Isolated Lumbar Extension Resistance Training Is Effective at Improving Extension Power and Disability in Subjects with Diagnosed Lumbar Multifidus Dysfunction
Background: Lumbar multifidus dysfunction is a prevalent cause of disability in individuals with lower back pain. Previous research highlights the benefits of isolated lumbar extension training for non-specific lower back pain, however, studies examining its efficacy in lumbar multifidus dysfunction are lacking. Objective: To evaluate the effectiveness of isolated lumbar extension resistance training on disability and strength in individuals with lumbar multifidus dysfunction. Methods: Subjects underwent a physiotherapy led structured rehabilitation program incorporating isolated lumbar extension. Sessions were conducted twice weekly targeting momentary muscular failure with time under load 90 - 120 seconds and progressions aimed at 5 - 10 lbs increments. Outcomes were assessed using the Oswestry Disability Index and lumbar extension strength testing at baseline and after 12 weeks, with statistical analysis using t-test and chi-squared 2 × 2. Results: Forty-five subjects (24 male, 21 female) with a median age of 48 completed the intervention. Improvements were noted in Oswestry Disability Index scores (median pre: 24, post: 15) and maximal lumbar extension strength (median pre: 122 lb, post: 186 lb), with p ≤ 0.05. Overall, 89% showed improvement in disability scores, 67% moved to a better disability category, and 51% saw at least a 50% increase in strength. No significant gender differences were observed. Conclusions: Isolated lumbar extension resistance training is effective at improving extension power and disability in subjects with lumbar multifidus dysfunction.
References
[1]
Ferreira, M.L., De Luca, K., Haile, L.M., Steinmetz, J.D., Culbreth, G.T., Cross, M., et al. (2023) Global, Regional, and National Burden of Low Back Pain, 1990-2020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021. TheLancet Rheumatology, 5, e316-e329.
[2]
Maher, C., Underwood, M. and Buchbinder, R. (2017) Non-Specific Low Back Pain. The Lancet, 389, 736-747. https://doi.org/10.1016/s0140-6736(16)30970-9
[3]
Nijs, J., Apeldoorn, A., Hallegraeff, H., Clark, J., Smeets, R., Malfliet, A., et al. (2015) Low Back Pain: Guidelines for the Clinical Classification of Predominant Neuropathic, Nociceptive, or Central Sensitization Pain. Pain Physician, 18, E333-E345. https://doi.org/10.36076/ppj.2015/18/e333
[4]
Russo, M., Deckers, K., Eldabe, S., Kiesel, K., Gilligan, C., Vieceli, J., et al. (2018) Muscle Control and Non-Specific Chronic Low Back Pain. Neuromodulation: Technology at the Neural Interface, 21, 1-9. https://doi.org/10.1111/ner.12738
[5]
Fortin, M. and Macedo, L.G. (2013) Multifidus and Paraspinal Muscle Group Cross-Sectional Areas of Patients with Low Back Pain and Control Patients: A Systematic Review with a Focus on Blinding. Physical Therapy, 93, 873-888. https://doi.org/10.2522/ptj.20120457
[6]
Freeman, M.D., Woodham, M.A. and Woodham, A.W. (2010) The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review. PM&R, 2, 142-146. https://doi.org/10.1016/j.pmrj.2009.11.006
[7]
Panjabi, M.M. (1992) The Stabilizing System of the Spine. Part II. Neutral Zone and Instability Hypothesis. Journal of Spinal Disorders, 5, 390-397. https://doi.org/10.1097/00002517-199212000-00002
[8]
Suni, J., Rinne, M., Natri, A., Statistisian, M.P., Parkkari, J. and Alaranta, H. (2006) Control of the Lumbar Neutral Zone Decreases Low Back Pain and Improves Self-Evaluated Work Ability: A 12-Month Randomized Controlled Study. Spine, 31, E611-E620. https://doi.org/10.1097/01.brs.0000231701.76452.05
[9]
Danneels, L.A., Vanderstraeten, G.G., Cambier, D.C., Witvrouw, E.E., De Cuyper, H.J. and Danneels, L. (2000) CT Imaging of Trunk Muscles in Chronic Low Back Pain Patients and Healthy Control Subjects. European Spine Journal, 9, 266-272. https://doi.org/10.1007/s005860000190
[10]
Tieppo Francio, V., Westerhaus, B.D., Carayannopoulos, A.G. and Sayed, D. (2023) Multifidus Dysfunction and Restorative Neurostimulation: A Scoping Review. Pain Medicine, 24, 1341-1354. https://doi.org/10.1093/pm/pnad098
[11]
Kjaer, P., Bendix, T., Sorensen, J.S., Korsholm, L. and Leboeuf-Yde, C. (2007) Are MRI-Defined Fat Infiltrations in the Multifidus Muscles Associated with Low Back Pain? BMC Medicine, 5, Article No. 2. https://doi.org/10.1186/1741-7015-5-2
[12]
Mar, N.B., Ndiaye, A., Diop, A.N., Diagne, G.S., Diao, B., Diao, S., et al. (2023) Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain. Forensic Medicine and Anatomy Research, 11, 1-13. https://doi.org/10.4236/fmar.2023.111001
[13]
Teichtahl, A.J., Urquhart, D.M., Wang, Y., Wluka, A.E., Wijethilake, P., O’Sullivan, R., et al. (2015) Fat Infiltration of Paraspinal Muscles Is Associated with Low Back Pain, Disability, and Structural Abnormalities in Community-Based Adults. The Spine Journal, 15, 1593-1601. https://doi.org/10.1016/j.spinee.2015.03.039
[14]
Chakravarthy, K., Lee, D., Tram, J., Sheth, S., Heros, R., Manion, S., et al. (2022) Restorative Neurostimulation: A Clinical Guide for Therapy Adoption. Journal of Pain Research, 15, 1759-1774. https://doi.org/10.2147/jpr.s364081
[15]
Steele, J., Bruce-Low, S. and Smith, D. (2014) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain. PM&R, 7, 169-187. https://doi.org/10.1016/j.pmrj.2014.10.009
[16]
Willemink, M.J., van Es, H.W., Helmhout, P.H., Diederik, A.L., Kelder, J.C. and van Heesewijk, J.P.M. (2012) 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. Spine, 37, E1651-E1658. https://doi.org/10.1097/brs.0b013e318274fb2f
[17]
Kader, D.F., Wardlaw, D. and Smith, F.W. (2000) Correlation between the MRI Changes in the Lumbar Multifidus Muscles and Leg Pain. Clinical Radiology, 55, 145-149. https://doi.org/10.1053/crad.1999.0340
[18]
Lee, S., Choi, D.S., Shin, H.S., Baek, H.J., Choi, H.C. and Park, S.E. (2018) FSE T2-Weighted Two-Point Dixon Technique for Fat Suppression in the Lumbar Spine: Comparison with SPAIR Technique. Diagnostic and Interventional Radiology, 24, 175-180. https://doi.org/10.5152/dir.2018.17320
[19]
Ekin, E.E., Kurtul Yildiz, H. and Mutlu, H. (2016) Age and Sex-Based Distribution of Lumbar Multifidus Muscle Atrophy and Coexistence of Disc Hernia: An MRI Study of 2028 Patients. Diagnostic and Interventional Radiology, 22, 273-276. https://doi.org/10.5152/dir.2015.15307
[20]
Carpenter, D.M., Graves, J.E., Pollock, M.L., Leggett, S.H., Foster, D., Holmes, B., et al. (1991) Effect of 12 and 20 Weeks of Resistance Training on Lumbar Extension Torque Production. Physical Therapy, 71, 580-588. https://doi.org/10.1093/ptj/71.8.580
[21]
Steele, J., Fisher, J., Giessing, J. and Gentil, P. (2017) Clarity in Reporting Terminology and Definitions of Set Endpoints in Resistance Training. Muscle & Nerve, 56, 368-374. https://doi.org/10.1002/mus.25557
[22]
Steele, J. (2013) intensity; in-ten-si-ty; noun. 1. Often Used Ambiguously within Resistance Training. 2. Is It Time to Drop the Term Altogether? British Journal of Sports Medicine, 48, 1586-1588. https://doi.org/10.1136/bjsports-2012-092127
[23]
Seif, H.E., Alenazi, A., Hassan, S.M., Kachanathu, S.J. and Hafez, A.R. (2015) The Effect of Stretching Hamstring, Gastrocnemius, Iliopsoas and Back Muscles on Pain and Functional Activities in Patients with Chronic Low Back Pain: A Randomized Clinical Trial. Open Journal of Therapy and Rehabilitation, 3, 139-145. https://doi.org/10.4236/ojtr.2015.34019
[24]
Steele, J., Bruce-Low, S. and Smith, D. (2013) A Review of the Specificity of Exercises Designed for Conditioning the Lumbar Extensors. British Journal of Sports Medicine, 49, 291-297. https://doi.org/10.1136/bjsports-2013-092197
[25]
Fairbank, J.C.T. and Pynsent, P.B. (2000) The Oswestry Disability Index. Spine, 25, 2940-2953. https://doi.org/10.1097/00007632-200011150-00017
[26]
Buchbinder, R., Underwood, M., Hartvigsen, J. and Maher, C.G. (2020) The Lancet Series Call to Action to Reduce Low Value Care for Low Back Pain: An Update. Pain, 161, S57-S64. https://doi.org/10.1097/j.pain.0000000000001869
[27]
Steiger, F., Wirth, B., de Bruin, E.D. and Mannion, A.F. (2011) Is a Positive Clinical Outcome after Exercise Therapy for Chronic Non-Specific Low Back Pain Contingent upon a Corresponding Improvement in the Targeted Aspect(s) of Performance? A Systematic Review. European Spine Journal, 21, 575-598. https://doi.org/10.1007/s00586-011-2045-6
[28]
Lederman, E. (2010) The Myth of Core Stability. Journal of Bodywork and Movement Therapies, 14, 84-98. https://doi.org/10.1016/j.jbmt.2009.08.001
[29]
Gilligan, C., Volschenk, W., Russo, M., Green, M., Gilmore, C., Mehta, V., et al. (2023) Three-Year Durability of Restorative Neurostimulation Effectiveness in Patients with Chronic Low Back Pain and Multifidus Muscle Dysfunction. Neuromodulation: Technology at the Neural Interface, 26, 98-108. https://doi.org/10.1016/j.neurom.2022.08.457
[30]
Martuscello, J.M., Nuzzo, J.L., Ashley, C.D., Campbell, B.I., Orriola, J.J. and Mayer, J.M. (2013) Systematic Review of Core Muscle Activity during Physical Fitness Exercises. Journal of Strength and Conditioning Research, 27, 1684-1698. https://doi.org/10.1519/jsc.0b013e318291b8da
