The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back

Abstract

BackgroundLow back pain is one of the most prevalent musculoskeletal conditions in the world. Many exercise treatment options exist but few interventions have utilised free-weight resistance training. To investigate the effects of a free-weight-based resistance training intervention on pain and lumbar fat infiltration in those with chronic low back pain.MethodsThirty participants entered the study, 11 females (age=39.6±12.4 years, height=164 cm±5.3 cm, body mass=70.9±8.2 kg,) and 19 males (age=39.7±9.7 years, height=179±5.9 cm, body mass=86.6±15.9 kg). A 16-week, progressive, free-weight-based resistance training intervention was used. Participants completed three training sessions per week. Participants completed a Visual Analogue Pain Scale, Oswestry Disability Index and Euro-Qol V2 quality of life measure at baseline and every 4 weeks throughout the study. Three-dimensional kinematic and kinetic measures were used for biomechanical analysis of a bodyweight squat movement. Maximum strength was measured using an isometric mid-thigh pull, and lumbar paraspinal endurance was measured using a Biering-Sorensen test. Lumbar paraspinal fat infiltration was measured preintervention and postintervention using MRIs.ResultsPostintervention pain, disability and quality of life were all significantly improved. In addition, there was a significant reduction in fat infiltration at the L3L4 and L4L5 levels and increase in lumbar extension time to exhaustion of 18%.ConclusionsA free-weight-based resistance training intervention can be successfully utilised to improve pain, disability and quality of life in those with low back pain.

The effect of high-intensity resistance exercise on lumbar musculature in patients with low back pain: a preliminary study

“…First, as this was a preliminary study, our sample size was small. However, we observed similar results to a similar study with a larger sample size by Welch et al, highlighting the potential importance of identifying patient subgroups [40]. Additionally, as patients were only enrolled in this study if they had pre-rehabilitation MR imaging, the pre-rehabilitation MRIs were acquired at outside facilities.…”

“…One study only included males in their cohort, and found similar results using an isolated lumbar extension protocol with variable frequency [17]. A study by Welch et al did find decreases in lumbar paraspinal muscle FF by 2.5% [40]. However their patient cohort was young with lower baseline FF, so their rehabilitation protocol may not exhibit muscle physiological changes in the average patient population with LBP.…”

Standardization and Methodological Considerations for the Isometric Midthigh Pull

“…The PF achieved during the IMTP has also been used to monitor adaptations to training (5,36,50,51,57,70,74), with some authors also including RFD (36,51,52,74). PF and peak RFD have also been used in an attempt to identify levels of fatigue or recovery (4,29,35,44).…”

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

“…Promisingly, there is preliminary evidence that fatty infiltration of the multifidus muscles can be reduced with exercise. A recent study showed that free weight-based resistance training decreased chronic LBP and disability, in conjunction with altered biomechanics of a squat exercise and reduced fatty infiltration of lumbar multifidus and lumbar erector spinae muscles at the L3/4 and L4/5 vertebral levels, but not at L5/S1 (Welch et al, 2015). The L5/S1 vertebral level had higher percentages of fatty infiltration pre-intervention, and the investigators proposed that muscles with a higher percentage of fatty infiltration may be more resilient to change in response to exercise, or alternatively that the loading may have been distributed unevenly with decreased loading on the multifidus muscle in that region.…”

“…The localized effect and recalcitrance to rehabilitation at this level parallels findings of some Earth based studies. The multifidus muscle at L5/S1 has been shown to be affected more than other vertebral levels in response to de-loading (Hides et al, 2007; Belavy et al, 2011), acute and chronic LBP (Hides et al, 1996, 2011) and in response to exercise interventions (Hides et al, 2008, 2012; Welch et al, 2015). The observation that size of the multifidus muscles at L4 and L5 predicts disability associated with LBP, reinforces the premise that these lower levels require special attention when prescribing exercise (Ranger et al, 2018).…”