By David Borenstein, MD
Executive Editor,

About 80 percent of the world’s population has an episode of low back pain sometime during their lives. Wouldn’t it be great if we had a way to prevent some of those episodes? You’d think that we’d already figured this problem out since we’ve been at risk for millions of years, but we’re still searching for the interventions that work.

An article published in JAMA Internal Medicine reported on a current review of the medical literature grading evidence for the benefits of interventions on the prevention of acute low back pain episodes over the short (weeks to months) and long (12 months or longer) term. The authors reviewed 6133 studies, but only 23 were of high enough quality to be included in the review.

The kinds of interventions studied included exercise, education, exercise and education, back belts, shoe inserts, and other presentation strategies. The subjects were mostly working-age populations. Some trials only looked at outcomes in weeks, while others looked at prevention at 12 months.

What worked? The best outcome for prevention, decreasing risk by 20 to 45 percent, was the combination of exercise and education. The effect was greatest in the short-term. At 12 months, the strength of the benefit was less, but present. Exercise alone, education alone, back belts, shoe inserts, or ergonomic modification strategies were not effective.

One of the shortcomings of low back pain research is the fact that there is no one standard of exercise or education for patients with this medical problem. The studies that showed benefits had different forms of back exercise—from stretching to core strengthening to aerobic fitness. The educational component usually included a review of back anatomy, but no consistency with biomechanics or basic ergonomic principles.

An accompanying editorial by Carey and Freburger emphasize the importance of education and exercise as a means to decrease the incidence of this common medical problem. They report that most individuals who have an episode of low back pain are not prescribed these interventions by physicians. Many institutions are more interested in paying medical premiums than supporting exercise and knowledge for employees.

The take-home message: There’s never a bad time to start an exercise program to prevent back pain. Education, like the content included here on, can make you aware of those factors that put you at risk. In addition, be sure to inquire if your workplace has facilities or benefits to exercise regularly; if so, you should take full advantage.

Steffens D, Maher CG, Pereira LS et al: Prevention of low back pain: A systematic review and meta-analysis JAMA Intern Med 2016;176:199-208

Carey TS, Freburger JK: Exercise and the prevention of low back pain: Ready for implementation. JAMA Internal Medicine 2016;176:208-209


Understanding Back Pain