Abstract
Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of three previous randomized controlled trials. Data from 77 participants were available for the intervention arms (males = 43, females = 34) 37 participants data (males = 20, females = 17) from the control arms. Intervention participants had all undergone 12 weeks of ILEX resistance training and changes in ILEX strength, pain (visual analogue scale; VAS), and disability (Oswestry disability index; ODI) measured. True inter-individual (i.e., between participants) variability in response was examined through calculation of difference in the standard deviation of change scores for both control and intervention arms. Intervention participants were classified into responder status using k-means cluster analysis for ILEX strength changes and using minimal clinically important change cut-offs for VAS and ODI. Change in average ILEX strength ranged 7.6 Nm (1.9%) to 192.1 Nm (335.7%). Change in peak ILEX strength ranged −12.2 Nm (−17.5%) to 276.6 Nm (169.6%). Participants were classified for strength changes as low (n = 31), medium (n = 36), and high responders (n = 10). Change in VAS ranged 12.0 mm to −84.0 mm. Participants were classified for VAS changes as negative (n = 3), non-responders (n = 34), responders (n = 15), and high responders (n = 19). Change in ODI ranged 18 pts to −45 pts. Participants were classified for ODI changes as negative (n = 2), non-responders (n = 21), responders (n = 29), and high responders (n = 25). Considerable variation exists in response to ILEX resistance training in CLBP. Clinicians should be aware of this and future work should identify factors prognostic of successful outcomes.
Highlights
Chronic low back pain (CLBP) is one of the most prevalent medical disorders in today’s societies [1,2] representing an enormous economic cost worldwide [3,4,5,6]
Considerable variation exists in response to isolated lumbar extension (ILEX) resistance training in CLBP
Bruce-Low et al [34] and Steele et al [35] two manipulations of ILEX resistance training were examined, both studies found no difference between the two intervention arms of each trial
Summary
Chronic low back pain (CLBP) is one of the most prevalent medical disorders in today’s societies [1,2] representing an enormous economic cost worldwide [3,4,5,6]. Exercise is a common prescription for CLBP This is despite the fact that previous Cochrane reviews have generally reported small effect sizes for most exercise approaches, reflecting either low average outcomes or high. The Cochrane reviews have not adequately described, defined and categorized the “exercise” studies they have examined and have been criticized for this flaw and their wide-sweeping conclusions [7,8,9,10]. Though, this may be because many empirical studies of exercise in CLBP lack an adequate description of the precise exercises used [11,12]. Searle et al [13] recently examined the impact of different exercise types reporting that resistance training and motor control type exercises may offer the greatest benefits
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