Evidence-Based Exercises for Chronic Low Back Pain

There are plenty of sources on the web the described exercises for low back pain, but how many of them are evidence-based? We review exercise regimens that have been studied in clinical trials and shown to be effective for people with subacute (4 to 12 weeks duration) and chronic (greater than 12 weeks duration) low back pain.

A systematic review of studies: The evidence

Hayden and co-authors reviewed 61 randomized trials that included nearly 6400 participants who had acute, subacute, and chronic nonspecific low back pain. Nonspecific low back pain is back pain without a precise cause or a precise cause cannot be found after medical workup. After exhaustive review and meta-analysis, the authors concluded there is strong evidence showing exercise therapy is effective at decreasing pain and improving function in adults with chronic low back pain.

What is exercise therapy?

The authors of the systematic review used a rather broad definition of exercise therapy. They defined exercise therapy as“a series of specific movements with the aim of training or developing the body by a routine practice or as physical training to promote good physical health.”About half of the clinical trials used an exercise therapy that was specifically tailored to each patient by a physical therapist based on clinical history and physical examination.1,2 The other half employed a standard exercise regimen for all patients in the exercise therapy arm of the trial. The authors found that supervise, individualized exercise therapy was most effective for treating chronic low back pain.2 Thus, a trip to a physical therapist is the best approach. Short of physical therapist visits, people who wish to use exercise therapy at home can perform a standard exercise regimen.

Which exercises are best for chronic low back pain?

Chronic low back pain exercises may include stretching, strengthening, aerobic, mobilizing, or coordination exercises. In terms of pain outcomes, stretching exercises are the best. In terms of physical functional outcome, however, strengthening exercises are the best. Therefore, the best approach to exercise for chronic low back pain is a combination of stretching and strengthening exercises.

One strengthening exercise for nonspecific chronic low back pain is core strengthening. The core muscles are abdominal, paraspinal, gluteal, diaphragmatic, pelvic floor, and hip girdle muscles. The goal of core muscle strengthening is to train muscles in an integrated manner to protect the spine from abnormal forces. An example of a core strengthening exercise is the abdominal crunch. To ease the strain on the back, perform crunches with your feet planted firmly on the wall and your knees and hips bent at 90° angles.

The McKenzie-based treatment approach is one of the most commonly used stretching exercises for low back pain . In these exercises, patients attempt to bend their spines backwards and forwards as much as possible. This stretches the back muscles and, when done under resistance, strengthens the muscles as well.


  1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005(3):CD000335. doi:10.1002/14651858.CD000335.pub2
  2. Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-785.
  3. O’Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). Dec 15 1997;22(24):2959-2967.
  4. Dunsford A, Kumar S, Clarke S. Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain. Journal of Multidisciplinary Healthcare. 2011;4:393-402. doi:10.2147/jmdh.s24733

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