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Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Kate Gamber, PA-C
Abstract
Introduction: Low back pain (LBP) is a multifactorial condition that is a major cause of lost work days and lowered quality of life and is associated with heavy healthcare resource use and loss of economic productivity. Conservative treatments include referrals to physical therapists, who commonly use the McKenzie Method of Mechanical Diagnosis and Treatment (MDT). This method has been recognized as one of the most effective treatments for LBP. Another, lesser known treatment for LBP is the use of isolated lumbar extension exercise (ILEX) to target deconditioned extensor muscles of the lumbar spine through pelvic stabilization. This review analyzes the use of ILEX (I) for the reduction of perceived pain (O) in patients suffering from chronic LBP (P) compared to MDT (C).
Methods: A literature search was conducted through PubMed and Google Scholar on November 2019. A total of eight articles were selected based on the relevance to the research question, year published, study design, and outcome measurements. The study design, methods, and results of these articles were then analyzed and compared.
Results: The ILEX articles selected here used the MedX Lumbar Extension Machine (Ocala, FL) to achieve isolated lumbar extension. The studies demonstrated significant improvements in the primary outcomes of pain and disability levels as well as a secondary outcome of isolated lumbar extension strength (ILEX-S) compared to the control group. In the 2 MDT studies, pain levels were not significantly reduced compared to baseline levels in one study. In the other study, pain levels were significantly reduced compared to the placebo group, but not the disability levels.
Discussion: Significant positive results were achieved in the ILEX studies, but a lack of blinding suggest that author bias is likely. Thus, the internal validity of these studies is weakened. In addition, long term follow-up was absent in all the ILEX studies except one, which was a longitudinal study (LS) and not a randomized control trial (RCT). In the MDT studies, blinding was incorporated through a placebo group as well as assessor blinding. However, results were not as significant as the results in the ILEX studies. In addition, the MDT treatment timeline was much shorter than that of the ILEX studies.
Conclusion: ILEX may be a promising mainstream treatment for LBP, but better designed studies are necessary to validate it as such. Future ILEX studies will need to incorporate proper blinding methods to reduce author bias and strengthen ILEX as a valid treatment. Long term follow-up is also ideal to measure the lasting benefits of ILEX.
Recommended Citation
Lee, Paul, "Efficacy of Isolated Lumbar Extension Exercise in the Treatment of Non-specific Chronic Low Back Pain" (2021). Capstone Showcase. 105.
https://scholarworks.arcadia.edu/showcase/2021/pa/105
Additional Files
Poster Presentation (The efficacy of isolated lumbar extension exercise in the treatment of non-specific chronic low back pain).pdf (2174 kB)Efficacy of Isolated Lumbar Extension Exercise in the Treatment of Non-specific Chronic Low Back Pain
Introduction: Low back pain (LBP) is a multifactorial condition that is a major cause of lost work days and lowered quality of life and is associated with heavy healthcare resource use and loss of economic productivity. Conservative treatments include referrals to physical therapists, who commonly use the McKenzie Method of Mechanical Diagnosis and Treatment (MDT). This method has been recognized as one of the most effective treatments for LBP. Another, lesser known treatment for LBP is the use of isolated lumbar extension exercise (ILEX) to target deconditioned extensor muscles of the lumbar spine through pelvic stabilization. This review analyzes the use of ILEX (I) for the reduction of perceived pain (O) in patients suffering from chronic LBP (P) compared to MDT (C).
Methods: A literature search was conducted through PubMed and Google Scholar on November 2019. A total of eight articles were selected based on the relevance to the research question, year published, study design, and outcome measurements. The study design, methods, and results of these articles were then analyzed and compared.
Results: The ILEX articles selected here used the MedX Lumbar Extension Machine (Ocala, FL) to achieve isolated lumbar extension. The studies demonstrated significant improvements in the primary outcomes of pain and disability levels as well as a secondary outcome of isolated lumbar extension strength (ILEX-S) compared to the control group. In the 2 MDT studies, pain levels were not significantly reduced compared to baseline levels in one study. In the other study, pain levels were significantly reduced compared to the placebo group, but not the disability levels.
Discussion: Significant positive results were achieved in the ILEX studies, but a lack of blinding suggest that author bias is likely. Thus, the internal validity of these studies is weakened. In addition, long term follow-up was absent in all the ILEX studies except one, which was a longitudinal study (LS) and not a randomized control trial (RCT). In the MDT studies, blinding was incorporated through a placebo group as well as assessor blinding. However, results were not as significant as the results in the ILEX studies. In addition, the MDT treatment timeline was much shorter than that of the ILEX studies.
Conclusion: ILEX may be a promising mainstream treatment for LBP, but better designed studies are necessary to validate it as such. Future ILEX studies will need to incorporate proper blinding methods to reduce author bias and strengthen ILEX as a valid treatment. Long term follow-up is also ideal to measure the lasting benefits of ILEX.