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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
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
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 [en]
Low back pain, Motor control, Deadlift, Randomized controlled trial, Pain, Disability, Activity
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-119939ISBN: 978-91-7601-481-3 (print)OAI: oai:DiVA.org:umu-119939DiVA: diva2:925706
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
List of papers
1. Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial
Open this publication in new window or tab >>Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial
2015 (English)In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 45, no 2, 77-85 p.Article in journal (Refereed) Published
Abstract [en]

Study Design Randomized controlled trial. Background Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. Objective To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Methods Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Methods Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Results Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). Conclusion An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance.

Keyword
deadlift,  functional rehabilitation,  motor learning,  stabilization exercises,  subgrouping
National Category
Orthopedics Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-100462 (URN)10.2519/jospt.2015.5021 (DOI)000349593300003 ()25641309 (PubMedID)
Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2017-12-04Bibliographically approved
2. Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises: a randomized controlled trial
Open this publication in new window or tab >>Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises: a randomized controlled trial
2017 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background Context

Assessment of posture and alignment is often a main focus in the classification and treatment for patients with low back pain. However, there is much not known regarding the effects of motor control interventions on objective measures of lumbo-pelvic alignment.

Purpose

The primary aim of this study was to describe the variation of sagittal lumbo-pelvic alignment in patients with nociceptive mechanical low back pain. The secondary aim was to compare the effects of low-load motor control exercises and a high-load lifting exercise on change in alignment with a special emphasis on patients with high and low degrees of lumbar lordosis and sacral angle.

Study Design

This study is a secondary analysis of a randomized controlled trial evaluating the effects of a high-load lifting exercise (HLL) and low-load motor control training (LMC).

Patient Sample

Patients from the primary study, i.e. patients with a dominating pattern of nociceptive mechanical low back pain, who agreed to participate in the radiographic examination were included (n=66).

Outcome measures

Lateral plain radiographic images were used to evaluate lumbo-pelvic alignment regarding lumbar lordosis and sacral angle as outcomes and posterior bend as an explanatory variable.

Methods

The participants were recruited from two occupational health care facilities. They were randomized to LMC or HLL intervention group and offered 12 sessions of exercise with an instructor. Outcome measures were collected at baseline at the end of intervention period 2 months after baseline.

Between and within group analyses of intervention groups and sub-groups based on the distribution of the baseline values for lumbar lordosis and sacral angle respectively, (LOW, MID, HIGH), were performed using both parametric and non-parametric tests.

This study was supported by two grants from Visare Norr and Norrbotten County Council.

Results

The lumbar lordosis and sacral angle in the present sample had a wide distribution, while the mean values for lumbar lordosis was 59.0, SD 11.5 degrees and for sacral angle 42.0, SD 9.6 degrees. There were no difference between groups in the percent change in either outcome measure. Neither did any outcome change significantly over time within the intervention groups. In the sub-groups based on the distribution of baseline values for lumbar lordosis and sacral angle respectively, the sub-group LOWlu representing low baseline values of lumbar lordosis increased their lumbar lordosis significantly. The sub-group HIGHsa, representing high baseline values for sacral angle, decreased their sacral angle significantly following intervention.

Conclusions

This study is the first to describe the wide distribution of values for lumbo-pelvic alignment for patients with nociceptive mechanical low back pain. There is however further need to investigate other types of low back pain in order to contrast these findings to other sub-groups of low back pain. The results also suggest that re-training of lumbo-pelvic alignment could be possible for patients with low back pain.

Keyword
Alignment, Deadlift, Low back pain, Lumbar lordosis, Lumbopelvic, Motor control, Sacral angle
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-119934 (URN)10.1016/j.spinee.2017.07.178 (DOI)28757287 (PubMedID)
Note

Originally published in manuscript form with title [Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises - a randomized controlled trial]

Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-11-30
3. The effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness – a randomized controlled trial
Open this publication in new window or tab >>The effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness – a randomized controlled trial
(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
Low Back Pain, morphology, multifidus, deadlift, motor control, resistance training
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-119936 (URN)
Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2016-05-11
4. Which patients with low back pain benefit from deadlift training?
Open this publication in new window or tab >>Which patients with low back pain benefit from deadlift training?
Show others...
2015 (English)In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 29, no 7, 1803-1811 p.Article in journal (Refereed) Published
Abstract [en]

Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.

Keyword
motor control, resistance training, Biering-Sørensen test, pain intensity, prediction
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-100463 (URN)10.1519/JSC.0000000000000837 (DOI)000357270000006 ()25559899 (PubMedID)
Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2017-12-04Bibliographically approved

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