Contemporary Biopsychosocial Exercise Prescription for Chronic Low Back Pain

By |February 16, 2018|Exercise and Chiropractic|

Contemporary Biopsychosocial Exercise Prescription for Chronic Low Back Pain:
Questioning Core Stability Programs and Considering Context

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2017 (Mar); 61 (1): 6–17


Peter Stilwell, B Kin, DC, MSc and Katherine Harman, PT, PhD

Dalhousie University,
5869 University Ave.
PO Box 15000
Halifax, NS B3H 4R2


This commentary explores the importance of considering the biopsychosocial model and contextual factors when prescribing exercise. Diverse exercise programs for patients with chronic low back pain (CLBP) produce similar outcomes, without one specific exercise protocol demonstrating clear superiority. One clear barrier to positive outcomes is poor exercise adherence. We suggest that there are certain common contextual factors present in all exercise prescription scenarios that may impact adherence and health-related outcomes. While challenging common core stability exercise prescription, we present an argument for enhancing and intentionally shaping the following contextual factors: the therapeutic alliance, patient education, expectations and attributions of therapeutic success or failure, and mastery or cognitive control over a problem. Overall, this commentary argues that to improve exercise adherence and outcomes in the CLBP population, the context in which exercise is delivered and the meaning patients embody need to be considered and shaped by clinicians.

KEYWORDS:   chiropractic; chronic; exercise; low back pain; prescription


From the FULL TEXT Article:

Burden of low back pain

Low back pain (LBP) is the leading cause of disability worldwide. [1] Many individuals with a LBP episode will not be pain-free within a year, despite seeking care from a general practitioner or chiropractor. [2] Although many individuals with acute LBP (pain for less than three weeks) see improvements over time; up to 73% will have a recurrence within 12 months. [3]

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