Gibbs MT, Morrison NM, Raftry S, et al. Does a powerlifting inspired exercise programme better compliment pain education compared to bodyweight exercise for people with chronic low back pain? A multicentre, single-blind, randomised controlled trial. Clin Rehabil. 2022 Apr 24:2692155221095484. doi: 10.1177/02692155221095484. (Original study)

BACKGROUND: Contemporary management of chronic low back pain involves combined exercise and pain education. Currently, there is a gap in the literature for whether any exercise mode better pairs with pain education. The purpose of this study was to compare general callisthenic exercise with a powerlifting style programme, both paired with consistent pain education, for chronic low back pain. We hypothesised powerlifting style training may better compliment the messages of pain education.

METHODS: An 8-week single-blind randomised controlled trial was conducted comparing bodyweight exercise (n = 32) with powerlifting (n = 32) paired with the same education, for people with chronic low back pain. Exercise sessions were one-on-one and lasted 60-min, with the last 5-15 min comprising pain education. Pain, disability, fear, catastrophizing, self-efficacy, anxiety, and depression were measured at baseline, 8-weeks, 3-months, and 6-months.

RESULTS: No significant between-group differences were observed for pain (p=0.40), or disability (p=0.45) at any time-point. Within-group differences were significantly improved for pain (p = 0.04) and disability (p = 0.04) at all time-points for both groups, except 6-month disability in the bodyweight group (p = 0.1). Behavioural measures explained 39-60% of the variance in changes in pain and disability at each time-point, with fear and self-efficacy emerging as significant in these models (p = 0.001).

CONCLUSIONS: Both powerlifting and bodyweight exercise were safe and beneficial when paired with pain education for chronic low back pain, with reductions in pain and disability associated with improved fear and self-efficacy. This study provides opportunity for practitioners to no longer be constrained by systematic approaches to chronic low back pain.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
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Comments from MORE raters

Physician rater

Another piece to add to the toolbox in dealing with this problem that is probably very appealing to some patients.

Physician rater

The conclusion of this single-blind RCT that both body weight, exercise, and powerlifting when combined with pain education are effective for people with chronic low-back pain indicates that there is a long way to go. Are there any specific exercises?

Physician rater

This is an interesting RCT that compared a general trunk-focused calisthenic exercise intervention with a power-lifting style resistance training model, both paired with consistent pain education, for people with chronic low back pain. I find the title misleading. Multicenter suggests the trial was conducted at multiple sites; however, it's mentioned in the Methods that the patient recruitment was done at only 2 centers in a single city. Also, the number of patients is too low to make a strong and meaningful correlation.

Rehab Clinician (OT/PT) rater

In this RCT contains valuable information underscoring the utility of exercise coupled with demystification education in chronic pain for CLBP sufferers, a caveat nonetheless applies, concealed by an enshrined denial of underlying pathoanatomy. An awareness of individual biomechanical limitations will lead to a more informed approach to activity. Certain activities will incontestably aggravate underlying (sensitised) peripheral afferent nociceptors. For example, an injured (and therefore degenerative) intervertebral disc is a veritable repository of neo-neuronal ingress, neo-vascularisation, and an inflammatory soup ready to broadcast its presence with suitable provocation. To deny underlying individual injury and consequent impaired/constrained biomechanics is to foster persistent pain and disability. After all, the anticipated and natural concessions made to healthy ageing are in many ways little different to the management of CLBP.
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