Low back strengthening for the prevention and treatment of low back pain

Purpose: Chronic low back pain (CLBP) remains one of the most difficult and costly medical problems in the industrialized world. A review of nineteent h and early twentieth century spine rehabilitation shows that back disorder s were commonly treated with aggressive and specific progressive resistance exercise (PRE). Despite a lack of scientific evidence to support their eff icacy, therapeutic approaches to back rehabilitation over the past 30 yr ha ve focused primarily upon passive care for symptom relief. Recent spine reh abilitation programs have returned to active reconditioning PRE centered ar ound low back strengthening to restore normal musculoskeletal function. Res earch has shown that lumbar extension exercise using PRE significantly incr eases strength and decreases pain in CLBP patients. It appears that isolate d lumbar extension exercise with the pelvis stabilized using specialized eq uipment elicits the most favorable improvements in low back strength, muscl e cross-sectional area, and vertebral bone mineral density (BMD). These imp rovements occur with a low training volume of 1 set of 8 to 15 repetitions performed to volitional fatigue one time per week. CLBP patients participat ing in isolated lumbar extension PRE programs demonstrate significant reduc tions in pain and symptoms associated with improved muscle strength, endura nce, and joint mobility. Improvements occur independent of diagnosis, are l ong-lasting, and appear to result in less re-utilization of the health care system than other more passive treatments. Low back strengthening shows pr omise for the reduction of industrial back injuries and associated costs.