Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain

Steele, James; Fisher, James; Perrin, Craig; Conway, Rebecca; Bruce-Low, Stewart; Smith, Dave

doi:10.1080/09638288.2018.1424952

Cited by 24 publications

(26 citation statements)

References 39 publications

(22 reference statements)

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“…Strength is an important target for exercise interventions and test scores are considered representative for clinical outcome. 38 However, authors’ findings are somewhat controversial, as a recently published meta-analysis of more than 5000 patients came to the conclusion that back muscle strength and, even to a greater extent, abdominal strength showed no significant association with low back pain. 39 These findings fit well with our own results, where flexion strength had no significant impact on limitations/restrictions in any of the activity or participation categories.…”

Section: Discussionmentioning

confidence: 99%

Changes in the International Classification of Functioning, Disability, and Health Components “Activity/Participation” as Predicted Through Patient-Reported Outcomes Along With Comprehensive Back Pain Rehabilitation

Kienbacher

Fehrmann

Tuechler

et al. 2021

The Clinical Journal of Pain

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Objectives: The World Health Organization (WHO) recommended the International Classification of Functioning, Disability and Health (ICF) but its use in clinical practice is sparse. This study investigated the limitations and restrictions in the most relevant brief ICF core set categories for chronic low back pain (cLBP) as automatically predicted from routinely measured outcomes using a novel, validated mapping algorithm. Materials and Methods: Of 2718 cLBP patients recruited, data from 1541 (64% females) were available from before and at the end of 6 months comprehensive outpatient rehabilitation. Assessments included the Roland Morris Disability Questionnaire (RMDQ) and Pain Disability Index (PDI) questionnaires, the percentage of patients with predicted limitations and restrictions in important activity and participation ICF categories, bodily functional measurements, pain intensity, and anxiety/depression (EQ-5D). Results: At baseline, both the RMDQ and the PDI measures were within the third of the lowest disability scores whilst 80% of the patients had limitations with “maintaining a body position” and 30% with “walking” ICF categories. Intervention-associated gains in the maximum isometric lumbar extension and flexion strength and the lumbar range of motion were significant overall, but improvements in patients’ ICF limitations/restrictions varied. Anxiety/depression, lumbar range of motion, and extension strength all had a significant impact on the majority of the ICF categories, whereas flexion strength had none. Discussion: The rate of patients with predicted limitations/restrictions in activity/participation ICF core categories for cLBP partly mirrored disability levels and the impact of the body function scores on these limitations/restrictions in ICF categories was varied. Thus, assessing problems in the ICF activity/participation core categories is of relevance to clinical practice for both treatment goal setting and intervention planning. This may be achieved by computer-generated mapping without additional time burden.

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Section: Discussionmentioning

confidence: 99%

Changes in the International Classification of Functioning, Disability, and Health Components “Activity/Participation” as Predicted Through Patient-Reported Outcomes Along With Comprehensive Back Pain Rehabilitation

Kienbacher

Fehrmann

Tuechler

et al. 2021

The Clinical Journal of Pain

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“…Thus, sarcopenia and back muscle degeneration should be considered separate factors influencing back pain. Lumbar extensor muscles are important for controlling gait in patients with back pain [21], and lumbar extensor strengthening exercises can substantially improve clinical outcome in patients with chronic back pain plus deconditioning [22]. Additionally, lumbar extensor muscles are critical for the dynamic control of spinal segments [23].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study

Kim

Song

et al. 2020

Asian Spine J

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Study Design: Case-control study.Purpose: To investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.Overview of Literature: The Asian Working Group for Sarcopenia recommends diagnosis using handgrip strength, gait speed, and skeletal muscle mass. However, these criteria do not strongly reflect back muscle degeneration.Methods: Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.Results: The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.Conclusions: We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

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“…By controlling these movements, the lumbar extensors also stabilize and protect the underlying osteoligamentous spinal structures from potentially harmful stresses that might otherwise be experienced as a result of movements made beyond their optimal functional range and/or over protracted periods [5]. There is evidence of an association between decreased strength, muscular endurance, atrophy, and excessive fatigability of the lumbar extensors, and chronic non-specific low back pain [6][7][8][9][10][11][12]. Prospective studies also suggest lumbar extensor deconditioning may be a common risk factor predicting acute low back injury and low back pain (LBP) [11,12].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Lumbar Extensor Muscles in the Context of Trunk Function, a Pilot Study in Healthy Individuals

Vlažná

Krkoška

Kuhn³

et al. 2021

Applied Sciences

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A comprehensive assessment of trunk function, including the lumbar extensor muscles, appears to be important in various conditions affecting axial musculature. This pilot cross-sectional observational study aimed to define a battery of tests that comprehensively assess trunk muscle function (strength and muscular endurance). Sixty subjects without low back pain (LBP) underwent measurement of isometric lower back extensor strength using a hand-held dynamometer (HHD) in three positions; measurement of respiratory muscle strength; and Biering–Sørensen, prone-plank, and side-bridge tests. The repeatability, short-term and long-term reliability using the HHD device in different postural positions was confirmed. The greatest isometric lower back extensor strength was generated in the sitting position by male subjects. Time of effort in the Biering–Sørensen test was longer in women and older subgroups than in men and younger individuals, although this was not the case for the other two muscular endurance tests. This pilot monitoring of trunk muscle strength and endurance in healthy volunteers may lead to a better understanding of trunk muscle function. Based on this methodological background, the authors aim to use the defined battery of tests in their further studies in a group of patients with LBP and certain neuromuscular diseases to verify its usefulness in clinical practice.

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Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain

Cited by 24 publications

References 39 publications

Changes in the International Classification of Functioning, Disability, and Health Components “Activity/Participation” as Predicted Through Patient-Reported Outcomes Along With Comprehensive Back Pain Rehabilitation

Changes in the International Classification of Functioning, Disability, and Health Components “Activity/Participation” as Predicted Through Patient-Reported Outcomes Along With Comprehensive Back Pain Rehabilitation

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study

Assessment of Lumbar Extensor Muscles in the Context of Trunk Function, a Pilot Study in Healthy Individuals

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