Isolated Exercise Interventions for Acute Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Therapeutic exercise (TE) is recommended as the first line of treatment for low back pain (LBP), but questions remain about the true efficacy of TE in the acute phase. This study aimed to evaluate the effectiveness of isolated TE in reducing pain intensity and disability in patients with acute or subacute LBP. Methods: A systematic review with meta-analysis was conducted following the PRISMA guidelines. Randomized controlled trials (RCTs) that analyzed therapeutic exercise alone in one of the intervention groups and assessed pain intensity and disability were included; both outcomes were considered primary in this review. The quality of evidence was assessed using the GRADE tool. Results: Five RCTs were included. Meta-analyses were performed in subgroups according to the comparators: usual care, education, manual therapy, and bed rest. Statistically significant differences in favor of TE were found only when compared to usual care (SMD = −0.23; 95% CI [−0.45, −0.01]; p = 0.04). Conclusions: TE, when prescribed as an isolated intervention, appears to be more effective than usual care in improving short-term disability outcomes in patients with acute LBP. However, the limited quality and number of available studies, together with the typically favorable natural course of acute LBP, suggest that these findings should be interpreted with caution. Current evidence supports the integration of exercise within a comprehensive, multimodal management plan that addresses the physical, psychological, and social dimensions of pain.