Complementary and Alternative Medicine for treating Low Back Pain with Teaching Exercise: A narrative review

Use of exercise for treating LBP

The summary of the details of exercises used for treating LBP are shown in Table 1.

Table 1

Effects of Flexion and Extension Exercise on LBP patients: Focusing on Pain and Disability

Summary of the effects of exercise treatment on LBP

This review summarizes the effects of exercise, including flexion and extension exercises, in patients with low back pain (Table 1, Table 2). In addition to McKenzie’s and Williams’ exercise therapy, all similar exercises are classified according to pain, disability, and muscle strength. The actual methods used for the McKenzie and Williams exercise therapies in each study are summarized in Table 3.

Table 2

Effects of Flexion and Extension Exercise on LBP patients: Focusing on Extensors and Flexors improvement

Table 3

McKenzie exercise and William’s flexion exercise actually used in each research paper

A summary of the studies on each exercise therapy showed that both the pain and disability levels decreased. It was more important to perform one of the exercises than to have the flexion and extension movements. Various exercises using both the flexors and extensors reduced pain and disability.

Some studies state that the McKenzie method is excellent (Ahn18), Qurat-ul-Ain et al30), Petersen et al33)), while others state that Williams’ flexion exercise is better (Jeganathan et al31)).

Pain and disability reduction by McKenzie’s and Williams’ exercise therapies could not be evaluated as superior to that by specific exercise therapy. However, Mackenzie’s exercise may be a better choice because both extensors and flexors improve muscle strength.

Moreover, the results of comparing pain and disability reduction between a ‘trained group on exercise therapy’ and a ‘control group’ showed greater pain and disability reduction with training.36)

The summary of McKenzie and Williams’ exercise therapy used in each paper was invalidated if there was no detail, and if the detailed description of the motion was in accordance with each exercise, a point was used to grade each movement. Mackenzie’s exercise therapy included lying prone, lying prone in extensions, sustained extensions, posture correction, extension mobility, extension in a standing position, slouch over correct/correcting, and flexion. Williams’ exercise therapy used pelvic tilt, single knee to chest, double knee to chest, partial sit-up, hamstring stretch, hip flexor stretch, and squat. Exercise methods used at least five times were lying prone, lying prone in extension, sustained extensions, extensions in a standing position, flexion in lying (FIL), flexion in sitting, and pelvic tilt in Williams’ exercise treatment (Table 3).

An effective method for treating diseases through a combination of exercise therapy and acupuncture has existed in Korean medicine as Dong-gi acupuncture (DGA), a kind of Dong-si acupuncture. The validity of using DGA for LBP by blood stasis and sprain has also been revealed. In particular, active DGA was more effective than passive DGA or common treatment.37) Another study compared simple acupuncture groups with acupuncture combined with DGA groups for treating cervical spondylosis. The difference in pain relief was not significant with acupuncture, but the time for pain relief was halved when compared with DGA (8.15±2.32 days) or simple acupuncture groups (13.25±4.62 days).38) There was also a study on DGA, which combined flexion and extension exercises for lower lumbar pain. This study combined acupuncture treatment and exercise therapy based on the movement system impairment syndrome (MSIS), and organized the acupuncture points that may affect exercise therapy.39)

LBP is a common condition that affects about 80% of the population at least once in their lifetimes, and Korean medicine treatment, which accounts for about 18% of the outpatient treatment in Korean medicine clinics, is the main treatment.1) Acupuncture is effective for treatment, and this has been demonstrated in guidelines for treatment in the United States and Europe.6,7) Acupuncture-related treatment was recommended as Grade A, and the level of evidence was also observed as Grade Fair. Additionally, acupuncture treatment for C-LBP was evaluated as ‘moderate level’ for the Magnitude of Effect, which is well recognized to signify the level of pain relief; NSAIDs are ‘Small to moderate level’ and Tramadol is ‘Moderate level’. The Non-Specific LBP guidelines are special in that they are also organized cases of better effects when combined with various non-invasive treatments.

By summarizing various studies, we have confirmed that the ‘lying prone, lying prone in extension, sustained extension, extension in standing, flexion in lying (FIL), and flexion in sitting’ of McKenzie’s exercise therapy, and the ‘pelvic tilt’ of Williams’ exercise reduces pain and disability (Table 1, Table 2, Table 3). It has already been confirmed that DGA, a Korean medicine treatment method, combines exercise therapy and acupuncture treatment.

Combining the information mentioned above, we can select an exercise motion within McKenzie’s and Williams’ exercises that is effective instead of utilizing other motions. Acupuncture and exercise therapy can simultaneously be performed at the acupuncture points where exercise is required. With further research, we can expect positive effects of combined acupuncture and exercise therapy rather than a common treatment and a reduction of treatment time for the same effect.