ObjectiveExamine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP).DesignNetwork meta-analysis (NMA).Data sourcesMEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL.Eligibility criteriaExercise training randomised controlled/clinical trials in adults with NSCLBP.ResultsAmong 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80%; −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80%; −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80%; −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80%; −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20%; −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria.Summary/conclusionThere is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.

A ssessment of function of the deep abdominal musculature in the laboratory has largely used methodologies such as functional movement tasks and fine-wire electromyography (EMG). 13,10,11,15,27 While fine-wire EMG is primarily restricted to laboratory research, rehabilitative ultrasound imaging (RUSI) offers a noninvasive and simpler method of assessing deep lumbopelvic muscle function. Recent work has shown that measures of transversus abdominis (TrA) muscle contraction, 20 internal oblique (IO) muscle contraction, and length of the TrA muscle obtained using RUSI correlated well with measures obtained by fine-wire EMG for isometric contractions of these muscles. 12,20 For increases in thickness of the TrA and IO muscles and changes in length of the TrA muscle (measured as lateral displacement of the fascial insertion of the TrA muscle) there were consistent, clear changes in sonographic parameters, with incremental changes for contractions of less than 20% of maximal voluntary contraction (MVC).Clinical muscle testing of the TrA muscle has been based on its anatomical structure and horizontal fiber arrangement. Two muscle tests include observation of the abdominal wall during either a voluntary drawing-in of the abdominal wall 26 or by using automatic responses of the muscle to expiration.18 A relationship between the clinical muscle test and laboratory EMG measures of TrA muscle function has been demonstrated.14 In addition, the action of the bilateral muscle bellies of the TrA muscle has been viewed during the drawing-in maneuver using RUSI and magnetic resonance imaging (MRI). 8,9 In a recent study conducted on elite asymptomatic cricketers, 9 the muscle bellies of the TrA muscle were seen to thicken as well as shorten in length durt sTudy design: Test-retest intrarater reliability study.t oBJecTive: To examine reliability of abdominal musculature measurements across a broad range of conditions for a physical therapist newly trained in assessment using rehabilitative ultrasound imaging (RUSI).t BAckground: RUSI has previously been used to assess abdominal muscle function during a drawing-in maneuver of the anterior abdominal wall, and measurements conducted by an experienced assessor have been validated by comparison with magnetic resonance imaging. Few studies have examined the reliability of less experienced operators, and only in isolated measurement conditions. t MeTHods And MeAsures: Nineteen subjects (11 female, 8 male) without a history of low back pain performed the abdominal drawing-in maneuver in a supine hook-lying position. RUSI was used bilaterally to assess the thickness of the internal oblique (IO) and transversus abdominis (TrA) muscles at rest and on contraction, as well as changes in the length of the TrA muscle (indicated by slide of the anterior abdominal fascia). The reliability of a novice rater who received 8 hours of training was examined (a) across 3 measurements of the same ultrasound image, (b) across 3 separate ultrasound images (averaged for days and sides of abdomen), and (c) ac...

Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health‐related quality‐of‐life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

Bed rest resulted in selective atrophy of the multifidus muscle. An increased CSA of the trunk flexor musculature (increases in psoas, anterolateral abdominal, and rectus abdominis muscles) may reflect muscle shortening or possible overactivity during bed rest. Some of the changes resemble those seen in low back pain and may in part explain the negative effects of bed rest seen in low back pain sufferers.

Patients with medical, orthopaedic and surgical conditions are often assigned to bed-rest and/or immobilised in orthopaedic devices. Although such conditions lead to muscle atrophy, no studies have yet considered differential atrophy of the lower-limb musculature during inactivity to enable the development of rehabilitative exercise programmes. Bed-rest is a model used to simulate the effects of spaceflight and physical inactivity. Ten male subjects underwent 56-days of bed-rest. Magnetic resonance imaging of the lower-limbs was performed at 2-weekly intervals during bed-rest. Volume of individual muscles of the lower-limb and subsequently, rates of atrophy were calculated. Rates of atrophy differed (F = 7.4, p < 0.0001) between the muscles with the greatest rates of atrophy seen in the medial gastrocnemius, soleus and vastii (p < 0.00000002). The hamstring muscles were also affected (p < 0.00015). Atrophy was less in the ankle dorsiflexors and anteromedial hip muscles (p > 0.081). Differential rates of atrophy were seen in synergistic muscles (e.g. adductor magnus > adductor longus, p = 0.009; medial gastrocnemius > lateral gastrocnemius, p = 0.002; vastii > rectus femoris, p = 0.0002). These results demonstrate that muscle imbalances can occur after extended periods of reduced postural muscle activity, potentially hampering recovery on return to full upright body position. Such deconditioned patients should be prescribed "closed-chain" simulated resistance exercises, which target the lower-limb antigravity extensor muscles which were most affected in bed-rest.