HANDI

HANDI Interventions

Exercise for acute lower back pain

Musculoskeletal
        1. Exercise for acute lower back pain


Intervention

Advising patients with acute low-back pain to stay active, rather than to rest in bed.

Indication

Psychosocial factors play a role in acute pain becoming chronic.

Low back pain present for less than six weeks, in patients who do not have neurological deficits.

To improve pain intensity and functional status.

Contraindications

Specific diagnoses should be considered for patients with clinical features of infection, malignancy and a history of trauma, or when pain worsens or persists without improvement.

There was only a benefit in patients with acute low-back pain not associated with objective neurological deficits.

Precautions

Patients should avoid heavy lifting, bending or twisting until the pain improves.

Adverse effects

There is no evidence that staying active is harmful.

Description

Staying active means continuing with normal daily activities as much as possible, including going to work. It also means avoiding sitting still for long periods of time.

Staying active does not mean participating in any specific exercises.

Tips and challenges

There is often confusion about what ‘staying active’ means. It means different things to different patients. For an office worker it might mean avoiding sitting for long periods and using a sit-stand desk, while for an athlete it might mean light training.

Staying active does not mean undertaking any particular activity and it does not mean resting.

Patients often fear that pain is a sign of deterioration and further damage. They may need reassurance that pain is likely to subside and that ongoing pain is unlikely to cause further damage.

Grading

NHMRC Level 1 Evidence.

Other resources

Further information about acute low- back pain management is available from the Australian Acute

Musculoskeletal Pain Guidelines Group’s Evidence-based Management of Acute Musculoskeletal Pain.

The Australian Prescriber has published a care pathway for low back pain with first and second line management strategies.

  1. Dahm K, Brurberg K, Jamtvedt G, Hagen K. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews. 2010;(6):CD007612. DOI: 10.1002/14651858.CD007612.pub2.