A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning

Steele, James; Bruce-Low, Stewart; Smith, Dave

doi:10.1185/03007995.2013.875465

Cited by 92 publications

(84 citation statements)

References 186 publications

(291 reference statements)

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“…The hypothesis of specific lumbar extensor deconditioning as a causal factor in LBP is supported [9] by evidence suggesting that paraspinal muscles have significantly less contractility in patients with LBP than controls and significantly less contractility on the affected side in patients with unilateral LBP [10]. These factors along with other structural findings in the spine such as fat infiltration of the paraspinal musculature, decreased muscular quality and individual variations in muscular activation may contribute to recurrence of LBP [24].…”

Section: Discussionmentioning

confidence: 99%

“…The active muscular structures are responsible for motion of the lumbar trunk in multiple directions [8]. Loss of strength and endurance of these muscles is considered predictive for the development of LBP [6, 9]. The extensors of the lumbar trunk; iliocostalis lumborum, longissimus thoracis and the deep and superficial portion of the lumbar multifidus muscle, (LMM) have been extensively studied.…”

Section: Introductionmentioning

confidence: 99%

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Impact of exercise programs among helicopter pilots with transient LBP

Andersen

Baardsen

Dalen

et al. 2017

BMC Musculoskelet Disord

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BackgroundFlight related low back pain (LBP) among helicopter pilots is frequent and may influence flight performance. Prolonged confined sitting during flights seems to weaken lumbar trunk (LT) muscles with associated secondary transient pain. Aim of the study was to investigate if structured training could improve muscular function and thus improve LBP related to flying.Methods39 helicopter pilots (35 men and 4 women), who reported flying related LBP on at least 1 of 3 missions last month, were allocated to two training programs over a 3-month period. Program A consisted of 10 exercises recommended for general LBP. Program B consisted of 4 exercises designed specifically to improve LT muscular endurance. The pilots were examined before and after the training using questionnaires for pain, function, quality of health and tests of LT muscular endurance as well as ultrasound measurements of the contractility of the lumbar multifidus muscle (LMM).ResultsApproximately half of the participants performed the training per-protocol. Participants in this subset group had comparable baseline characteristics as the total study sample. Pre and post analysis of all pilots included, showed participants had marked improvement in endurance and contractility of the LMM following training. Similarly, participants had improvement in function and quality of health. Participants in program B had significant improvement in pain, function and quality of health.ConclusionsThis study indicates that participants who performed a three months exercise program had improved muscle endurance at the end of the program. The helicopter pilots also experienced improved function and quality of health.Trial registrationIdentifier: NCT01788111 Registration date; February 5th, 2013, verified April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1631-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of exercise programs among helicopter pilots with transient LBP

Andersen

Baardsen

Dalen

et al. 2017

BMC Musculoskelet Disord

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“…Despite deficiencies in these areas having been linked to LBP,12 24 the use of free weight RT in the rehabilitation of those with LBP is limited. It is known that RT can alter muscle composition and illicit high levels of lumbar erector and other posterior chain muscle activity 25…”

Section: Introductionmentioning

confidence: 99%

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

Welch

Moran

Antony

et al. 2015

BMJ Open Sport & Exercise Medicine

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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.

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“…The lack of a proper biopsychosocial (BPS) diagnosis coupled with untreated psychological aspects reduced the effectiveness of his previous treatments. This enhances a catastrophic state [51] which is a crucial step in the fear-avoidance model [52], reducing his social and occupational functioning and further deconditions his muscles [53].…”

Section: The Patient's Psychosocial Aspectsmentioning

confidence: 99%

Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report

Schembri

2018

SN Compr. Clin. Med.

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This review, with the help of a case study, provides a detailed account of the possible biopsychosocial risk factors underlying piriformis muscle syndrome, post discectomy. The diagnostic process including imaging, nerve conduction studies, musculoskeletal examination coupled with provocation maneuvers, palpation, and the musculoskeletal differential diagnosis of buttock pain is illustrated. Reference is made to the aberrant sciatic nerve anatomy and to the myofascial component which is frequently reported to underlie piriformis muscle syndrome. Additionally, the use of validated neuropathic pain assessment tools in grading the possibility of neuropathic pain due to piriformis muscle syndrome is discussed. The prevalence and mechanisms of piriformis muscle syndrome, especially post sipnal surgery, are reviewed. Evidence-based multidisciplinary management underlying this condition is discussed. In refractory cases, treatment escalation, using intramuscular botulinum neurotoxin injection, usually yields very positive results and long-term pain resolution, as evidenced by the case study.

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A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning

Cited by 92 publications

References 186 publications

Impact of exercise programs among helicopter pilots with transient LBP

Impact of exercise programs among helicopter pilots with transient LBP

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

Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report

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