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Poor association between chronic low back pain and physical deconditioning

PainSci » bibliography » Smeets et al 2006
Tags: back pain, strength, exercise, pain problems, spine, self-treatment, treatment

Two articles on PainSci cite Smeets 2006: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Low Back Pain

PainSci notes on Smeets 2006:

This 2006 review is painfully vague about the importance of low back muscle condition in chronic low back pain. Although there is some evidence that suggests that core stability training is good for back pain (see O’Sullivan), it’s nowhere near as strong as it should be, considering how popular the concept has been for the last fifteen years. Cardiovascular training for back pain has barely been studied, and the authors found no high quality studies of that at all — an unfortunate gap. There is only a little evidence of wasting of the deep multifidus muscle (which many assume to be deconditioned in back pain, though it could easily just be a symptom of being in pain, not a cause of it). They also conclude from the available evidence that “general and lumbar muscle strengthening are equally effective as other active treatments,” and the authors believe that it is “more promising” to study “the interplay between biological, social and psychological factors.” Not exactly a resounding endorsement of going to the gym for your low back pain!

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

PURPOSE: Does physical deconditioning (loss of cardiovascular capacity and strength/endurance of paraspinal muscles) exist in patients with chronic low back pain (CLBP) and are treatments specifically aimed to reduce these signs effective?

METHOD: Systematic literature search in PUBMED, MEDLINE, EMBASE and PsycINFO until December 2004 to identify observational studies regarding deconditioning signs and high quality RCTs regarding the effectiveness of cardiovascular and/or muscle strengthening exercises. Internal validity of the RCTs was assessed by using a checklist of nine methodology criteria in accordance with the Cochrane Collaboration.

RESULTS: There is conflicting evidence that cardiovascular deconditioning is present in CLBP and limited evidence for wasting of the multifidus muscle. No study examined the effectiveness of cardiovascular training specifically. General and lumbar muscle strengthening are equally effective as other active treatments. Only moderate evidence is available for the effectiveness of intensive low back extensor muscle strengthening compared to less intensive strengthening.

CONCLUSION: Probably reactivation caused by active treatment and not the reconditioning itself is the important factor in the reduction of disability. Further prospective and evaluative research into the role of physical deconditioning is necessary. It seems more promising to further explore the interplay between biological, social and psychological factors.

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