Back exercises One review found evidence that McKenzie treatment may be more effective than passive therapies (such as educational booklets, ice packs, and massage) and flexion exercises at improving pain and disability, but less effective than spinal manipulation or advice to stay active.Another review found no significant difference in short-term disability between McKenzie treatment and the NSAID ketoprofen (follow-up at less than 3 months). One RCT added found no significant difference between graded activity and usual care in pain severity and functional status at 12 months.One RCT added found that neuromuscular training plus CBT improved pain intensity for the 7 days before assessment, but not for the 2 months before assessment, compared with CBT alone. The RCT found no significant difference between treatments in functional status. Categorisation changed (from Unlikely to be beneficial to Unknown effectiveness). For specific exercises, there is a growing but still limited amount of evidence for short-term pain reduction and increased function. Given the methodological flaws associated with RCTs and systematic reviews of back exercises, and the lack of relevant detail of the primary studies, it is not possible to either support or oppose the use of exercise in patients with back pain.
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