Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 9 , Pages 1675-1685 , September 2008

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

  • Pieter H. Helmhout, MSc

      Affiliations

    • Department of Training Medicine and Training Physiology, Personnel Command, Royal Netherlands Army, Utrecht, The Netherlands
    • Corresponding Author InformationReprint requests to Pieter H. Helmhout, MSc, Dept of Training Medicine and Training Physiology, Personnel Command, Royal Netherlands Army, PO Box 90004, Utrecht, 3509 AA, The Netherlands
    • ,
  • Chris C. Harts, MSc

      Affiliations

    • Department of Training Medicine and Training Physiology, Personnel Command, Royal Netherlands Army, Utrecht, The Netherlands
    • ,
  • Wolfgang Viechtbauer, PhD

      Affiliations

    • Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
    • ,
  • J. Bart Staal, PhD

      Affiliations

    • Department of Epidemiology and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
    • ,
  • Rob A. de Bie, PhD

      Affiliations

    • Department of Epidemiology and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands

References 

  1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581–585
  2. Hutubessy RC, van Tulder MW, Vondeling H, Bouter LM. Indirect costs of back pain in the Netherlands: a comparison of the human capital method with the friction cost method. Pain. 1999;80:201–207
  3. Morken T, Riise T, Moen B, et al. Frequent musculoskeletal symptoms and reduced health-related quality of life among industrial workers. Occup Med (Lond). 2002;52:91–98
  4. Morken T, Riise T, Moen B, et al. Low back pain and widespread pain predict sickness absence among industrial workers. BMC Musculoskelet Disord. 2003;4:21
  5. Berkowitz SM, Feuerstein M, Lopez MS, Peck CA. Occupational back disability in U.S. Army personnel. Mil Med. 1999;164:412–418
  6. Lahiri S, Markkanen P, Levenstein C. The cost effectiveness of occupational health interventions: preventing occupational back pain. Am J Ind Med. 2005;48:515–529
  7. Hashemi L, Webster BS, Clancy EA, Volinn E. Length of disability and cost of workers' compensation low back pain claims. J Occup Environ Med. 1997;39:937–945
  8. Alexanderson KA, Borg KE, Hensing GK. Sickness absence with low-back, shoulder, or neck diagnoses: an 11-year follow-up regarding gender differences in sickness absence and disability pension. Work. 2005;25:115–124
  9. Feuerstein M, Berkowitz SM, Peck CA. Musculoskeletal-related disability in US Army personnel: prevalence, gender, and military occupational specialties. J Occup Environ Med. 1997;39:68–79
  10. Van Tulder MW, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol. 2002;16:761–775
  11. Marras WS. Occupational low back disorder causation and control. Ergonomics. 2000;43:880–902
  12. Burdorf A, Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health. 1997;23:243–256
  13. Van Tulder MW, Koes B, Malmivaara A. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2006;15(Suppl 1):S64–S81
  14. Slade SC, Keating JL. Trunk-strengthening exercises for chronic low back pain: a systematic review. J Manipulative Physiol Ther. 2006;29:163–173
  15. Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142:776–785
  16. Taylor NF, Dodd KJ, Damiano DL. Progressive resistance exercise in physical therapy: a summary of systematic reviews. Phys Ther. 2005;85:1208–1223
  17. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works?. Pain. 2004;107:176–190
  18. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004;4:106–115
  19. Ferreira ML, Ferreira PH, Latimer J, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain. 2007;131:31–37
  20. Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine. 2006;31:E670–E681
  21. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 1999;24:2435–2448
  22. Bouter LM, van Tulder MW, Koes BW. Methodologic issues in low back pain research in primary care. Spine. 1998;23:2014–2020
  23. Leboeuf-Yde C, Lauritsen JM, Lauritzen T. Why has the search for causes of low back pain largely been nonconclusive?. Spine. 1997;22:877–881
  24. Helmhout PH, Harts CC, Staal JB, de Bie RA. Rationale and design of a multicenter randomized controlled trial on a “minimal intervention” in Dutch army personnel with nonspecific low back pain [ISRCTN19334317]. BMC Musculoskelet Disord. 2004;5:40
  25. Helmhout PH, Harts CC, Staal JB, Candel MJ, de Bie RA. Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial. Eur Spine J. 2004;13:537–547
  26. Leggett S, Mooney V, Matheson LN, et al. Restorative exercise for clinical low back pain: a prospective two-center study with 1-year follow-up. Spine. 1999;24:889–898
  27. Nelson BW, O'Reilly E, Miller M, Hogan M, Wegner JA, Kelly C. The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up. Orthopedics. 1995;18:971–981
  28. Risch SV, Norvell NK, Pollock ML, et al. Lumbar strengthening in chronic low back pain patients: physiologic and psychological benefits. Spine. 1993;18:232–238
  29. Miltner O, Wirtz DC, Siebert CH. [Strengthening lumbar extensors: therapy of chronic back pain: an overview and meta-analysis] [German]. Z Orthop Ihre Grenzgeb. 2001;139:287–293
  30. Manniche C, Hesselsoe G, Bentzen L, Christensen I, Betzen L, Lundberg E. Clinical trial of intensive muscle training for chronic low back pain. Lancet. 1988;2:1473–1476
  31. Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselsoe G. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain. 1991;47:53–63
  32. Harts CC, Helmhout PH, de Bie RA, Staal JB. A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial. Aust J Physiother. 2008;54:23–31
  33. Fleck SJ, Kraemer WJ. Designing resistance training programs. 2nd ed. Champaign: Human Kinetics; 1997;
  34. Pollock ML, Leggett SH, Graves JE, Jones A, Fulton M, Cirulli J. Effect of resistance training on lumbar extension strength. Am J Sports Med. 1989;17:624–629
  35. Carpenter DM, Graves JE, Pollock ML, et al. Effect of 12 and 20 weeks of resistance training on lumbar extension torque production. Phys Ther. 1991;71:580–588
  36. Tucci JT, Carpenter DM, Pollock ML, Graves JE, Leggett SH. Effect of reduced frequency of training and detraining on lumbar extension strength. Spine. 1992;17:1497–1501
  37. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins; 2000;
  38. Gommans I, Koes B, Van Tulder M. Validiteit en responsiviteit Nederlandse Roland Disability Questionnaire: Vragenlijst naar functionele status bij patiënten met lage rugpijn. Ned Tijdschr Fysiother. 1997;2:28–33
  39. Roland M, Morris R. A study of the natural history of back pain, part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141–144
  40. Beurskens AJ, de Vet HC, Köke AJ, et al. A patient-specific approach for measuring functional status in low back pain. J Manipulative Physiol Ther. 1999;22:144–148
  41. Beurskens AJ, de Vet HC, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996;65:71–76
  42. Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manag. 1990;35–43Jan/Feb
  43. Goubert L, Crombez G, Vlaeyen J, van Damme S, van den Broeck A, van Houdenhove B. De Tampa schaal voor kinesiofobie: Psychometrische karaktersitieken en normering. Gedrag Gezond. 2000;28:54–62
  44. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363–372
  45. Bouter LM, van Dongen MC. Epidemiologisch onderzoek: opzet en interpretatie. 3rd. Houten/Diegem: Bohn Stafleu Van Loghum; 1995;
  46. Rosner BA. Fundamentals of biostatistics. 4th ed. Belmont: Duxbury Pr; 1995;
  47. Resnik L, Dobrzykowski E. Guide to outcomes measurement for patients with low back pain syndromes. J Orthop Sports Phys Ther. 2003;33:307–316; discussion 17-8
  48. Pinheiro JC, Bates DM, DebRoy S, Sarkar D. Linear and nonlinear mixed effects models. Version 3.1-80. 2007. http://cran.r-project.org/web/packages/nlme/index.htmlAccessed June 7, 2007
  49. R Developement Core Team. R: a language and environment for statistical computing. Viennaa: R Foundation for Statistical Computing; 2007;Available at: http://www.R-project.org. Accessed Jan 7, 2007
  50. Babyak MA. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med. Psychosom Med. 2004;66:411–421
  51. Bekkering GE, Hendriks HJ, van Tulder MW, et al. Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques. Spine. 2005;30:1881–1886
  52. Fritz JM, George SZ. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Phys Ther. 2002;82:973–983
  53. Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156:1028–1034
  54. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109–E120
  55. De Vet HC, Bouter LM, Bezemer PD. Reproducibility and responsiveness of evaluative outcome measures: theoretical considerations illustrated by an empirical example. Int J Technol Assess Health Care. 2001;17:479–487
  56. Petersen T, Kryger P, Ekdahl C, Olsen S, Jacobsen S. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: a randomized controlled trial. Spine. 2002;27:1702–1709
  57. Kuukkanen T, Malkia E. Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain. Physiother Res Int. 2000;5:46–61
  58. Kankaanpaa M, Taimela S, Airaksinen O, Hanninen O. The efficacy of active rehabilitation in chronic low back pain: effect on pain intensity, self-experienced disability, and lumbar fatigability. Spine. 1999;24:1034–1042
  59. Bendix AF, Bendix T, Labriola M, Haestrup C, Ebbehoj N. Functional restoration for chronic low back pain: 2-year follow-up of 2 randomized clinical trials. Spine. 1998;23:717–725
  60. Hansen FR, Bendix T, Skov P, et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain: a randomized, observer-blind trial. Spine. 1993;18:98–108
  61. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142:776–785

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)00389-4

doi: 10.1016/j.apmr.2007.12.050

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 9 , Pages 1675-1685 , September 2008

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