Isolated Lumbar Extension Resistance Training Improves Strength, Pain, and Disability, but Not Spinal Height or Shrinkage ("Creep") in Participants with Chronic Low Back Pain

Adherence and Effect of Home-Based Rehabilitation with Telemonitoring Support in Patients with Chronic Non-Specific Low Back Pain: A Pilot Study

Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.

Heavier- and lighter-load isolated lumbar extension resistance training produce similar strength increases, but different perceptual responses, in healthy males and females

OBJECTIVES

Muscles dominant in type I muscle fibres, such as the lumbar extensors, are often trained using lighter loads and higher repetition ranges. However, literature suggests that similar strength adaptations can be attained by the use of both heavier- (HL) and lighter-load (LL) resistance training across a number of appendicular muscle groups. Furthermore, LL resistance exercise to momentary failure might result in greater discomfort.

DESIGN

The aims of the present study were to compare strength adaptations, as well as perceptual responses of effort (RPE-E) and discomfort (RPE-D), to isolated lumbar extension (ILEX) exercise using HL (80% of maximum voluntary contraction; MVC) and LL (50% MVC) in healthy males and females.

METHODS

Twenty-six participants (n = 14 males, n = 12 females) were divided in to sex counter-balanced HL (23 ± 5 years; 172.3 ± 9.8 cm; 71.0 ± 13.1 kg) and LL (22 ± 2 years; 175.3 ± 6.3 cm; 72.8 ± 9.5 kg) resistance training groups. All participants performed a single set of dynamic ILEX exercise 1 day/week for 6 weeks using either 80% (HL) or 50% (LL) of their MVC to momentary failure.

RESULTS

Analyses revealed significant pre- to post-intervention increases in isometric strength for both HL and LL, with no significant between-group differences (p > 0.05). Changes in strength index (area under torque curves) were 2,891 Nm degrees 95% CIs [1,612-4,169] and 2,865 Nm degrees 95% CIs [1,587-4,144] for HL and LL respectively. Changes in MVC were 51.7 Nm 95% CIs [24.4-79.1] and 46.0 Nm 95% CIs [18.6-73.3] for HL and LL respectively. Mean repetitions per set, total training time and discomfort were all significantly higher for LL compared to HL (26 ± 8 vs. 8 ± 3 repetitions, 158.5 ± 47 vs. 50.5 ± 15 s, and 7.8 ± 1.8 vs. 4.8 ± 2.5, respectively; all p < 0.005).

CONCLUSIONS

The present study supports that that low-volume, low-frequency ILEX resistance exercise can produce similar strength increases in the lumbar extensors using either HL or LL. As such personal trainers, trainees and strength coaches can consider other factors which might impact acute performance (e.g. effort and discomfort during the exercise). This data might prove beneficial in helping asymptomatic persons reduce the risk of low-back pain, and further research, might consider the use of HL exercise for chronic low-back pain symptomatic persons.

Variability in Strength, Pain, and Disability Changes in Response to an Isolated Lumbar Extension Resistance Training Intervention in Participants with Chronic Low Back Pain

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.