Chronic low back pain: A critical review of specific therapeutic exercise protocols on musculoskeletal and neuromuscular parameters

Although exercise is often used in the treatment of chronic non-specific low back pain, little is known about the efficacy of specific exercises on the physiological or structural processes underlying this form of back pain. We evaluated the current published studies that used specific exercise interventions for non-specific low back pain and that utilized strength, endurance, neuromuscular control, flexibility, or posture as primary outcome variables. Our review revealed that 11 different control trials fit our criteria (15 published papers), with the majority evaluating strengthening protocols (N=13). Moderate evidence indicates that specific exercises improve abdominal and trunk extensor strength and endurance, while minimal evidence supports improvements in neuromuscular control characteristics, posture, spinal motion, or muscle tissue characteristics. Most studies reported improvements in both functional daily activities as well as an accompanying reduction in low back pain. We concluded that more thorough investigations utilizing better diagnostic classifications are needed to determine whether specific exercise protocols produce the desired effects on neuromuscular control impairments as well as on the mechanical environments that have been shown to contribute detrimentally to low back pain.