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The Effects of Dynamic Isolated Lumbar Extensor Training on Lumbar Multifidus Functional Cross-Sectional Area and Functional Status of Patients With Chronic Nonspecific Low Back Pain

Willemink, Martin J. MD*; van Es, Hendrik W. MD, PhD*; Helmhout, Pieter H. PhD; Diederik, Arjen L. MD*; Kelder, Johannes C. MD; van Heesewijk, Johannes P. M. MD, PhD*

doi: 10.1097/BRS.0b013e318274fb2f
Occupational Health/Ergonomics

Study Design. A prospective single-arm trial.

Objective. To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP).

Summary of Background Data. LM morphology is associated with the recurrence of CNSLBP.

Methods. Sixteen male patients underwent a dynamic isolated resistance-training program for the lower back muscles of approximately 10 sessions in 12 weeks. In the next 12 weeks, frequency of training was tailored to the patients' need. Participants underwent lumbar magnetic resonance imaging at baseline (T 0), after 12 weeks (T 12), and after 24 weeks (T 24). Functional cross-sectional area was obtained by analyzing the magnetic resonance images. Functional status was assessed using the patient-specific functional scale, Roland-Morris disability questionnaire, and global perceived effect scale.

Results. Roland-Morris disability questionnaire and patient-specific functional scale scores showed significant and clinically relevant improvements between baseline and T 12, with 44% and 39%, respectively. Between T 12 and T 24, these scores did not change significantly. Seven participants (44%) reported clinically relevant improvements in global perceived effect at T 12. At T 24, 1 more participant reported a relevant global perceived effect improvement, whereas 2 participants (13%) reported worsening of their condition. The magnetic resonance imaging analysis showed minor nonsignificant changes in functional cross-sectional area.

Conclusion. Our study shows that 10 weeks of dynamic isolated training of the lumbar extensors, once a week, leads to clinically relevant improvements in functional status of men with CNSLBP, without accompanying improvements in functional cross-sectional area of LM. These findings suggest that improvement in LM morphology is not a critical success factor in restoring functional status of patients with CNSLBP, at least in the short term (6 mo).

Dynamic isolated resistance training of the lower back in 16 male adults with chronic nonspecific low back pain significantly improved functional status without influencing lumbar multifidus functional cross-sectional area as determined by magnetic resonance imaging.

Departments of *Radiology and

Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; and

Department of Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, the Netherlands.

Address correspondence and reprint requests to Martin J. Willemink, MD, PO Box 2500, 3430 EM Nieuwegein, the Netherlands; E-mail:

Acknowledgment date: March 21, 2012. First revision date: July 15, 2012. Second revision date: August 28, 2012. Acceptance date: September 10, 2012.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication. No funds were received in support of this work. No relevant financial activities outside the submitted work.

© 2012 Lippincott Williams & Wilkins, Inc.