Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis

Abstract

Background: While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE).

Objectives: To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP.

Methods: Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3.

Results: Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12-16 weeks compared to 6-8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = - 0.61 (95% CI - 1.21 to 0.00), p = 0.05; I² = 74%) and level of disability (SMD = - 0.53 (95% CI - 0.97 to - 0.09), p = 0.02; I² = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I² = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = - 0.02 (95% CI - 0.10 to 0.05), p = 0.57; I² = 72%).

Conclusion: Results of the meta-analysis indicated that 12-16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12-16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population.

Trial registration: PROSPERO CRD42020155700 .

Keywords: Aerobic training; Chronic low back pain; Deadlift; Pain; Posterior chain; Resistance training.

Fig. 1

PRISMA flow diagram

Fig. 2

Forest plot of comparison between GE vs PCRT articles for changes in pain. SD, standard deviation; IV, inverse variable; CI, confidence intervals; PCRT, posterior chain resistance training; GE, general exercise

Fig. 3

Forest plot of comparison between GE vs PCRT articles for changes in level of disability. SD, standard deviation; IV, inverse variable; CI, confidence intervals; PCRT, posterior chain resistance training; GE, general exercise

Fig. 4

Forest plot of comparison between GE vs PCRT articles for changes in strength. SD, standard deviation; IV, inverse variable; CI, confidence intervals; PCRT, posterior chain resistance training; GE, general exercise

Fig. 5

Forest plot of comparison between GE vs PCRT articles for changes in adverse events. SD, standard deviation; IV, inverse variable; CI, confidence intervals; PCRT, posterior chain resistance training; GE, general exercise

Fig. 6

Funnel plot of comparison between GE vs PCRT articles for changes in pain. SE, standard error; MD, mean difference

Fig. 7

Funnel plot of comparison between GE vs PCRT articles for changes in level of disability. SE, standard error; MD, mean difference

Fig. 8

Funnel plot of comparison between GE vs PCRT articles for changes in strength. SE, standard error; MD, mean difference

Fig. 9

Funnel plot of comparison between GE vs PCRT articles for number of adverse events. SE, standard error; RD, risk difference