Lower back pain develops for lots of reasons, including genetics, lifestyle, ergonomics, sports injuries, snow shoveling, or just bad luck. Often, the underlying cause is unknown.

For most people, a first episode of back pain will go away within a week or so.

However, back pain can recur with frequency. About 75% of people who have had one debilitating episode of lower back pain will have another within a year.

Doctors and researchers have called these repeated bouts a “spiral of decline,” in which someone takes to his or her couch because of the pain; this inactivity weakens muscles and joints; the person’s now-weaker back and core become less able to sustain the same level of activity as before and succumb when he or she tries to return to normal life, leading to more pain and more inactivity; and the spiral accelerates.

Until now, few studies have systematically examined what really works against repeated back pain and what doesn’t.

So for the new review, which was published in JAMA Internal Medicine, researchers at the University of Sydney and other institutions gathered and analyzed as many relevant studies as possible.

The prevention techniques under review included education about lifestyle changes, shoe orthotics, black belts, various types of exercise programs and exercise programs that also included education about back-pain prevention.

Educational efforts by themselves showed essentially zero ability to prevent a recurrence of back pain. Black belts and orthotics were almost completely ineffective, leaving people who used either very prone to experiencing more back pain within a year.

However, exercise programs, either with or without additional educational element, proved to be strong preventatives, the researchers found.

Chris Maher, a professor at the George Institute said, “The size of the protective effect” from exercise “was quite large.” “Exercise combined with education reduced the risk of an episode of low back pain in the next year by 45%. In other words, it almost halved the risk.”

The type of exercise program didn’t matter. In some of the experiments Dr. Maher and his colleagues reviewed, the regimens focused solely on strengthening the core and back muscles. In others, the training was more general, combining aerobic conditioning with strength and balance training.

The end result was that if someone with a history of back pain exercised in a regular way, he or she was considerably less likely to have more back pain within a year.

However, the protective effects typically wore off after that, with recurrences rising after 12 months, probably because many of the people who’d been involved in the studies stopped exercising, Dr. Maher said, and their back problems returned.

For now, he says, “of all the options currently available to prevent back pain, exercise is really the only one with any evidence that it works.”

nytimeshealth.com

January 27, 2016