Periodized Resistance Training: Strength, Function and Low Back Pain.

The influence of periodized resistance training on recreationally active males with chronic nonspecific low back pain. J Strength Cond Res. 2011 Jan;25(1):242-51.
Jackson JK, Shepherd TR, Kell RT.

From the study:

Abstract
The most common musculoskeletal health issue is chronic nonspecific low back pain (CLBP). CLBP increases pain and disability, which reduces quality of life (QoL). Generally, pain, disability, and QoL are improved with a moderate volume and intensity of physical activity. Recently, periodized resistance training (PRT) was shown to be effective at improving CLBP in sedentary young, middle-age, and older adults. The purpose of this study was to determine if PRT would increase strength, reduce pain and disability, and improve QoL in recreationally active, moderately trained middle- and older-age males. Forty-five male subjects were divided according to age into 1 of 3 groups: (a) middle-age exercise (ME), (b) old-age exercise (OE), or (c) control (C). All subjects suffered from CLBP and were considered to be moderately trained, participating in recreational ice hockey for 60 minutes, 2 times per wk(-1) for ∼5 months/year along with other recreational activities. The study ran for 16 weeks (3-week familiarization and 13 weeks of testing and PRT) with 5 repetition maximum testing at baseline and weeks 8 and 12. The PRT program systematically and progressively overloaded all major muscle groups (whole-body workout). The results indicate that middle- and old-age recreationally active males with CLBP respond similarly in magnitude to PRT, with improvements in all outcome measures (strength, pain, disability, QoL) across all time points of the study. Clinical significance (≥ 25%) in outcome measures was reached on most variables for the ME and OE groups. The results suggest that PRT may be effectively applied as rehabilitation for moderately trained recreational athletes with CLBP.

Chad’s comments:

This is a great study regarding strengthening and low back pain, as most people are taught that they need to stretch. In it the middle aged men averaged 52 years and the older group average age was 63. Age did not have much effect on the outcomes. The percent changes were great on all variables including strength on all exercises. Decrease in disability as per the Oswestry questionnaire was considerable 46-52%. Initially I was least impressed with the pain reduction which while it was a significant 26-27% decrease, means pain only decreased from 4.3-4.5/10 to a 3.2-3.3/10, which I feel could be better. Looking at their exercise program I was initially critical as I think there are some exercise selections that would have improved outcomes further. What they used were:

  1. Leg press
  2. Leg extensions
  3. Leg curl
  4. Bench Press
  5. Incline Bench Press
  6. Lat Pulldown
  7. Low cable row
  8. DB shoulder press
  9. Arm curl
  10. Triceps pushdown
  11. Ab Crunches
  12. Swiss ball crunch
  13. Prone superman

However when I read the preceding study by the same authors using the same exercise program they specifically stated they wanted  as few confounding variables as possible and wanted to know what periodized strengthening alone did, not strengthening in combination with some other factor.  I would prefer more exercises like standing cable presses, standing cable rows, squats, Romanian deadlifts (RDLs), and lunges. The latter I think would better challenge the ability to maintain a neutral spine, and teach motor control of the spine while doing so, but would introduce additional variables into the study. That said the researchers appear to have all major muscle groups covered, including the core. This was explained in the prior paper as well, as they wanted to know what total body strengthening did as opposed to core strength alone. I agree that the total body approach is best because a strong core does the back little good if the arms and legs are not strong as well. It’s not easy to bend over and pick up something heavy with a neutral spine if your legs and arms are not strong also.  A strong core that does most of the lifting with by flexing and extending the spine, rather than flexing and extending the hips, still often hurts.

Overall it’s a great study to see what the effects increases in strength have on pain and disability. I still I think a complete lumbar rehabilitation program should also include postural awareness/spine/hip motor control teaching the ability to maintain a neutral spine during work, rest and play, this study showed what total body strength by itself contributes. The results were still substantial and considerably better than just staying active (as the control group did), which is more than you can say for the McKenzie method, flexion stretches, etc. so physical therapists should take note.  I expect I’ll be citing this study on the reg.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

3 thoughts on “Periodized Resistance Training: Strength, Function and Low Back Pain.

  1. Hey Chad,

    Do you have a specific workout plan for someone with LBP and mild sciatica. I have had sciatica for the last 3 months after a knee injury. I also had sciatica last year. I got into strength training last time and it went away entirely but I have lost allot of confidence since the last episode and I want to know where to start so I can end with a stronger back and be the active person I have always been

    Thanks,

    Ricky

  2. Hello-

    I have the same question as above from Ricky E. Do you have a workout plan for someone with sciatica?

    I look forward to your reply!

    Thank you-
    Shane

    • Hi Shane (and Ricky!),

      Sorry for getting back to the two of you late. I was in India studying yoga for the soul purpose of helping treat spine pain and sciatica from afar and without equipment. For what it’s worth I don’t endorse typical stretchy based yoga for sciatica as I think all the spine flexion mimics the source of pain rather than treats it, but my yoga sequence is based more on my strength and conditioning programs and spine awareness like I teach with my weights. The new website, which is only partially finished at this point is spinalflowyoga.com.

      However, since you guys are asking about weights, I have a video on this page, that shows my basic program that I work most of my back/sciatic pain patients up to. I’ll usually start with the rows and presses, and maybe one or two other exercises with light weights on the first day, then preferably training three times per week, I’ll start increasing the weights and adding an exercise or two a day until everything is strong and painless. Spine awareness and good postures during the day is often more important than the exercise. EMS, like you see the woman doing at the end improves the rate of recovery (pain and abdominal strength) at least 100% in my estimation. The exercises are done three sets of 15 reps each assuming no pain, progressing weights on each of the three sets from an (easy-medium-hard) manner. I hope that helps.

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