Physical capacity and low back pain: Is there a connection?

We frequently advise patients that having strong trunk muscles and better lumbar mobility are important strategies to prevent future episodes of LBP. These types of recommendations go a long way to emphasizing autonomy versus dependence in managing this common musculoskeletal problem.

However, emerging evidence has spawned some serious questions and criticisms of our current paradigm regarding exercise and low back pain. For example, we still don't have a clear picture as to whether specific exercise programs or just activity in general is more effective at preventing LBP. We have even less specific guidelines regarding key exercise parameters such as volume or intensity of activity.

A recent systematic review in Pain raises even more difficult questions regarding the relationship between LBP and trunk strength, endurance, or mobility. After all inclusion criteria were met, the authors reviewed 24 articles. Relevant findings provided some very interesting food for thought.

• Trunk muscle strength and low back pain: Thirteen quality studies and four low-quality studies met the inclusion criteria and were reviewed. The authors found inconclusive evidence to support a specific relationship between trunk muscle strength and low back pain.

• Trunk muscle endurance and low back pain: Eight high quality studies and four low-quality studies were reviewed. In this case, there is strong evidence that there is no relationship between trunk muscle endurance and risk for LBP.

• Trunk mobility and low back pain: Seven high-quality studies and one low-quality study were reviewed. There was inconclusive evidence connecting lumbar mobility and low back pain due to conflicting results.

It should be acknowledged that there are some significant methodological limitations within this systematic review. There was substantial heterogeneity between many of the studies which should prompt the reader to cautiously interpret the results. However, as we are often keen to site evidence to support our interventions, we must all be prepared for the eventuality that our current paradigm may not be as rock-solid as we think.

Exercise will continue to be a significant part of my plans of care in the management of low-back pain. I doubt this will change dramatically, but systematic reviews like this have me looking even harder for the best available theoretical and clinical evidence to support my approach. Until next time!

H HAMBERGVANREENEN, G ARIENS, B BLATTER, W VANMECHELEN, P BONGERS (2007). A systematic review of the relation between physical capacity and future low back and neck/shoulder pain Pain, 130 (1-2), 93-107 DOI: 10.1016/j.pain.2006.11.004