Abstract Objective Chronic low back pain (CLBP) is prevalent, costly, and acknowledged as multifactorial in nature. However, deconditioning of the lumbar extensor musculature may be a common factor. ...Thus specific resistance exercise is often recommended. Many resistance exercises for the lumbar extensors exist, although recent evidence suggests that isolated lumbar extension (ILEX) resistance training may best for conditioning these muscles. Thus this review aimed to examine the use of ILEX resistance training in participants with CLBP to provide a best-evidence synthesis for practitioners and clinicians. Literature Survey Reference lists from previous reviews were searched in addition to SPORTDiscus, PubMed, and Google Scholar databases up to May 2014 using search terms including combinations and synonyms of “isolation,” “lumbar extension,” “lumbar exercise,” “lumbar strength,” “lumbar endurance,” “lumbar spine,” “low back exercise,” “CLBP,” “pain,” and “disability.” Methodology A “snowballing”-style literature search was used that involved an emergent approach. Studies examining ILEX resistance training as an intervention in symptomatic CLBP populations reporting pain, disability, or global perceived outcomes (GPO) as outcomes were examined. Pain and disability were outcomes and were compared to consensus guidelines for minimal clinically important changes. Single case reports were excluded. Synthesis Results suggest that ILEX resistance training produces significant and meaningful improvements in perceived pain, disability, and GPOs, as part of a multiple intervention or stand-alone approach. A low frequency (once per week) yet high intensity of effort (to momentary muscular failure) approach using either full or limited range-of-motion ILEX resistance training appears to be sufficient and best for significant and meaningful outcomes. Limited comparative studies between ILEX resistance training and other specific exercise approaches exist; however, only limited evidence supports ILEX resistance training as being more effective. Conclusions These findings highlight ILEX resistance training as effective for significant and meaningful improvements in perceived pain, disability, and GPOs for CLBP participants. Further research should elucidate comparisons between ILEX resistance training and other specific exercise approaches and should clarify whether lumbar extensor conditioning is the mechanism responsible for the improvements reported.
Abstract Background context Low back pain (LBP) is highly prevalent and presents an enormous cost both through direct health care and indirectly through significant work and production loss. Low back ...pain is acknowledged widely to be a multifactorial pathology with a variety of symptoms, dysfunctions, and a number of possible sources of pain. One source that has been suspected and evidenced for some time is the intervertebral disc. Some degree of disc degeneration is a physiologic process associated with aging, however, more severe degeneration and/or structural abnormality may be indicative of a pathologic process or injury and is more commonly present in those suffering from LBP. Much like other tissues (ie, muscle, bone, etc.), it has been suspected that there exists an optimal loading strategy to promote the health of the disc. Exercise is often prescribed for LBP and effectively reduces pain and disability. However, whether specific loading through exercise might plausibly heal or regenerate the intervertebral discs is unknown. Purpose To examine the effects of loading on regenerative processes in the intervertebral disc and consider the potential for specific exercise to apply loading to the lumbar spine to produce these effects. Study design A brief narrative literature review. Methods Studies examining the effects of loading on the intervertebral discs were reviewed to examine the plausibility of using loading through exercise to induce regeneration or healing of the intervertebral disc. Results Research from animal model studies suggests the existence of a dose-response relationship between loading and regenerative processes. Although high loading at high volumes and frequencies might accelerate degeneration or produce disc injury, high loading, yet of low volume and at low frequency appears to induce potentially regenerative mechanisms, including improvements in disc proteoglycan content, matrix gene expression, rate of cell apoptosis, and improved fluid flow and solute transport. Conclusions Research suggests a dose-response relationship between loading and disc regenerative processes and that the loading pattern typically used in the lumbar extension resistance exercise interventions (high load, low volume, and low frequency) might impart healing or regeneration of the intervertebral discs. Future research should examine an exercise intervention with in vivo measurement of changes in disc condition. This may provide further evidence for the “black box” of treatment mechanisms associated with exercise interventions.
Abstract Background Chronic low back pain (CLBP) is a multifactorial condition with a variety of symptoms, one of which is abnormal gait. The lumbar spine and its musculature are important in ...controlling gait, and in CLBP the lumbar extensors are often deconditioned. Because of this specific isolated lumbar extension, exercise often is recommended. It was therefore of interest to examine its effects of upon gait variability. Objective To examine the effects of isolated lumbar extension resistance training on lumbar kinematic variability during gait in participants with CLBP. Design Randomized controlled trial. Setting University Health, Exercise and Sport Science Laboratory. Participants Twenty-four participants with nonspecific CLBP. Interventions Participants were randomly allocated to a 12-week isolated lumbar extension exercise intervention (1×/week performing a single set to momentary muscular failure using a load equal to 80% max tested torque) or nontraining control period. Main Outcome Measurements Lumbar kinematics during gait, including angular displacement, kinematic waveform pattern (CVp ), and offset (CVo ) variability, were examined via 3-dimensional analyses. Results No significant changes in displacement or CVo were found as a result of the intervention; however, a small but significant reduction in sagittal plane CVp (−20.90 ± 3.53%, effect size = 0.48, P = .044) occurred, indicating improved motor pattern replication through this movement plane. Conclusions Considering the role of the lumbar extensors in gait, and their common deconditioning in CLBP, an isolated lumbar extension resistance exercise intervention may reduce gait variability. These results suggest isolated lumbar extension exercise may specifically reduce sagittal plane variability, indicating improved motor pattern replication through this movement plane, perhaps attributable to the plane of movement used during the exercise.
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