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The effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness – a randomized controlled trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Study Design

Randomized controlled trial

Objective

The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness among patients with nociceptive mechanical low back pain.

Summary of Background Data

There is evidence that patients with low back pain may have a decreased size of the lumbar multifidus muscles with an asymmetry between left/right sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry; essentially, it is effective in equalizing side differences in lumbar multifidus muscle size. It is, however, not known whether a high-load exercise has the same effect.

Methods

Sixty-five participants diagnosed with nociceptive mechanical low back pain were included and randomized into low-load motor control exercises or a high-load lifting exercise, the deadlift. The lumbar multifidus thickness at the fifth lumbar vertebra was measured, using rehabilitative ultrasound imaging, at baseline and after a 2-month training period.

Results

There were no differences between interventions regarding effect on lumbar multifidus muscle thickness. However, the linear mixed model analysis showed a significant effect for asymmetry. The thickness of the lumbar multifidus muscle on the small side increased significantly compared to the large side in both intervention groups.

Conclusions

There was a difference in thickness of the lumbar multifidus muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.

Keyword [en]
Low Back Pain, morphology, multifidus, deadlift, motor control, resistance training
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-119936OAI: oai:DiVA.org:umu-119936DiVA: diva2:925692
Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2016-05-11
In thesis
1. Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises
Open this publication in new window or tab >>Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise.

All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness.

There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline.

The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention.

The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1806
Keyword
Low back pain, Motor control, Deadlift, Randomized controlled trial, Pain, Disability, Activity
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-119939 (URN)978-91-7601-481-3 (ISBN)
Public defence
2016-06-02, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-05-12 Created: 2016-05-03 Last updated: 2016-05-26Bibliographically approved

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