Studies show over and over that staying active and exercising are the first steps to take in treating low back pain (LBP). But what kind of exercises work best? Are aerobic programs ideal? What about strength training? Perhaps a more specific approach such as the McKenzie exercises should be followed?

In this study, a group of physiotherapists compared results for patients treated by the McKenzie method with patients who followed a strength-training program. A second goal of the study was to look back at factors present before treatment and see if any of them were linked with a poor outcome.

Both groups of patients were seen by a physiotherapist (PT) for eight weeks. A maximum of 15 sessions was allowed. Everyone was instructed to continue his or her exercise program for two more months after discharge from PT.

Results were measured at the end of 14-months. The data collected included functional status, pain level, and work status. The number of health care visits for back pain during that time period was also recorded.

The authors report that the long-term results weren't any different between the groups. This seems to support the idea that any type of exercise will benefit patients with LBP. The key finding of this study was that pretreatment factors were more important than type of exercise.

Patients who smoked or who had a longer period of symptoms had poorer outcomes. Patients who were more likely to drop out of the program or to have poor results had higher levels of disability and pain.

Patients on sick leave at the start of the program were more likely to withdraw from the study or still be on sick leave at the end of the study. In addition, patients who had low expectations about work were more likely to have high levels of disability.

The authors conclude that some factors can predict results. But these factors should not exclude patients from treatment. Rather, therapists should provide these patients with specialized care.

Reducing pain and disability in order to return to work may take more than just exercise. Cognitive or behavioral therapy and vocational training may be needed as well.

Tom Petersen, PT, PhD, et al. One-Year Follow-up Comparison of the Effectiveness of McKenzie Treatment and Strengthening Training for Patients with Chronic Low Back Pain. In Spine. December 15, 2007. Vol. 32. No. 26. Pp. 2948-2956.