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.

“If somebody had told me I’d feel like I do now, I wouldn’t have believed them…” Older adults’ experiences of the BELL trial: a qualitative study

“…For people living with painful chronic health conditions, the influence of exercise interventions on pain is equivocal, with mostly small to moderate but inconsistent effects (56) , suggesting that exercise alone may only have small positive effects on disability and limited effects on coping in those with low back pain (57) . The experience of participants in this study, suggests a greater reduction in back pain than previous studies using exercise and resistance training programs for the treatment of chronic low back pain (59,60) , however, mediators and moderators of this change are unclear.…”

Relation between Physical Fitness Components and the Occurrence and Subjective Intensity of Back Pain in Secondary School Adolescents

“…Finally, our data suggests that the main features of the FM cluster, i.e., higher cardiorespiratory fitness and higher flexibility of the trunk than both the other clusters, may be the determining factors for reduced back pain in our sample. The impact of cardiorespiratory fitness on back pain has been confirmed previously: for instance, Tataryn et al [ 62 ] observed that general exercise and walking activities are more efficient than muscular training for reducing back pain. Furthermore, aerobic fitness and activities may prevent and reduce the effects of back pain through mechanisms such as increased blood perfusion in the area [ 63 ].…”

“If somebody had told me I’d feel like I do now, I wouldn’t have believed them…” older adults’ experiences of the BELL trial: a qualitative study

“…For low back pain, exercise on its own has only small positive effects on disability, and limited ffects on coping [41]. Although the mediators and moderators are unknown, the experience of participants in this study, however, suggests a greater reduction in back pain than previous studies using exercise and resistance training [66,67].…”