What is the efficacy of strengthening exercises for the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Lumbar extensor strengthening exercises describes a supervised progressive resistance exercise (PRE) program with isolation and intensive loading of the lumbar extensor muscles. This type of therapy can be performed through a variety of physical activities including directed physical exercise; aquatic rehabilitation; directional preference exercises (eg, McKenzie approach); flexibility exercises (eg, yoga); stabilization exercises (ie, low-load targeted strengthening of the core trunk muscles with the lumbar spine in a close-packed posture with all components of the rejoin complex engaged; Pilates and general strengthening exercises, preferably with a reduced gravity load across the lumbar spine).

A recent systematic review of the best available evidence for lumbar extensor strengthening exercises was performed by Mooney et al in 2008. The authors examined various lumbar extensor strengthening devices and protocols including both high-tech and lower-tech approaches. The specific muscles targeted included the lumbar erector spinae (including iliocostalis lumborum and longissimus thoracis) and multifidi muscles. Some techniques specifically isolated these muscle groups, while others sought to improve trunk extension as a compound movement by including the action and strengthening of both the lumbar extensors and hip girdle extensors (eg, buttocks and hamstring muscles). This type of preferential strengthening enhances the spine's capacity to act as a crane.

This intervention's theoretical mechanism of action is likely related to the physiological effects of conditioning the lumbar spine muscles through progressive tissue resistance or enhancing the metabolic exchange of water and nutrients to the lumbar disks (and muscles) through repetitive motion. These strengthening exercises may also use psychological mechanisms that force improvements such as retaking the locus of control and reconditioning the mind to offset fear-avoidance.

Current evidence suggests that short-term lumbar strengthening administered alone is more effective than either no treatment or most passive modalities for improving pain, disability, and other patient-reported outcomes with cLBP. However, no clear benefit of lumbar extension exercises can be demonstrated relative to similar exercise programs when looking at the long-term effects on pain and disability. However, lumbar extensor strengthening exercises administered with co-interventions are more effective than those other exercises (eg, stabilization, no treatment, or just passive modalities) administered alone with respect to improving lumbar muscle strength and endurance.

This improvement of strength and endurance in the isolated lumbar extensor muscles with cLBP through safe, gradually loaded, and measurable PREs that include lumbar dynamometer machines appears to be the best option. Roman chairs and benches are viable options, whereas floor or stability ball exercises are not recommended without supervision. Higher-quality RCTs with a larger sample size and well-defined patient groups followed for the long-term are necessary to determine more accurate recommendations in this regard. [279]


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