School-based exercise may reduce back pain in adolescents

The largest trial (Fanucchi et al.) reported between-group reductions in past-month pain of 2.2 cm on a 10-cm visual analogue scale at 3 months and 2.0 cm at 6 months. The same trial found absolute reductions in 3-month low back pain prevalence of 24% and 40%, respectively. A second trial (Jones et al.) reported a large effect size for pain severity after 8 weeks (ES = 1.47). A third trial (Javadipour et al.) showed favorable pain and motor-function outcomes, though reporting was incomplete and inconsistent. No study measured low-back-pain-related disability using a validated instrument, and all three trials carried high risk of bias in at least one domain, most commonly blinding. Heterogeneity among the interventions prevented statistical pooling into a meta-analysis.

The effects, while modest, appeared consistent across trials: pain reductions ranged from 2.0–2.2 cm on a 10-cm scale over 3–6 months, with some trials showing larger effect sizes for severity (ES 1.47). One trial measured pain prevalence and found 24–40% absolute reductions, suggesting exercise may help prevent new cases as well as reduce existing pain. However, interpretation is limited by the small number of trials (n=3), differences in exercise type and duration across studies, and high risk of bias—particularly unblinded designs that may have inflated perceived benefit. Notably, none of the three trials validated pain-related disability outcomes, missing a key dimension of functional impact. The review found no consensus on optimal dosage or exercise modality (e.g., stretching, strengthening, mixed), making it difficult to translate these findings into specific school programs.