Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis

Abstract Background While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE). Objectives To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP. Methods Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3. Results Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12–16 weeks compared to 6–8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = − 0.61 (95% CI − 1.21 to 0.00), p = 0.05; I2 = 74%) and level of disability (SMD = − 0.53 (95% CI − 0.97 to − 0.09), p = 0.02; I2 = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I2 = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = − 0.02 (95% CI − 0.10 to 0.05), p = 0.57; I2 = 72%). Conclusion Results of the meta-analysis indicated that 12–16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12–16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population. Trial registration PROSPERO CRD42020155700.

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A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

PLoS ONE ◽

10.1371/journal.pone.0052082 ◽

2012 ◽

Vol 7 (12) ◽

pp. e52082 ◽

Cited By ~ 89

Author(s):

Xue-Qiang Wang ◽

Jie-Jiao Zheng ◽

Zhuo-Wei Yu ◽

Xia Bi ◽

Shu-Jie Lou ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Core Stability ◽

Low Back ◽

General Exercise

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Faculty Opinions recommendation of A meta-analysis of core stability exercise versus general exercise for chronic low back pain.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976197.793471712 ◽

2013 ◽

Author(s):

Rajesh Gupta

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Core Stability ◽

Low Back ◽

General Exercise

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Spinal manipulative therapy and acupuncture for chronic low back pain: a systematic review and meta-analysis of RCTs

10.21203/rs.3.rs-1192409/v1 ◽

2021 ◽

Author(s):

Ting Yue ◽

Jingjing Li ◽

Jiaman Yang ◽

Dehui Fan

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Adverse Events ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Cochrane Library ◽

Low Back ◽

Quality Of Evidence ◽

Moderate Quality

Abstract Background Spinal manipulation therapy (SMT) and acupuncture are commonly used for low back pain (LBP) among complementary and alternative therapies. However, it remains unclear which of the two therapies is more effective for LBP. Therefore, the purpose of this meta-analysis was to evaluate the effectiveness of SMT and acupuncture on LBP. Methods Four electronic databases were searched for randomized controlled trials (all years until July 2021), including PubMed, Embase, Web of Science, and Cochrane Library. Two reviewers independently abstracted data, assessed risk of bias, and rated the quality of evidence. The primary outcome was pain; secondary outcomes included functional status and adverse events. Review Manager 5.3 software and Stata 12.0 were used for all statistical analyses. Results 9 RCTs with a total of 714 participants were identified, who were on average middle aged (39-60 years) without signs of radiating pain. These trials included patients with mild to moderate pain. Overall, moderate quality of evidence suggested that SMT had better effects for pain relief (MD: 0.32, 95%CI: 0.09 to 0.55, I2=34%) and similar effects in function (MD: 0.24, 95%CI: -0.45 to 0.94, I2=21%) when compared to acupuncture. Moderate quality of evidence showed SMT reduced pain better than acupuncture at month 2 (MD: 0.61, 95%CI: 0.08 to 1.14, I2=0%) and at month 12 (MD: 1.02, 95%CI: 0.28 to 1.75, I2=42%). In addition, Low quality of evidence showed SMT may provide better improvement in pain at month 3 (MD: 0.74, 95%CI: 0.09 to 1.39, I2=42%) and in function at month 4 (MD: 3.50, 95%CI: 0.71 to 6.29). Adverse events associated with SMT and acupuncture were rare and mild. Conclusions SMT showed better effects than acupuncture for chronic low back pain, while SMT and acupuncture had similar effects in functional improvement. Although SMT and acupuncture were tolerable and safe, patients should be informed about the potential risks of adverse events before starting therapy.

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Core Stability Exercise Versus General Exercise for Chronic Low Back Pain

Journal of Athletic Training ◽

10.4085/1062-6050-51.11.16 ◽

2017 ◽

Vol 52 (1) ◽

pp. 71-72 ◽

Cited By ~ 20

Author(s):

Brian J. Coulombe ◽

Kenneth E. Games ◽

Elizabeth R. Neil ◽

Lindsey E. Eberman

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Functional Status ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Exercise Group ◽

Core Stability ◽

Low Back ◽

The Core ◽

General Exercise

Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)? Data Sources: The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica. Study Selection: Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals. Data Extraction: The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given. Main Results: Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD = −1.29, 95% CI = −2.47, −0.11; P = .003) but not at 6 months (MD = −0.50, 95% CI = −1.36, 0.35; P = .26). Functional status was improved at 3 months (MD = −7.14, 95% CI = −11.64, −2.65; P = .002) but not at 6 months (MD = −0.50, 95% CI = 0.36, 0.35; P = .26) or 12 months (MD = −0.32, 95% CI = −0.87, 0.23; P = .25). All of the included studies assessed back-specific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD = −7.14, 95% CI = −11.64, −2.65; P = .002); no results were recorded at 6 or 12 months. Conclusions: In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.

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Exercise interventions can improve muscle strength, endurance, and electrical activity of lumbar extensors in individuals with non-specific low back pain: a systematic review with meta-analysis

Scientific Reports ◽

10.1038/s41598-021-96403-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sacha Clael ◽

Lorrane Freitas Campos ◽

Karina Lisboa Correia ◽

Joana Marcela Sales de Lucena ◽

Paulo Gentil ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Muscle Strength ◽

Electrical Activity ◽

Meta Analysis ◽

Low Back ◽

Exercise Interventions ◽

Evidence Database ◽

Active Controls ◽

Improve Muscle Strength

AbstractExercise interventions have been recommended for people with non-specific low back pain. The literature is scarce regarding the effects of exercise on muscle strength, endurance, and electrical activity of lumbar extensor muscles. Electronic searches were carried out from May 2020 until August 2020 in the following databases: PUBMED, CENTRAL, EMBASE, PEDro, SPORTDiscus, Scielo, and LILACS. Only randomized controlled trials with passive and active control groups were included. The methodological quality of the included studies was performed using the Physiotherapy Evidence Database Scale. Eight studies, involving 508 participants, were included in metanalytical procedures. Exercise interventions demonstrated superior effects on muscle activity (Electromyography) when compared with active controls (p < 0.0001). Exercise interventions demonstrated superior effects on muscle endurance (Sorensen Test) when compared with passive (p = 0.0340) and active controls (p = 0.0276). Exercise interventions demonstrated superior effects on muscle strength (Machine) when compared with passive controls (p = 0.0092). Exercise interventions can improve muscle strength, endurance, and electrical activity in people with non-specific low back pain.

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Efficacy and Safety of Abdominal Trunk Muscle Strengthening Using an Innovative Device in Elderly Patients With Chronic Low Back Pain: A Pilot Study

Annals of Rehabilitation Medicine ◽

10.5535/arm.19100 ◽

2020 ◽

Vol 44 (3) ◽

pp. 246-255 ◽

Cited By ~ 2

Author(s):

Satoshi Kato ◽

Satoru Demura ◽

Yuki Kurokawa ◽

Naoki Takahashi ◽

Kazuya Shinmura ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Muscle Strength ◽

Adverse Events ◽

Chronic Low Back Pain ◽

Exercise Program ◽

Trunk Muscle ◽

Low Back ◽

Efficacy And Safety ◽

Muscle Strengthening

Objective To examine the efficacy and safety of an innovative, device-driven abdominal trunk muscle strengthening program, with the ability to measure muscle strength, to treat chronic low back pain (LBP) in elderly participants.Methods Seven women with non-specific chronic LBP, lasting at least 3 months, were enrolled and treated with the prescribed exercise regimen. Patients participated in a 12-week device-driven exercise program which included abdominal trunk muscle strengthening and 4 types of stretches for the trunk and lower extremities. Primary outcomes were adverse events associated with the exercise program, improvement in abdominal trunk muscle strength, as measured by the device, and improvement in the numerical rating scale (NRS) scores of LBP with the exercise. Secondary outcomes were improvement in the Roland-Morris Disability Questionnaire (RDQ) score and the results of the locomotive syndrome risk test, including the stand-up and two-step tests.Results There were no reports of increased back pain or new-onset abdominal pain or discomfort during or after the device-driven exercise program. The mean abdominal trunk muscle strength, NRS, RDQ scores, and the stand-up and two-step test scores were significantly improved at the end of the trial compared to baseline.Conclusion No participants experienced adverse events during the 12-week strengthening program, which involved the use of our device and stretching, indicating the program was safe. Further, the program significantly improved various measures of LBP and physical function in elderly participants.

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