Strength Training, Function and Low Back Pain.

The influence of periodized resistance training on recreationally active males with chronic nonspecific low back pain. J Strength Cond Res. 2011 Jan;25(1):242-51.
Jackson JK, Shepherd TR, Kell RT.

From the study:

Abstract
The most common musculoskeletal health issue is chronic nonspecific low back pain (CLBP). CLBP increases pain and disability, which reduces quality of life (QoL). Generally, pain, disability, and QoL are improved with a moderate volume and intensity of physical activity. Recently, periodized resistance training (PRT) was shown to be effective at improving CLBP in sedentary young, middle-age, and older adults. The purpose of this study was to determine if PRT would increase strength, reduce pain and disability, and improve QoL in recreationally active, moderately trained middle- and older-age males. Forty-five male subjects were divided according to age into 1 of 3 groups: (a) middle-age exercise (ME), (b) old-age exercise (OE), or (c) control (C). All subjects suffered from CLBP and were considered to be moderately trained, participating in recreational ice hockey for 60 minutes, 2 times per wk(-1) for ∼5 months/year along with other recreational activities. The study ran for 16 weeks (3-week familiarization and 13 weeks of testing and PRT) with 5 repetition maximum testing at baseline and weeks 8 and 12. The PRT program systematically and progressively overloaded all major muscle groups (whole-body workout). The results indicate that middle- and old-age recreationally active males with CLBP respond similarly in magnitude to PRT, with improvements in all outcome measures (strength, pain, disability, QoL) across all time points of the study. Clinical significance (≥ 25%) in outcome measures was reached on most variables for the ME and OE groups. The results suggest that PRT may be effectively applied as rehabilitation for moderately trained recreational athletes with CLBP.

Chad’s comments:

This is a great study regarding strengthening and low back pain, as most people are taught that they need to stretch. In it the middle aged men averaged 52 years and the older group average age was 63. Age did not have much effect on the outcomes. The percent changes were great on all variables including strength on all exercises. Decrease in disability as per the Oswestry questionnaire was considerable 46-52%. Initially I was least impressed with the pain reduction which while it was a significant 26-27% decrease, means pain only decreased from 4.3-4.5/10 to a 3.2-3.3/10, which I feel could be better. Looking at their exercise program I was initially critical as I think there are some exercise selections that would have improved outcomes further. What they used were:

1. Leg press
2. Leg extensions
3. Leg curl
4. Bench Press
5. Incline Bench Press
6. Lat Pulldown
7. Low cable row
8. DB shoulder press
9. Arm curl
10. Triceps pushdown
11. Ab Crunches
12. Swiss ball crunch
13. Prone superman

However when I read the preceding study by the same authors using the same exercise program they specifically stated they wanted  as few confounding variables as possible and wanted to know what periodized strengthening alone did, not strengthening in combination with some other factor.  I would prefer more exercises like standing cable presses, standing cable rows, squats, Romanian deadlifts (RDLs), and lunges. The latter I think would better challenge the ability to maintain a neutral spine, and teach motor control of the spine while doing so, but would introduce additional variables into the study. That said the researchers appear to have all major muscle groups covered, including the core. This was explained in the prior paper as well, as they wanted to know what total body strengthening did as opposed to core strength alone. I agree that the total body approach is best because a strong core does the back little good if the arms and legs are not strong as well. It’s not easy to bend over and pick up something heavy with a neutral spine if your legs and arms are not strong also.  A strong core that does most of the lifting with by flexing and extending the spine, rather than flexing and extending the hips, still often hurts.

Overall it’s a great study to see what the effects increases in strength have on pain and disability. I still I think a complete lumbar rehabilitation program should also include postural awareness/spine/hip motor control teaching the ability to maintain a neutral spine during work, rest and play, this study showed what total body strength by itself contributes. The results were still substantial and considerably better than just staying active (as the control group did), which is more than you can say for the McKenzie method, flexion stretches, etc. so physical therapists should take note.  I expect I’ll be citing this study on the reg.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.