Exercise Progression in Nonspecific Low Back Pain

Physical therapists and physical therapist assistants who deliver exercise-based care for adults with nonspecific low back pain, along with clinical educators and students who want a clear read on how poorly progression is documented in the trial literature.

Licensed physical therapists and physical therapist assistants. Physical therapist assistants carry out exercise progression under the direction of the supervising physical therapist, who holds evaluation, diagnosis, and plan-of-care decisions.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

This course reports on a single peer-reviewed systematic review. Every finding, figure, and conclusion described in the course comes from that paper; nothing has been added from other literature.

Tuninetti A, Barbari V, Storari L, Bisconti M, Piano L, Dunning J, Mourad F, Maselli F. Therapeutic Exercise Progression in Patients with Nonspecific Low Back Pain: A Systematic Review. Journal of Pain Research. 2025;18:6397–6407. Open access under a Creative Commons Attribution – Non Commercial (unported, v4.0) License.

Registered in PROSPERO (CRD42024497282) and reported in line with the PRISMA statement.

Scope note

The review covered adults over 18 years of age with nonspecific low back pain enrolled in randomized controlled trials. It did not cover specific spinal pathology such as fracture, tumour, infection, or radiculopathy, and it did not cover children or adolescents.

After completing this course, you will be able to:

1. Describe the subjective and objective criteria that the included randomized trials used to decide when to advance therapeutic exercise in adults with nonspecific low back pain.
2. State what the review found about whether exercise guided by predefined progression criteria produced better short-term, medium-term, and long-term pain and function outcomes than exercise without such criteria.
3. Explain the limits the authors identified — wide variation between trials, frequent methodological weaknesses, and the inability to combine results numerically — and how those limits shaped the conclusions they were willing to draw.

1. Start Here: How This Course Works
2. Podcast: When Is a Patient Ready for More? (about nine minutes)
3. The Question Behind the Review and the Patients in It
4. How the Reviewers Searched, Screened, and Rated the Trials
5. Progression Criteria in Use and What They Delivered
6. Why the Authors Stopped Short of Firm Conclusions
7. From Findings to the Clinic: The Authors' Preliminary Algorithm
8. Key Takeaways
9. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 0.5 contact hours (30 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. This course reports on a single peer-reviewed systematic review. Every finding, figure, and conclusion described in the course comes from that paper; nothing has been added from other literature.
2. Tuninetti A, Barbari V, Storari L, Bisconti M, Piano L, Dunning J, Mourad F, Maselli F. Therapeutic Exercise Progression in Patients with Nonspecific Low Back Pain: A Systematic Review. Journal of Pain Research. 2025;18:6397–6407. Open access under a Creative Commons Attribution – Non Commercial (unported, v4.0) License.
3. Registered in PROSPERO (CRD42024497282) and reported in line with the PRISMA statement.
4. Scope note
5. The review covered adults over 18 years of age with nonspecific low back pain enrolled in randomized controlled trials. It did not cover specific spinal pathology such as fracture, tumour, infection, or radiculopathy, and it did not cover children or adolescents.