Can low back pain be prevented in a population that has had a previous episode? In 2016, a systematic review by Steffens et al. found exercise, when combined with education, effective in reducing the risk of a future episode of low back pain with a relative risk of 0.55 (95% CI 0.41-0.73). Other interventions were ineffective or lacked evidence. Importantly, they included individuals who did not have low back pain at the time of inclusion in the study. But as was mentioned previously, the recurrent character of the condition makes it important to study how the transition from acute low back pain to chronic conditions can be prevented.
In a recent systematic review and meta-analysis by de Campos et al. (2020) it was investigated whether preventive strategies exist to reduce the future impact of low back pain. They concluded by moderate quality evidence that exercise was able to prevent future low back pain intensity (MD −4.50; 95% CI −7.26 to −1.74) in the short term. When exercise was combined with education, interestingly no preventive effects were found in the short term and long term for low back pain intensity and neither for disability in the short term. However, moderate quality evidence found education and exercise effective in reducing future disability (MD −6.28; 95% CI −9.51 to −3.06). Education alone was not effective in preventing future disability and pain intensity in the short and long term follow-up.