment. Spine 1995;20:469-72.
- , . Conservative treatment of acute low back pain: a prospective randomized trial. Spine 1990;15:120-3.
Storheim 2003 {published data only}
- , , , , . Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. J Rehabil Med 2003;35:132-40.
Torstensen (ex2) {published data only}
Torstensen 1998 {published data only}
- , , , , , . Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain: a pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up. Spine 1998;23:2616-24.
Tritilanunt (ex2) {published data only}
Tritilanunt 2001 {published data only}
- , . The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. J Med Assoc Thailand 2001;84:S528-33.
Turner (ex2) {published data only}
Turner 1990 {published data only}
- , , , . Effectiveness of behavioral therapy for chronic low back pain: a component analysis. J Consult Clin Psychol 1990;58:573-9.
Underwood 1998 {published data only}
- , . The use of a back class teaching extension exercises in the treatment of acute low back pain in primary care. Fam Pract 1998;15:9-15.
Waterworth 1985 {published data only}
- , . An open study of diflunisal, conservative and manipulative therapy in the management of acute mechanical low back pain. N Z Med J 1985;95:372-5.
Yelland 2004 {published data only}
- , , , , . Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9-16.
Yeung (ex2) {published data only}
Yeung 2003 {published data only}
- , , . The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. J Alternative & Complementary Medicine 2003;9:479-90.
Yozbatiran (ex2) {published data only}
Yozbatiran 2004 {published data only}
- , , . Effects of fitness and aquafitness exercises on physical fitness in patients with chronic low back pain. The Pain Clinic 2004;16:35-42.
Zylbergold 1981 {published data only}
- , . Lumbar disc disease: comparative analysis of physical therapy treatments. Arch Phys Med Rehabil 1981;62:176-9.
References to studies excluded from this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Coxhead 1981 {published data only}
- , , , , . Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet 1981;i:1065-8.
Danielsen 2000 {published data only}
- , , , . Early aggressive exercise for postoperative rehabilitation after discectomy. Spine 2000;25:1015-20.
Danneels 2001 {published data only}
- , , , , , , et al. The effects of three different training modalities on the cross-sectional area of the paravertebral muscles. Scand J Med Sci Sports 2001;11:335-41.
- , , , , , , et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med 2001;35:186-91.
Friedrich 1998 {published data only}
- , , , , . Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Arch Phys Med Rehab 1998;79:475-87.
Ghoname 1999 {published data only}
- , , , , , , et al. Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. [see comments.] [erratum appears in JAMA 1999 May 19;281(19):1795.]. JAMA 1999;281:818-23.
Hagen 2000 {published data only}
- , , . Does early intervention with a light mobilization program reduce long-term sick leave for low back pain?. Spine 2000;25:1973-6.
Helewa 1999 {published data only}
- , , , , . Does strengthening the abdominal muscles prevent low back pain - A randomized controlled trial. J Rheum 1999;26:1808-15.
Horneij 2001 {published data only}
Lang 2003 {published data only}
Little 2001 {published data only}
- , , , , , , et al. Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain. Spine 2001;26:2065-72.
Manniche 1993 {published data only}
- , , , , , , et al. Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion: a clinical trial. Spine 1993;18:560-7.
Martin 1980 {published data only}
- , , , , . Physiotherapy exercises for low back pain: process and clinical outcome. Int Rehabil Med 1980;8:34-8.
Morton 1999 {published data only}
Muller 2001 {published data only}
- , , , . [Coordinative treatment and quality of life - A randomised trial of nurses with back pain] German.. Gesundheitswesen 2001;63:609-18.
Nwuga 1982 {published data only}
- . Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982;61:273-8.
Nwuga 1985 {published data only}
- , . Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain management. Physiother Pract 1985;1:99-105.
O'Sullivan 1997 {published data only}
- , , . Evaluation of specific stabilising exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 1997;22:2959-67.
Sachs 1994 {published data only}
- , , , , , , et al. Objective assessment for exercise treatment on the B-200 isostation as part of work tolerance rehabilitation: a random prospective blind evaluation with comparison control population. Spine 1994;19:49-52.
Scrimshaw 2001 {published data only}
- , . Randomized controlled trial of neural mobilization after spinal surgery. Spine 2001;26:2647-52.
Snook 1998 {published data only}
- , , , , . The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. A randomized controlled trial. Spine 1998;23:2601-7.
Spratt 1993 {published data only}
- , , , , . Efficacy of flexion and extension treatments incorporating braces for low back pain patients with retrodisplacement, spondylolisthesis, or normal sagittal translation. Spine 1993;18:1839-49.
Strand 2001 {published data only}
- , , , . The impact of physical function and pain on work status at 1-year follow-up in patients with back pain. Spine 2001;26:800-8.
White 1966 {published data only}
- . Low back pain in men receiving workmen's compensation. Can Med Assoc J 1966;95:50-56.
References to studies awaiting assessment
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Erhard 1994 {published data only}
- , , . Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome. Phys Ther 1994;74(12):1093-100.
Gillan 1998 {published data only}
Kladny 2003 {published data only}
- , , . [Evaluation of specific stablizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation][German]. Zeitschrift fur Orthopadie und Ihre Grenzgbiete 2003;141:401-5.
Additional references
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Abenhaim 2000
- , , , , , , et al. The role of activity in the therapeutic management of back pain: Report of the International Paris Task Force on back pain. Spine 2000;25:1S-33S.
Begg 1996
- , , . Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA 1996;276:637-9.
Bombardier 2001
- , , . Minimally clinically important difference: Low back pain outcome measures. J Rheumatol 2001;28:431-8.
DerSimonian 1986
- , . Meta-analysis in clinical trials. Controlled Clinical Trials 1986;7:177-88.
Deyo 1998
- , , , , , , et al. Outcome measures for low back pain research: A proposal for standardized use. Spine 1998;23:2003-13.
Egger 1997
- , , , , , . Language bias in randomised controlled trials published in English and German. Lancet 1997;350:326-9.
Ernst 2003
- , . The Alexander technique: a systematic review of controlled clinical trials. Forschende Komplementarmedizin und Klassische Naturheilkunde 2003;10:325-9.
Higgins 2002
- , . Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002;21(11):1539-58. Direct Link:
Hilde 1998
- , . Effect of exercise in the treatment of chronic low back pain: a systematic review emphasizing type and dose of exercise. Physical Therapy Reviews 1998;3:107-17.
Jadad 1996
- , , , , , , et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17(1):1-12.
Kool 2004
- , , , , , . Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis. Journal of Rehabilitation Medicine 2004;36:49-62.
Kopec 2000
- . Measuring functional outcomes in persons with back pain: A review of back-specific questionnaires. Spine 2000;25:3110-4.
Liddle 2004
- , , . Exercise and chronic low back pain: what works?. Pain 2004;107:176-90.
Pengel 2002
- , , . Systematic review of conservative interventions for subacute low back pain. Clin Rehabil 2002;16:811-20.
Salaffi 2004
- , , , , . Minimally clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain 2004;8:283-91.
Song 2003
- , , , . Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ 2003;326:472.
Tugwell 2001
- . Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Physical Therapy 2001;81:1641-74.
van Tulder 2003
- , , , , the Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28:1290-9.
von Korff 2000
- , , . Assessing global pain severity by self-report in clinical health services research. Spine 2000;25:3140-51.
Waddell 1997
- , , . Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997;47:647-52.
References to other published versions of this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Hayden 2005a
- , , , . Meta-analysis: Exercise Therapy for Nonspecific Low Back Pain. Annals of Internal Medicine 2005;142:765-75.
Hayden 2005b
- , , . Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine 2005;142:776-85.
van Tulder 2000a
van Tulder 2000b
- , , , . Exercise therapy for low back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;25(21):2784-96.
