Abstract
BackgroundExercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers.MethodsA total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 individually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week; self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.DiscussionThe results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP.Trial registrationNTCT04257253, registered prospectively on February 5, 2020.
Highlights
Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP)
The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP
In accordance with the ever-increasing body of evidence demonstrating accelerate atrophy and fatty infiltration in patients with chronic LBP, improving strength, function and control of the trunk muscle through therapeutic exercises is a primary goal in physical rehabilitation of patients with LBP
Summary
Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. While chronic LBP is a prevalent and persistent global burden, up to 90% of the North American population alone, is at risk of developing LBP [3,4,5]. Of these cases, only 10% are thought to be the result of identifiable radiological characteristics, such as nerve root compression, fractures, or stenosis [6]. Exercise is more effective than no intervention, the effect size of exercise are small to moderate, and to date there is no evidence that one exercise approach is superior to another [14,15,16]
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