Exercise as a Therapeutic Strategy for Managing Low Back Pain: A Systematic Review

Authors

  • Kasim Nurhas Jaiddin
  • Maria Justine
  • Zarina Zahari

Keywords:

Low Back Pain, Exercise, Therapeutic, pain

Abstract

The study aimed to analyze research on exercise as a therapeutic strategy for treating low back pain (LBP), with a focus on its effectiveness and exercise modalities. PRISMA guidelines were used in this systematic review. The retrieved articles were published from 2020 to 2024 and focused on the management of LBP with exercise. The literature search was conducted on 5 main bases. Boolean operators and specific keywords were used. The Cochrane Collaboration and the Physiotherapy Evidence Database (PEDro) scale were used to assess the risk of bias. This systematic review synthesized all the studies identified. Exercise is an effective core therapeutic strategy for managing LBP. An educational program; Back School Program significantly increased physical activity and reduced pain intensity compared to standard therapy. Non-pharmacological approaches, including Transcutaneous Electrical Nerve Stimulation aimed at evaluating exercise modalities and gym ball therapy, have shown significant results in pain management in various populations, including pregnant women and athletes.

In conclusion, the integration of physical activity with therapeutic modalities (massage and cognitive behavioral therapy) is essential for a holistic approach to pain management. Therefore, exercise should be considered the primary approach of managing LBP, although adjunctive treatment can contribute to patient recovery. Hence, strengthening an exercise regimen should be an integral part of clinical interventions for LBP.

References

1. Altug Z. Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach. Am J Lifestyle Med. 2021; 15(4): 425–33.

2. Essman M, Lin CY. The Role of Exercise in Treating Low Back Pain. Curr Sports Med Rep. 2022; 21(8): 267–71.

3. Anheyer D, Klose P, Koch AK, Haller H, Dobos G, Cramer H. Comparative efficacy of different exercise interventions in chronic nonspecific low back pain: protocol of a systematic review and network meta-analysis. BMJ Open. 2020; 10(8): 1–7.

4. Hirota R, Teramoto A, Murakami T, Yoshimoto M, Iesato N, Yamashita T. Effects and limitations of home-based motor-control exercise for chronic low back pain: A single-centre prospective study. PLoS One. 2023; 18(4): 1–10.

5. Baharuddin MY, Kudri MH, Aminudin SNA. Effect of Core Stabilization Exercise for Nonspecific Low Back Pain among Athletes. Int J Clin Invent Med Sci. 2021; 3(1): 18–25.

6. Wahyuni W, Kurnia NE. The effectiveness of core stability exercises on pain in patients with low back pain: a meta-analysis. Phys Ther J Indonesia. 2023; 4(1): 85–90.

7. de Jesus FLA, Fukuda TY, Souza C, Guimarães J, Aquino L, Carvalho G et al. Addition of specific hip strengthening exercises to conventional rehabilitation therapy for low back pain: a systematic review and meta-analysis. Clin Rehabil. 2020; 34(11): 1368–77.

8. Zhu F, Zhang M, Wang D, Hong Q, Zeng C, Chen W. Yoga compared to non-exercise or physical therapy exercise on pain, disability, and quality of life for patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2020; 15(9): 1–21.

9. Wahyuni W, Kurnia NE. The Effectiveness of Core Stability Exercises on Pain in Patients with Low Back Pain: A Meta-Analysis. Phys Ther J Indonesia. 2023; 4(1): 85–90.

10. Nwodo OD, Ibikunle PO, Ogbonna NL, Ani KU, Okonkwo AC, Eze CJ et al. Review of Core Stability Exercise Versus Conventional Exercise in the Management of Chronic Low Back Pain. Afr Health Sci. 2022; 22(4): 148–67.

11. Navas?Otero A, Calvache?Mateo A, Martín?Núñez J, Valenza-Peña G, Hernández SH, Ortíz?Rubio A et al. The Effectiveness of Combined Exercise and Self-Determination Theory Programmes on Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Healthcare. 2024; 12(3): 382.

12. Hock M, Járomi M, Prémusz V, Szekeres ZJ, Ács P, Szilágyi B et al. Disease-Specific Knowledge, Physical Activity, and Physical Functioning Examination among Patients with Chronic Nonspecific Low Back Pain. Int J Environ Res Public Health. 2022; 19(19): 1–9.

13. Honcharov A, Ruban L, Litovchenko A, Okun D, Turchinov A. Physical therapy for old-timer athletes with chronic back pain. Physiotherapy Quarterly. 2020; 28(2): 20–4.

14. Bloxham SR, Layden J, Jane B, Peers C, Scragg S. The longitudinal effects of a physical activity programme on the physical fitness and disability of back pain patients: Service evaluation. J Back Musculoskelet Rehabil. 2020; 33(1): 7–13.

15. Purim-Shem-Tov Y, Daniel JP, Dyer K, Lavin M, Chien N, Shah S. Comparison of Routine Care Versus Transcutaneous Electrical Nerve Stimulation (TENS) for Treatment of Back Pain in the ED. Arch Emerg Med Intens Care. 2021; 4(1): 1–8.

16. Maidawilis MSD, Welis W, Alimuddin A, Chaeroni A. The Effect of Endhorpin Massage and Physical Activity on Reducing Back Pain Intensity of Pregnant Women. Int J Human Movement Sports Sci. 2022; 10(4): 633–7.

17. Kataoka H, Hirase T, Goto K, Nomoto Y, Kondo Y, Nakagawa K et al. Effects of a Rehabilitation Program Combined with Pain Management That Targets Pain Perception and Activity Avoidance in Older Patients with Acute Vertebral Compression Fracture: a Randomised Controlled Trial. Pain Res Manag. 2023; 2023(2): 1–11.

18. Kannabiran B, Sithara JA, Mugaviya N. A Comparative Study on the Effectiveness of Spine Stabilization Exercises Devoid of Swiss Ball and Dynamic Spine Stabilization Exercises with Swiss Ball in Patient with Low Back Pain (LBP). Acta Sci Neurol. 2022; 5(7): 30–9.

19. Hamadou A, Kouassi JP, Minye EE, Mbouh S, Bidzoni P, Gbenou JD et al. Cumulative effects of Swedish massage and physical exercise on anthropometric parameters and pain intensity in women suffering from low back pain in Yaounde (Cameroon). Int J Phys Educ Sports Health. 2023; 10(6): 175–81.

20. Cahyani IA, Winarsih S, Arfiana A. The Effect of Endorphin Massage towards Decreasing Low Back Pain in Third Trimester Pregnant Women. Midwif Nurs Res. 2020; 2(1): 41–5.

21. Hasnia H, Dinengsih S. The Differences in Effect Between Back Massage Therapy and Gym Ball on Back Pain in Pregnant Women Third Trimester. Jurnal Midpro. 2024; 15(2): 289–97.

22. Adenis N, Gosselin K, Stetsenko N, Thevenon A. Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review. J Back Musculoskelet Rehabil. 2023; 36(5): 995–1010.

23. Biçer B, Si?li T, Fakio?lu M, Cilli K, Gökdemir CE. Nonspecific chronic low back pain: which exercise? Ankara Üniversitesi Beden E?itimi ve Spor Yüksekokulu Spormetre Beden E?itimi ve Spor Bilimleri Dergisi. 2022; 20(3): 193–209.

24. Zimmer C, McDonough MH, Hewson J, Toohey A, Din C, Crocker PRE et al. Experiences with Social Participation in Group Physical Activity Programs for Older Adults. J Sport Exerc Psychol. 2021; 43(4): 335–44.

25. Bong May Ing J, Singh DKA, Tan MP, Adam Bujang M, Tiong IK, Whitney J et al. Group?based exercise interventions for community?dwelling older people in Southeast Asia: A systematic review. Australas J Ageing. 2023; 42(4): 624–37.

26. Otones P, García E, Sanz T, Pedraz A. A physical activity program versus usual care in the management of quality of life for pre-frail older adults with chronic pain: randomized controlled trial. BMC Geriatr. 2020; 20(1): 1–9.

27. Lai DWL, Ou X, Jin J. A Quasi-Experimental Study on the Effect of an Outdoor Physical Activity Program on the Well-Being of Older Chinese People in Hong Kong. Int J Environ Res Public Health. 2022; 19(15): 1–8.

28. Arkkukangas M, Strömqvist Bååthe K, Ekholm A, Tonkonogi M. Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study. Int J Environ Res Public Health. 2022; 19(22): 1–10.

29. Ikeda T, Suzuki T, Takagi M, Murakami M. Effect of Early Rehabilitation Treatment on Activities of Daily Living in Patients Receiving Conservative Treatment for Vertebral Compression Fracture. Prog Rehabil Med. 2021; 6(12): 1–15.

30. Scaturro D, Tomasello S, Mauro GL. Back pain, postural balance and quality of life in vertebral fragility fractures: a prospective cohort study. Int J Bone Fragility. 2023; 3(3): 83–8.

31. Tombers N, Grob M, Ollenburg K, Appicelli M, Cabelka CA. Effects of Exercise on Lumbopelvic Pain During Pregnancy: A Systematic Review and Meta-analysis. J Womens Health Phys Therap. 2023; 47(1): 36–45.

32. Astuti Y, Nurmaguphita D, Wijayanti E, Apriliani N. Self-Empowerment of Pregnant Women to Maintain Wellness During Pregnancy. Proceed Int Conf Community Service. 2023; 1(1): 294–8.

33. Salari N, Mohammadi A, Hemmati M, Hasheminezhad R, Kani S, Shohaimi S et al. The global prevalence of low back pain in pregnancy: a comprehensive systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023; 23(1): 1–13.

34. Lim CG. Comparison of the effects of joint mobilization, gym ball exercises, and breathing exercises on breathing pattern disorders and joint position sense in persons with chronic low back pain. Phys Ther Rehabil Sci. 2020; 9(1): 25–35.

35. Marani IN, Subarkah A, Octrialin V. The Effectiveness of Core Stability Exercises on Increasing Core Muscle Strength for Junior Swimming Athletes. Int J Human Mov Sports Sci. 2020; 8(6A): 22–8.

36. Miri H, Safari A, Dostdar Rozbahani A, Habibi M. The Effect of a Course of Swiss Ball Training and Ear Acupuncture on Pain and Endurance of Trunk Muscles in People with Low Back Pain. J Arch Military Med. 2022; 10(4): 1–7.

37. Lee SM, Lim HS, Byun HJ, Kim MJ. Changes of abdominal muscle activity according to trunk stabilization exercises using a Swiss ball. Phys Ther Rehabil Sci. 2020; 9(1): 18–24.

38. Hong SJ, Park J, Park S, Eze B, Dorsey SG, Starkweather A et al. Software?based interventions for low back pain management: A systematic review and meta?analysis. J Nurs Scholarship. 2024; 56(2): 206–26.

39. Puschmann AK, Lin CI, Wippert PM. Sustainability of a Motor Control Exercise Intervention: Analysis of Long-Term Effects in a Low Back Pain Study. Front Sports Act Living. 2021; 3(7): 1–8.

40. Wulansari D, Marzuqi I, Nur Arniati L, Surya Saputra B. Effect of transcutaneous electrical nerve stimulation (TENS) on the patients with chronic low back pain: systematic review. J Adv Res Med Health Sci. 2024; 10(3): 41–8.

41. Elshinnawy AM, Eraky ZS, Abdelaziz SS, Abd?Elrahman NAF. Effect of cold application versus transcutaneous nerve stimulation on chemotherapy induced diabetic peripheral neuropathy post mastectomy. Physiother Res Int. 2024; 29(1): 1–11.

42. Muhammet Tugay, Ayhan Kul. Efficacy of Interferential Current Therapy in Patients Diagnosed with Subacromial Impingement Syndrome. Eurasian J Med. 2023; 55(3): 192–8.

43. Jannah M, Rahmawati A. The Effect of Breathing Relaxation Techniques and Body Exercises on The Decrease of Pregnant Women's Discomforts in The Third Trimester. J Issues Midwif. 2023; 7(1): 31–9.

44. Pawestri P, Yunitasari E, Khayati N, Pranata S. Effectiveness of progressive muscle relaxation compared to BL 23 and GV 3 point acupressure therapy in reducing back pain intensity in third-trimester pregnant women. Scr Med (Brno). 2024; 55(2): 173–9.

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Published

30-04-2026

How to Cite

1.
Kasim Nurhas Jaiddin, Maria Justine, Zarina Zahari. Exercise as a Therapeutic Strategy for Managing Low Back Pain: A Systematic Review. J Liaq Uni Med Health Sci [Internet]. 2026 Apr. 30 [cited 2026 May 1];25(02):78-85. Available from: http://ojs.lumhs.edu.pk/index.php/jlumhs/article/view/1641

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