Isolated Lumbar Extensor Strengthening Versus Regular Physical Therapy in an Army Working Population With Nonacute Low Back Pain: A Randomized Controlled Trial

Abstract 

Helmhout PH, Harts CC, Viechtbauer W, Staal JB, de Bie RA. Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial.

Objective

To evaluate the effectiveness of specific lumbar extensor training compared with regular physical therapy (PT) in workers with nonspecific nonacute low back pain (LBP).

Design

A multicenter randomized controlled trial with 1-year follow-up.

Setting

PT department in (military primary care) health centers.

Participants

Predominantly male soldiers (N=129) with 4 weeks or more of low back complaints who were referred by the health center's general practitioner for PT (mean age, 35.9±10.8y; range, 20–56y), of whom 127 randomized participants were included in the analyses. One patient withdrew because of adverse effects during treatment.

Interventions

Participants were assigned to 1 of 2 treatment programs: (1) a 10-week device-supported isolated lumbar extension training, twice a week, or (2) regular PT, mainly consisting of exercise therapy and aerobic activities.

Main Outcome Measures

Functional status (Roland-Morris Disability Questionnaire, Patient-Specific Functional Scale) and global perceived effect were assessed in the short term (5wk, 10wk) and long term (6mo, 12mo).

Results

Both groups showed a favorable development in main outcomes over time: short-term improvements (after 10 weeks of treatment) remained stable or even slightly increased throughout the 12-month follow-up. No significant differences between the 2 groups were shown for any of the outcome measures, at any time.

Conclusions

Consistent with prior evidence, specific back strengthening does not seem to offer incremental benefits in LBP management compared with regular PT care that mainly consists of general exercise therapy. (ISRCTN identifier ISRCTN19334317.)

Key Words: Exercise, Low back pain, Rehabilitation

List of Abbreviations: GP, general practitioner, GPE, global perceived effect, LBP, low back pain, 1-RM, 1-repetition maximum, PSFS, Patient-Specific Functional Scale, PT, physical therapy, RMDQ, Roland-Morris Disability Questionnaire, TSK, Tampa Scale for Kinesiophobia