Exercise is ‘most effective’ method of preventing lower back pain

Playing golf

Exercises for golfers to prevent back pain. Watchfit

“Exercise is the best medicine to banish back pain and stop people taking sick days,” reports the Daily Mirror. While this may be true, the research in question did not look at treatments for existing back pain.

In fact, the researchers reviewed previously gathered evidence about what helps prevent, not treat, lower back pain. Also, the evidence that exercise reduced sick leave was judged to be poor quality.

The review found exercise with or without education about the back and back pain was the most likely intervention to prevent lower back pain. This included core muscle strengthening, stretching and aerobic exercise carried out over a period of about 3 to 18 months.

Education alone, back belts, shoe insoles, and ergonomics (changes to objects such as chairs to make them more “back friendly”) were not found to prevent lower back pain. But this finding was based on low-quality studies, so it should be viewed with caution.

Some of these interventions, such as shoe insoles, were only studied in army recruits, so the results may not be applicable to other population groups.

These limitations aside, exercise would seem to be the best option based on the available evidence. Exercise is known to offer a range of benefits. This review suggests preventing lower back pain is another potential benefit.


This systematic review and meta-analysis found exercise reduces the risk of lower back pain and sick leave as a result of lower back pain.

The types of exercise studied included improving core strength (abdominals and lumbar region), leg and back muscle strengthening, stretching and cardiovascular workouts.

Although the researchers concluded that, “education alone, back belts, shoe insoles, and ergonomics do not prevent LBP”, this is based on limited low-quality evidence.

However, these interventions might prove effective for individuals in situations that have not been studied, or if tested in better-quality trials. For example, the shoe insoles were only studied on army recruits, so the results may not be generalisable to the general population.

The review also purely focused on people who have not already experienced anything other than mild lower back pain, so it does not tell us whether these interventions are effective strategies for managing the condition.

For people with non-specific lower back pain, giving education advice and advising people to stay physically active and exercise are part of the early management currently recommended by the UK’s National Institute for Health and Care Excellence NICE.

The evidence for the effect of each intervention on the risk of sick leave for lower back pain was based on between one and three small trials, which limits the reliability of the results.

These limitations aside, the study adds to the weight of evidence that one of the many benefits of exercise may be preventing back pain. Additionally, there is expert consensus it can also be effective at relieving the symptoms of back pain in most people – though, as mentioned, the study did not look at this issue.

Get more exercises recommended for low back pain.

Back Pain NHS Health A to Z

Analysis by Bazian. Edited by NHS blogs. Follow NHS on Twitter. Join the Healthy Evidence forum.

Prevention of Low Back Pain: A Systematic Review and Meta-analysis, Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M, Teixeira-Salmela LF, Hancock MJ. JAMA Intern Med. 2016 Jan 11:1-10. doi: 10.1001/jamainternmed.2015.7431. [Epub ahead of print]

Also see
Low back pain and sciatica in over 16s: assessment and management National Institute for Health and Care Excellence NICE
To Prevent back pain, orthotics are out, exercise is in The  New York Times
Exercises for golfers to prevent back pain Watchfit
Preventing back pain at work and at home OrthoInfo – American Academy of Orfthpaedic Surgeons
Living with back pain – 11 ways to avoid back pain WebMD
Low back pain – Treatment FamilyDoctor.org

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