Low Back Pain exercises should match patient’s Directional Preference

According to a recently conducted study, Low Back Pain (LBP) patients should be trained in exercise that matches their directional preference (DP). Directional preference is defined (for patients with LBP) as exercise in a specific plane that decreases lumbar pain or the radiation of pain.

In the study, 312 patients of acute, subacute or chronic LBP with or without sciatica underwent a standardized mechanical assessment classifying them by their pain response, specifically eliciting either a “DP” (i.e., an immediate, lasting improvement in pain from performing either repeated lumbar flexion, extension, or side glide/rotation tests) , or no DP. Further the DP groups are further divided in three groups to:

1) Directional exercises matching their preferred direction (DP)
2) Exercises directionally opposite to their DP
3) Nondirectional exercises.

The outcome is measured in the terms of pain intensity, location, disability, medication use, degree of recovery, depression, and work interference.

The results indicated that the first DP group (exercises matched with directional preference) had greater improvements in every outcome, including a threefold decrease in medication use. Exercises matching subjects’ DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. On the other hand one third of both the opposite and non-directionally treated patients withdrew within 2 weeks because of no improvement or worsening of symptoms.

This study concluded that using DP to guide back exercises vs. general exercises can improve multiple outcomes of pain, function and treatment satisfaction in patients with LBP. The study authors hypothesized that the identification of DP has good interrater reliability and a short term exercise programme focusing on DP could outperform standard exercise programs for LBP with respect to pain control, disability scores and treatment satisfaction.