Site Search

The evidence for strength-based rehab for back pain.

By Shervan Khanna

Chronic low back pain is most often related to insufficient muscle strength and deconditioning1,2. People experiencing pain will avoid movement and activity in an attempt to decrease pain, but this results in more muscle atrophy, increased pain and psychological distress. The most effective way to manage low back pain is educating the patient about pain processes and mobility and improving strength. Understanding that guarding and protecting our backs is part of the problem should be the primary focus of recovery. Our back needs to be strong and flexible in order for us to tolerate our daily activities.

There many research studies supporting the value of high intensity, low force strength training for the management of low back pain 2-4. This protocol shows ideal results for the treatment of backpain. The following articles support this evidence, but also show important clinical implications in the management of low back pain.

Rish et al.5 showed that strength training not only increased strength and decreased pain, but improved the perception of physical and psychological functioning. If patients learn that they don’t have to stop using their backs and that building muscle helps with function and pain it will improve quality of life.

For those who are unable to move through full range of motion, they can still make strength gains. There is research that reports that strength gains through untrained ROM does occur6. The authors showed that subjects who strengthened their lumbar musculature through a limited range of motion showed improvement in isometric testing at different joint angles, including those outside the ROM strengthened. Furthermore, the participants who trained in a limited range showed comparable gains throughout ROM as those training through full ROM, but also showed more gains in the ROM trained than those who trained through full range. All participants had considerable increase in strength compared to controls who did not train.

Recent research has shown the effectiveness of high intensity strength training at a low frequency, but Tucci et al.1 went even further to show that subjects who built base strength during a 12 week program maintained that strength afterwards with infrequent maintenance sessions of either once every 2 weeks or once every 4 weeks. Control subjects who completely stopped training showed a 55% reduction in lumbar strength after the initial gains they made in the first 12 weeks. Clinically, we need to ensure that patients continue to exercise at a high intensity even after they see improvements in base strength.

It is important to note that the research further indicates that training intensity is a key factor for maintenance of muscular strength. Working with physiotherapists trained in pain management and high intensity strength training can provide optimal results for people experiencing low back pain.

References

  1. Tucci, JT, Carpenter, DM, Pollock, ML, Graves, JE, and Leggett, SH. 1992. Effect of reduced frequency of training and detraining on lumbar extension strength. Spine. 17(2): 1.

  2. Pollock, ML, Leggett, SH, Graves, JE, Jones, A, Fultan, M, and Cirulli, J. 1989. Effect of resistance training on lumbar extension strength. The American Journal of Sports Medicine. 17(5): 624-629.

  3. Carpenter, DM, and Nelson, BW. 1999. Low back strengthening for the prevention and treatment of low back pain. Medicine & Science in Sports & Exercise. 31 (1): 18-24.

  4. Graves, JE, Webb, DC, Pollock, ML, Matkozick, J, Leggett, SH, Carpenter, DM, Foster, DN, and Cirulli, J. 1994. Pelvic stabilization during resistance training: Its effect on the development of lumbar extension strength. Arch Phys Med Rehabilitation. 75: 210-215.

  5. Risch, SV, Pollock, ML, Langer, H, Graves, JE, Fulton, M, and Leggut, SH. 1993. Lumbar strengthening in chronic low back pain patients: Physiological and psychological benefits. Spine 18 (2):232-238

  6. Graves, JE, Leggett, SH, Fix, CK, Pollock, ML, Carpenter, DM, and Fulton, MN. 1992. Limited range of motion lumbar extension strength training. Medicine and Science in Sports and Exercise. 24 (1): 128-133

About the Author:

Shervan Khanna with One to One Wellness Centre, which is a Personal Training Studio & Rehab Clinic located in Halifax, Nova Scotia. Their website is www.121wellness.ca