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Comparing Treatment Programs for Low Back Pain
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Posted on: 09/11/2008
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Specific back strengthening doesn't work any better than general exercise in the treatment of low back pain (LBP). This is the final conclusion of a multicenter study done in a military setting with male soldiers.
This study was conducted by the Royal Netherlands (Dutch) Army. But even though it is restricted to army soldiers, the findings can apply to other groups that employ workers involved in strenuous jobs. This could include police officers, fire fighters, and construction workers. Any other workers in occupations that involve pushing, pulling, bending, and lifting may benefit from this information.
The results of this study support findings from previous studies that exercise of any kind is helpful in recovering from an acute episode of LBP. Some subgroups of patients do need a specific exercise program. But to prevent acute LBP from turning into a chronic problem, the key is to get active and stay active during the recovery process.
This information is especially helpful in a military setting. Chronic back pain can reduce soldier productivity, run up the cost of health care, and negatively affect the injured soldier's quality of life. Disability from chronic low back pain means higher costs in terms of disability pensions and replacement costs.
Previous studies done by this same group have shown that a 10-minute program to train lumbar extensor muscles works just as well as a more extensive multidisciplinary exercise program. They have continued with their studies looking for the best type of exercise needed for LBP. Frequency, intensity, and duration of for each type of exercise is being investigated.
In this study, one group was enrolled in a 10-week program of isolated lumbar extension training. A specific strengthening device called the Total Trunk Rehab machine was used. This machine is used for low back strength-training. There is a special knee-lock system and thigh-restraining belt that keep both the thighs and knees from moving. This helps isolate the muscles of the lumbar spine.
Everyone in the lumbar extension group worked out on the machine for 10 minutes under the supervision of a physical therapist. A total of 14 training sessions were completed (twice a week for seven weeks). Body mechanics, pace, motion, weight load, and number of repititions were observed and modified for safety.
In the second group, the soldiers received regular physical therapy (PT). PT consisted of a 10-week program of hands-on treatment such as manual therapy, joint mobilization, stretching exercises. Some patients received instruction in aerobic exercise or core strength training. Each session was 25 to 30 minutes long. The therapists could also include patient education and instructions in back function. The soldiers in this group did not use the Total Trunk Rehab device.
Results were measured using the Roland-Morris Disability Questionnaire (RMDQ). The RMDQ assesses physical function. A second tool called the Patient Specific Functional Scale was used to measure functional status. A third tool (the Tampa Scale for Kinesiophobia (TSK)) was used to measure how much patients' fear of movement or fear of reinjury affected their activities.
Isometric back strength was measured on the lower back machine. Everyone was followed for a full year. Short-term results were observed at the end of five and 10 weeks. Long-term results were reported after six and 12 months. Patient satisfaction was also measured directly by asking each person if they were satisfied with their treatment.
The authors report no differences in outcomes between the two groups. Soldiers in each group improved equally no matter what measure was used to assess the results. Everyone was equally satisfied with their program. They were given a chance at the end of the study to switch to the other type of treatment.
There is some question as to whether the findings reflect treatment effects versus just the natural history of recovery (the soldiers just got better with time). The only way to sort this out would be to include a control group (soldiers who got no treatment). But in a military organization, this isn't an acceptable option.
Future studies with civilians comparing three groups (strength-training, physical therapy, control) are advised. Different age groups for both genders should also be compared as this study only included young, otherwise healthy, adult males.
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References:
Pieter H. Helmhout, MSc, et al. Isolated Lumbar Extensor Strengthening Versus Regular Physical Therapy in an Army Working Population With Nonacute Low Back Pain: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabiliation. September 2008. Vol. 89. No. 9. Pp. 1675-1685.
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