Richard’s Research Review

This month’s research review: Which exercise is best for chronic low back pain?

Low back pain is the most common musculoskeletal condition we see, and there is plenty of conflicting advice about which exercise helps most. This month we look at a large 2022 network meta-analysis in the Journal of Orthopaedic & Sports Physical Therapy. It pooled data from 118 studies to compare Pilates, strength, core-based, mind-body and other exercise approaches for adults with back pain lasting more than 12 weeks. Here’s what we took from it:

• All exercise types helped. Every form of exercise studied improved pain, disability, or both, compared with no exercise.
• Pilates ranked first for reducing both pain and disability.
• The runners-up differed by outcome. Mind-body and core-based exercise followed for pain, and strength and combined programmes followed for disability.
• You don’t need huge time commitments. The most effective programmes involved 1–2 sessions per week, under 60 minutes each, over 3–9 weeks.
• It’s a large evidence base. The review covered over 9,000 participants, though many included studies carried a moderate-to-high risk of bias. That is common in exercise research, where blinding isn’t possible.
• The best exercise is the one that gets done. The differences between exercise types were often modest, so consistency and enjoyment may matter more than picking the “top” option.
• Individual needs still matter. Pilates won’t suit everyone, but for many it works well as a bridge back to strength training, running or the activity you love.
• Our approach: we match the exercise to your assessment and goals. That might mean our Pilates-trained physios, strength work with our sports therapists, or a return-to-sport plan.