Low Back Pain and Sciatica and Exercise

The human body was designed to use its physical capacities yet many of us have become sedentary. Not only does this have major effects on our weight and body mass index, but our muscles themselves, when unused, become weak and unable to function well. So, while decreasing strenuous exercise does have some benefits, such as reducing injuries, this decrease also presents major drawbacks.

Increasing strength and flexibility through exercise can be an extremely effective treatment for low back pain and sciatica.

The theory behind exercise for back pain and sciatica treatment is that the more flexible are the muscles in the back, the less pain the back will have. Also, when muscles that support back muscles are strong, the actual muscles in the back will not have to work as hard, and thus be less susceptible to pain. Though exercise hasn't been extensively studied individually for it's effectiveness as a treatment for low back pain and sciatica, it has been studied in conjunction with other therapies such as chiropractic care, massage, and prolotherapy.

Read more details about Exercise.

In one well-designed study, 2 months of chiropractic spinal manipulation and exercise therapy were studied, with chiropractic spinal manipulation proving to be marginally more effective than massage therapy.⁴¹

One study found that exercise (along with education) appears to enhance the effectiveness of massage when used as a treatment for low back pain and sciatica. In a review of 13 randomized trials, researchers concluded that massage may be effective for nonspecific low back pain, and the beneficial effects can last for up to 1 year in patients suffering from chronic pain.⁷⁷

A subsequent controlled trial involving 579 patients with chronic or recurrent low back pain found that Alexander technique lessons, particularly when combined with exercise, was more effective than normal care or massage after one year.⁷⁸

Both spinal manipulation and exercise have shown to help prolotherapy be more effective than control treatments.⁸¹

It is important to pick a type of exercise and durations that are compatible with your physical health. If you have a serious health condition, consult with your physician before starting an exercise program.

A health condition or injury may prevent you from engaging in certain types of exercise such as jogging or bike riding but walking. Gentler forms of movement such as stretching or yoga may still be safe and beneficial options.

1. Clinical Practice Guideline Number 14: Acute Low Back Problems in Adults. Rockville, Md: Agency for Health Care Policy and Research, US Dept of Health and Human Services; 1994. AHCPR publication 95-0642.

2. American Academy of Orthopaedic Surgeons website. Available at: http://www.orthoinfo.aaos.org. Accessed November 20, 2000.

3. Carey TS, Garrett J, Jackman A, et al. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med. 1995;333:913-917.

4. Kendrick D, Fielding K, Bentley E, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001;322:400-405.

5. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9-14.

9. Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag. 1999;12:26-28.

10. Liu YK, Tipton CM, Matthes RD, et al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95-102.

11. Reeves KD. Prolotherapy: present and future applications in soft tissue pain and disability. Phys Med Rehab Clin North Am. 1995;6:917-926.

12. Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-146.

13. Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.

14. Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers—a randomized controlled clinical trial in a 2×2 factorial design [in German; English abstract]. Forsch Komplementarmed Klass Naturheilkd. 2000;7:286-293.

15. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.

16. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Med. 1974;31:59-64.

17. Triano JJ, McGregor M, Hondras MA, et al. Manipulative therapy versus education programs in chronic low back pain. Spine. 1995;20:948-955.

18. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.

19. Leibing E, Leonhardt U, Koster G, et al. Acupuncture treatment of chronic low-back pain—a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain. 2002;96:189-196.

20. Newswanger DL, Patel AT, Ogle A. Osteopathic medicine in the treatment of low back pain. Am Fam Physician. 2000;62:2414-2415.

21. Nielson WR, Weir R. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain. 2001;17:S114-127.

22. Hoehler FK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. JAMA. 1981;245:1835-1838.

23. Pope MH, Phillips RB, Haugh LD, et al. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine. 1994;19:2571-2577.

24. Hadler NM, Curtis P, Gillings DB, et al. A benefit of spinal manipulation as adjunctive therapy for acute low back pain: a stratified controlled trial. Spine. 1987;12:702-706.

25. Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021-1029.

26. Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low back pain. Ann Intern Med. 1992;117:590-598.

27. Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor and vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10-18.

28. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.

29. Mendelson G, Selwood TS, Kranz H, et al. Acupuncture treatment of chronic back pain. A double-blind placebo controlled trial. Am J Med. 1983;747:49-55.

30. Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Can Anaesth Soc J. 1976;23:303-306.

31. Baxter GD, Kerr DP, Walsh DM. Acupuncture in the management of chronic low back pain: a blinded randomised controlled trial [abstract]. FACT. 2001;6:70-71.

32. Duplan B, Cabanel G, Piton JL, et al. Acupuncture st lombosciatique a la phase aigue. Semin Hop Paris. 1983;59:310-3114. Cited by: Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.

33. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain. 1999;82:9-13.

34. Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbagia and ischialgia. Am J Chin Med. 1976;4:169-175.

35. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther. 1999;22:376-381.

36. Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.

37. Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79:331-335.

38. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anaesthesiol. 1999;16:118-129.

39. Chrubasik S, Zimpfer CH, Schutt U, et al. Effectiveness of Harpagophytum procumbens in treatment of acute low back pain. Phytomedicine. 1996;3:1-10.

40. Andersson GB, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426-1431.

41. Aure OF, Hoel Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525-531.

42. Schiller L. Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial. J Manipulative Physiol Ther. 2001;24:394-401.

43. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ. 1991;303:1298-1303.

44. Klein G, Kullich W. Reducing pain by oral enzyme therapy in rheumatic diseases [translated from German]. Wien Med Wochenschr. 1999;149:577-580.

45. Jayson MIV, Sims-Williams H, Young S, et al. Mobilization and manipulation for low-back pain. Spine. 1981;6:409-416.

46. Farrell JP, Twomey LT. Acute low back pain. Comparison of two conservative treatment approaches. Med J Aust. 1982;1:160-164.

47. Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-1259.

48. Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004;29:9-16.

49. Assendelft WJJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Int Med. 2003;138:871-881.

50. Ferreira ML, Ferreira PH, et al. Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. J Manipulative Physiol Ther. 2003;26:593-601.

51. Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004;27:388-398.

52. Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Int Med. 2003;138:898-906.

53. Kerr DP, Walsh DM, Baxter D. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Clin J Pain. 2003;19:364-370.

54. Frerick H, Keitel W, Kuhn U. Topical treatment of chronic low back pain with a capsicum plaster. Pain. 2003;106:59-64.

55. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-1362.

56. Ernst E, Canter PH. The Alexander Technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd. 2003;10:325-329.

57. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131-137

58. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006;166:450-457.

59. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]

60. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]

61. Kucera M, Barna M, Horacek O, et al. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study. Adv Ther. 2005;22:681-692.

62. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107-117.

63. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. A randomized, controlled trial. Ann Intern Med. 2005;143:849-856.

64. Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;CD000335.

65. van Tulder MW, Koes B, Malmivaara A, et al. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2005 Dec 1. [Epub ahead of print]

66. Pittler MH, Karagulle MZ, Karagulle M, et al. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford). 2006;45:880-884.

67. Balogh Z, Ordogh J, Gasz A, et al. Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd. 2005;12:196-201.

68. Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007;32:151-158.

69. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain. 2007 May 31. [Epub ahead of print]

70. Khoromi S, Blackman MR, Kingman A, et al. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. J Pain Symptom Manage. 2007 Jul 6. [Epub ahead of print]

71. Collacot EA, Zimmerman JT, White DW, et al. Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study. JAMA. 2000;283:1322-1325.

72. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892-1898.

73. Yousefi-Nooraie R, Schonstein E, Heidari K, et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database of Systematic Reviews. 2008;(2):CD005107.

74. Wilkey A, Gregory M, Byfield D, et al. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Altern Complement Med. 2008;14:465-473.

75. Tekur P, Singphow C, Nagendra HR, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14:637-644.

76. Juni P, Battaglia M, Nuesch E, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2008 Sep 5.

77. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.

78. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ. 2008;337:a884.

79. Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.

80. Cherkin DC, Sherman KJ, AVins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858-866.

81. Dagenais S, Yelland M, Del Mar C, Schoene M. Prolotherapy injections for chronic low back pain. Cochrane Database of Systematic Reviews. 2007;2.

82. Dagenais S, Mayer J, Haldeman S, Borg-Stein J. Evidence-informed management of chronic low back pain with prolotherapy. Spine J 2008 Jan-Feb;8(1):203-12.