Exercise is medicine, but perhaps not for preventing low back pain: a randomized trial of exercise and education to prevent low back pain recurrence

Review written by Dr Sandy Hilton info

Key Points

  1. Exercise and education, compared to an educational booklet, did not result in greater reductions in recurrent low back pain (LBP).
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The global burden of low back pain (LBP) remains high despite decades of research and a plethora of techniques and specialized training specifically to address back pain. Since two-thirds of people who experience an episode of LBP are likely to have a recurrence within a year, there is significant benefit to preventing further episodes (1).

The authors designed this study to address the limitations of previous trials that showed reduced risk of LBP with exercise (2). They devised a randomized “Trial of Prevention Strategies” (TOPS) to assess the relative effectiveness of exercise and education for prevention of recurrent LBP.

Two-thirds of people who experience an episode of low back pain are likely to have a recurrence within a year.
Participants in the exercise and education group had a higher expectation of a positive outcome.


TOPS is a superiority, pragmatic, parallel-group randomized controlled trial. Participants had recovered from an episode of LBP within the previous week, had pain 20/100 or less (on VAS), and met the inclusion/exclusion criteria. Proper blinding was used for allocation and

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