Q: I started having back pain about two years ago. The doctor says its mechanical and nothing is seriously wrong with me. When I do the exercises the therapist gave me, the pain goes away. But if I miss more than a week, it comes right back. Isn't there some way to get past this stage?

A: Long-term management of low back pain (LBP) is often a combination of proper nutrition, posture, and activity or exercise. Many people find that doing a regular routine of exercises maintains a pain free status. Exercise also seems to help prevent back pain from recurring.

Research shows that about half of the people with LBP who get better with exercises must keep them up on a regular basis. That means that an equal number could stop doing their exercises and return to work and daily activities without further intervention.

What's the difference between those who must follow a regular program and those who get better and stay better? Further studies show that there are some factors linked with chronic LBP. People who smoke are more likely to have recurrent symptoms.

Patients with low expectations for overcoming disability and getting back to normal also seem to be at risk for poor outcome. Other risk factors under investigation include age, gender, pain intensity and duration, and prior surgery.

Studies report mixed results between these (and other) variables linked to chronic LBP. More study is needed to identify risk or prognostic factors and results (outcomes). Right now we just don't have a sure fire way to predict who must continue exercising or how to remain pain free without exercise.

Tom Petersen, PT, PhD, et al. One-Year Follow-up Comparison of the Effectiveness of McKenzie Treatment and Strengthening Training for Patients with Chronic Low Back Pain. In Spine. December 15, 2007. Vol. 32. No. 26. Pp. 2948-2956.