KELLY MCEVERS, HOST:
Most people will have back pain in their lower back at some point in their lives. People actually spend billions of dollars each year on it. But NPR's Rae Ellen Bichell reports that research shows the best way to prevent lower back pain isn't pills or devices - it's exercise.
RAE ELLEN BICHELL, BYLINE: There are all sorts of gizmos and treatments to help with lower back pain, but are they worth anything?
CHRIS MAHER: Things like insoles and back supports and redesigning the workplace, those things don't seem to work.
BICHELL: That's Chris Maher, a researcher at the University of Sydney. He and his colleagues in Australia and Brazil wanted to know which approaches actually reduce people's risk of getting an episode of acute lower back pain. So they rounded up 21 studies done around the world, involving over 30,000 participants in total.
MAHER: What we found was exercise is effective for preventing lower back pain.
BICHELL: Exercise reduced the risk of another episode in the next year by 25 percent to 40 percent. And it didn't really matter what kind of exercise - aerobic, core strengthening, flexibility, stretching. Dr. Tim Carey, an internist at the University of North Carolina at Chapel Hill, says health care providers don't prescribe exercise nearly enough given its effectiveness.
TIM CAREY: If there were a pill out there that could reduce your risks of future episodes of back pain by 30 percent, I'd probably be seeing ads on television every night.
BICHELL: In researching what docs do and don't prescribe, Carey found it was much more common to prescribe passive treatments, often something a patient can wear or swallow rather than do.
CAREY: Why is this? Why are we not prescribing an inexpensive, effective treatment?
BICHELL: Part of it, he says, is that the health industry is centered on products that sell, and exercise isn't one - not nearly to the extent that medications are. Chris Maher agrees.
MAHER: We've got this perverse incentive in our health care system where we encourage people to innovate in terms of drugs, but we don't have the same system to get people to innovate in terms of physical activity.
BICHELL: The result is massive costs and likely a lot of avoidable back pain. By some estimates, in some years the U.S. has spent about $80 billion on spine problems including lower back pain. That's money lost on treatments, imaging, surgery, pain medication and missed work days.
MAHER: When you start packaging it all up, you know, the costs around the world are horrendous.
BICHELL: So, he says, ditch the strap-on belts and shoe inserts and get off the couch.
MAHER: What we do understand about the back is that the more that you use it, the more likely you are to keep it strong, fit and healthy.
BICHELL: The findings were published Monday in the journal JAMA Internal Medicine. Rae Ellen Bichell, NPR News.