Using an approach to Strength and conditioning to provide public benefit in those with Chronic Low Back Pain (CLBP).
Submitting InstitutionSouthampton Solent University
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
The sport and exercise science team at Southampton Solent began its work
only in 2007, with little or no previous scholarly history. The new team
focussed on the area of strength and conditioning within the area of
sport, exercise and health. The overarching approach to strength and
conditioning training methodology defined in the work of Fisher et al
(2011) is momentary muscular fatigue (MMF) whereby training is undertaken
to maximal exertion. Using MMF the research team have demonstrated public
benefit, and thus interim impact, through improving performance within
client groups suffering from chronic low back pain (CLBP). Thus, we hope
to show interim impact and reach using this methodological approach
improving performance in those with CLBP.
During the past thirty or so years, the popularity of strength training
has increased enormously. However the relationship between strength
training and chronic lower back pain has remained ambiguous, without clear
guidance on appropriateness or application. The research team through
their scholarly activity have attempted to address the issue of confusion
through quality research and develop a strategic approach to training with
groups who suffer from CLBP.
Momentary Muscular Failure (MMF) and Chronic Lower Back Pain
The paper by Fisher et al (2012) challenges many of the approaches to
conventional strength training building on previous work undertaken by
Smith and Bruce-Low in 2004. The use of training to momentary muscular
fatigue enhances training efficiency as well as strength gains and is the
salient point covered in this article. Conditioning the muscles of the
lower back (erector spinae and multifidus) using MMF, through specific
lumbar extension exercise (as highlighted through the work of Fisher et
al, 2011; Fisher et al, 2012; Bruce-Low et al, 2012; Smith et al, 2011;
Steele et al, 2013; Steele et al, 2013a and Steele et al, 2013b) halts
deconditioning of these muscles which in turn reduced the risk for low
back injury and pain (Steele et al, 2013b).
Chronic Low Back Pain (CLBP)
As low back pain is one of the leading causes of work absenteeism around
the world and is therefore considered a major international problem with
escalating costs in the billions of pounds (£10.6 billion in 1998 which
has only escalated since). In the UK, up to 50 million working days are
lost each year as a result of individuals suffering from lower back pain,
with 20 % (1 in 5) of the UK reporting back pain to their general
practitioner (Bruce-Low et al, 2012). Therefore, a greater understanding
of how to implement interventions to reduce CLBP would be extremely
valuable socially and financially.
Therefore, using the training intervention of MMF, this research has
potential for huge impact for helping to reduce one of the world's leading
causes of absenteeism. It is the claim of this research group that this
research has both reach and interim impact.
Positions held during research period
Bruce-Low — Associate Professor Southampton Solent University
Fisher — Senior Lecturer Southampton Solent University
Steele — Associate Lecturer Southampton Solent University
Smith — Senior Lecturer Manchester Metropolitan University
References to the research
1. Fisher J, Steele J, Bruce-Low S, and Smith D (2011). Evidence-based
resistance training recommendations. Medicina Sportiva: 15 (3):
2. Fisher J, Bruce-Low S, Smith D. (2012). A Randomized Trial to consider
the effect of Romanian deadlift exercise on the development of lumbar
extension strength. Physical Therapy in Sport, August, 1-7.
3. Bruce-Low S, Smith D, Burnet S, Fisher J, Bissell G, Webster L.
(2012). One lumbar extension training session per week is sufficient for
optimal strength gains and reductions in low back pain in chronic
participants. Ergonomics: 55 (4), 500-7.
4. Steele J, Bruce-Low S, Smith D, Jessop D, Osbourne N (2013). A
Randomised Controlled Trial of Limited Range of Motion Lumbar Extension
Exercise in Chronic Low Back Pain. Spine.
5. Steele J, Bruce-Low S, Smith D (2013a). Clinical use of Specific
Exercise for the Lumbar Extensors in Chronic Low Back Pain. Clinical
Journal of Pain.
6. Steele J, Bruce-Low S, Smith D (2013b). A review of the specificity of
exercises designed for conditioning the lumbar extensors. British
Journal of Sport Medicine.
7. Smith D & Bruce-Low S. (2004) Strength training methods and the
work of Arthur Jones. Journal of Exercise Physiology online. 7
8. Smith D, Bissell G, Bruce-Low S, Wright C (2011). The effect of lumbar
extension training with and without pelvic stabilization on lumbar
strength and low back pain. Journal of Back and Musculoskeletal
Rehabilitation, 24, 1-9.
Articles 1, 2, 7 and 8 are well cited in the literature suggesting impact
within the academic field.
Articles 3, 4, 5 and 6 are published in
well-respected journals known for their rigorous peer review process
suggesting the quality of the articles is high.
Details of the impact
The manner in which the MMF strength training is undertaken is key and
the research from this group has shown that our work has interim impact.
Using this strength training approach, we believe this research has
interim impact for those with chronic low back pain and would argue has
high impact for those practitioners within the field of sport, exercise
and fitness working with those with CLBP across the world.
Chronic Low Back Pain and Strength Training
The approaches of the research team have also influenced their approach to
strength training for chronic low back pain (CLBP). With CLBP currently
costing the world's economy billions of pounds through loss of workforce
in the form of absenteeism, this is most certainly an area that is
important to address. The team have shown that the use of isolated lumbar
extension exercise has huge impact for the manner in which CLBP can be
treated in the future. The results have not only shown statistically
significant changes but also minimally clinical important changes for pain
reduction which is the bench mark requirement for impact within the health
care setting. This will have impact for the manner in which practitioners
deal with those with chronic low back pain in relation to how they either
rehabilitate or try to prevent low back pain with prehabilitation. This is
of particular importance considering the method suggested by the research
team is to isolate the muscles of the low back whilst training where the
majority of the world's training and rehabilitation professionals prefer
to not isolate when exercising. Furthermore, this evidence shows that
exercising the lumbar extensor musculature specifically once a week to
momentary muscular failure, through restricting concurrent pelvic
movement, even in a limited range of movement can alleviate the symptoms
of chronic low back pain (CLBP). This research has potential for high
interim impact for helping to reduce the world's leading cause of
absenteeism. Thus, this method of exercise training does indeed have high
interim impact, as it is novel and successful.
Sources to corroborate the impact
- Monthly Prescribing Reference — 11-07-13 Research from James Steele on
chronic lower back pain featured in Pharmaceuticals, demonstrating the
reach to practitioners Reference bitly.com/1buvEvh
- Exercise is good for back pain: BBC Radio clip including patient
testimony on SSU work http://www.bbc.co.uk/programmes/p01dy1fr
Researcher User Testimonials:
Anglo European College of Chiropractic corroborate the claim that SSU
research has changed the way that patients with lower back pain are
treated through prescribed exercise