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A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Steele, James Bruce-Low, Stewart Smith, Dave
Description	Country affiliation: United kingdom Author Affiliation: Steele J ( Southampton Solent University , Southampton, Hampshire , UK.)
Abstract	OBJECTIVE: 'Disuse' and 'Deconditioning' in relation to low back pain (LBP) are terms often used interchangeably. Discussions of 'disuse' refer to general physical inactivity, which evidence suggests does not differ between symptomatic and asymptomatic persons. 'Deconditioning' refers to a decrease in function, commonly both cardiovascular/aerobic fitness and muscular strength/endurance, again noting little difference. However, examination of decreased function relating specifically to lumbar extensor musculature deconditioning has yet to be examined, corroborating all possible methods. Thus, this review attempts to reappraise the deconditioning hypothesis in LBP, specifically considering lumbar extensor deconditioning. METHODS: A literature review was conducted examining both cross-sectional and prospective data on specific lumbar extensor deconditioning and LBP. A narrative approach and 'snowballing' style literature search was used involving initial use of PubMed and Google Scholar databases searching up to December 2012. Included were studies utilizing the following three research methods, allowing specific induction of the role of such deconditioning; (1) strength/endurance testing of the isolated lumbar extensor musculature, (2) imaging and histochemical examination of the lumbar extensor musculature, and (3) fatigue testing of the lumbar extensor musculature using electromyography. RESULTS/FINDINGS: Despite issues interpreting individual studies due to methods, the majority of evidence suggests LBP is associated with decreased strength/endurance, atrophy, and excessive fatigability of the lumbar extensors. Prospective studies also suggest lumbar extensor deconditioning may be a common risk factor predicting acute low back injury and LBP. CONCLUSIONS: The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported. It is by no means the only causative factor and further research should more rigorously test this hypothesis addressing the methodological issues highlighted regarding previous studies. However, its role suggests specific exercise may be a worthwhile preventative and rehabilitative approach.
File Format	HTM / HTML
ISSN	03007995
Issue Number	5
Journal	Current Medical Research and Opinion
Volume Number	30
e-ISSN	14734877
Language	English
Publisher	Taylor & Francis
Publisher Date	2014-05-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Medicine Low Back Pain Physiopathology Humans Lumbosacral Region Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Medicine

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