Physical activity and low back pain: a critical narrative review - 28/02/22

Doi : 10.1016/j.rehab.2022.101650

Alexandra Roren, PT, PhD ^1,^2,^3,^4,^⁎ , Camille Daste, MD, MSc ^1,², Marvin Coleman, PT, MSc ^1,⁵, François Rannou, MD, PhD ^1,^2,^4,⁶, Damien Freyssenet, PhD ⁷, Cedric Moro, PhD ⁸, Marie-Martine Lefèvre-Colau, MD, PhD ^1,^2,^3,⁴, Christelle Nguyen, MD, PhD ^1,^2,⁶
¹ AP-HP, Groupe Hospitalier AP-HP. Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France.
² Université de Paris, Faculté de Santé, UFR Médecine Paris Descartes, 75006 Paris
³ INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne Cité, ECaMO Team, 75004 Paris, France
⁴ Institut Fédératif de Recherche sur le Handicap, 75013 Paris, France
⁵ Laboratoire de l'Institut des Sciences du Sport-Santé de Paris, URP 3625, Université de Paris. Paris, France
⁶ INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Faculté des Sciences Fondamentales et Biomédicales, Université de Paris, Sorbonne Paris Cité, 75006 Paris, France
⁷ Laboratoire Inter-universitaire de biologie de la motricité (LIBM), EA 7424, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
⁸ Inserm/UPS UMR1297, Université Paul Sabatier, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Equipe MetaDiab, Toulouse, France

^⁎Corresponding author: Mrs. Alexandra Roren, Rehabilitation AP-HP: Assistance Publique - Hopitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, Ile de France, FranceRehabilitation AP-HP: Assistance Publique - Hopitaux de Paris27 rue du Faubourg Saint JacquesParisIle de France75014France

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Highlights

•	The physical treatment of low back pain includes a wide range of non-specific and specific physical activity.
•	The value of physical activity in acute or subacute low back pain has not been demonstrated.
•	General exercise, more specific interventions and multidisciplinary functional restoration programs reduce pain and improve physical function in patients with chronic low back pain.
•	The optimal delivery of physical activity in terms of modalities, quantity and intensity of the intervention, supervision, and setting is not well defined.

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Abstract

Background

: Non-specific low back pain (LBP) is the leading cause of years lived with disability worldwide. Physical activity is an integral part of LBP treatment.

Objective

: To critically review available evidence regarding the efficacy of physical activity for people with LBP.

Methods

: Up to date critical narrative review of the efficacy of physical activity for the managment LBP. The process of article selection was unsystematic; articles were selected based on authors’ expertise, self-knowledge and reflective practice.

Results

: Therapeutic physical activity for LBP includes a wide range of non-specific and specific activities. The efficacy of physical activity on pain and activity limitations has been widely assessed. In acute and subacute LBP, exercise did not reduce pain compared to no exercise. In chronic low back pain (CLBP), exercise reduced pain at the earliest follow-up compared with no exercise. In a recent systematic review, exercise improved function both at the end of treatment and in the long-term compared with usual care. Exercice also reduced work disability in the long-term. We were unable to establish a clear hierarchy between different exercise modalities. Multidisciplinary functional programs consistently improved pain and function in the short- and long-term compared with usual care and physiotherapy and improved the long-term likelihood of returning to work compared to non-multidisciplinary programs.