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MSK Pain – Reduces work absence

Evidence Summary (Updated 2022)
A Cochrane review concluded that physical conditioning interventions have a small positive effect on reducing sick leave in those with chronic low back pain at 12 months follow up (23). There was no effect in those with acute low back pain. In those with non-specific low back pain, there is good evidence of a moderate reduction in work disability with exercise interventions versus usual care, with long-term work disability reduced by 34% (24). However, the authors were unable to determine which of the different exercise interventions were most effective, and there was no significant effect observed in the short or medium term.

Quality of Evidence
Grade B – moderate quality

Strength of recommendation
Grade 1 – strong recommendation.

Long-term work absence in those with chronic low back pain is not uncommon, and physical activity interventions, ideally with biopsychosocial components, are likely to benefit many.


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  3. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Vol. 2021, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2021.
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  7. Zhu F, Zhang M, Wang D, Hong Q, Zeng C, Chen W. Yoga compared to non-exercise or physical therapy exercise on pain, disability, and quality of life for patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS One [Internet]. 2020 Sep 1 [cited 2022 Jul 6];15(9). Available from:
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  9. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane database Syst Rev [Internet]. 2014 Sep 2 [cited 2022 Aug 18];2014(9). Available from:
  10. Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, et al. Back Schools for chronic non-specific low back pain. Cochrane database Syst Rev [Internet]. 2017 Aug 3 [cited 2022 Aug 18];8(8). Available from:
  11. Poquet N, Lin CWC, Heymans MW, van Tulder MW, Esmail R, Koes BW, et al. Back schools for acute and subacute non-specific low-back pain. Cochrane database Syst Rev [Internet]. 2016 Apr 26 [cited 2022 Aug 18];4(4). Available from:
  12. De Campos TF, Maher CG, Fuller JT, Steffens D, Attwell S, Hancock MJ. Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis. Br J Sports Med [Internet]. 2021 May 1 [cited 2022 Jul 7];55(9):468–76. Available from:
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  14. Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med [Internet]. 2017 Oct 1 [cited 2022 Aug 18];51(19):1410–8. Available from:
  15. Steffens D, Maher CG, Pereira LSM, Stevens ML, Oliveira VC, Chapple M, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med [Internet]. 2016 Feb 1 [cited 2022 Aug 18];176(2):199–208. Available from:
  16. Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. 2020 Nov 1 [cited 2022 Mar 7];54(21):1279–87. Available from:
  17. Lawford BJ, Walters J, Ferrar K. Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review. Clin Rehabil [Internet]. 2016 Jun 1 [cited 2022 Aug 18];30(6):523–36. Available from:
  18. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One [Internet]. 2012 Dec 17 [cited 2022 Aug 18];7(12). Available from:
  19. Kristensen J, Franklyn-Miller A. Resistance training in musculoskeletal rehabilitation: a systematic review. Br J Sports Med [Internet]. 2012 Aug [cited 2022 Aug 18];46(10):719–26. Available from:
  20. Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther [Internet]. 2009 Jan [cited 2022 Aug 18];89(1):9–25. Available from:
  21. Denham-Jones L, Gaskell L, Spence N, Pigott T. A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions. Musculoskeletal Care [Internet]. 2021 May 24 [cited 2022 Jan 5]; Available from:
  22. National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management. 2016 [cited 2022 Aug 18];(November):0–816. Available from:
  23. Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane database Syst Rev [Internet]. 2013 Aug 30 [cited 2022 Aug 18];2013(8). Available from:
  24. Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomised controlled trials. J Rehabil Med [Internet]. 2010 Mar [cited 2022 Aug 18];42(3):193–205. Available from: