Prescription of therapeutic exercise for chronic low back pain management: a narrative review

Abstract Background The results of recent systematic reviews have concluded that most exercise types are more effective than minimal treatment for improving outcomes in the management of non-specific chronic low back pain. However, exercise prescriptions are criticised for being prescribed without a clear rationale and with a high level of uncertainty. The preferred mode of exercise in this population is not outlined in clinical guidelines. The objective of this review is to describe the indications and dosimetry for the most common exercise interventions prescribed. Methods Literature was sourced from searches of MEDLINE, CINAHL, SPORTDiscus, and PEDro databases until October 2021 using descriptors related to pain, exercise, and prescription, totaling 33 articles that fulfilled the inclusion and exclusion criteria. The first author independently selected studies and extracted data on study characteristics of interest. Any doubts were resolved through discussion with the other reviewers. Results The results of the review showed that a baseline assessment comprising the patient’s pain, thoughts, beliefs, and behaviours concerning physical activity or exercises may be undertaken, and specific exercises may be prescribed based on the indication to reduce pain, allay fear, or re-educate neuromotor control. Conclusion Based on the heterogeneity in the understanding, administration, and progression of exercises and the sub-optimal or poor reporting of exercise prescriptions or dosages and outcomes reported, we conclude that it may not be possible to synthesise any evidence to inform precision exercise prescription for CLBP. Future studies should be of higher quality for the development of effective exercise programmes.