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A randomised controlled trial of limited range of motion lumbar extension exercise in chronic low back pain [with consumer summary]
Steele J, Bruce-Low S, Smith D, Jessop D, Osborne N
Spine 2013 Jul 1;38(15):1245-1252
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To compare the effects of full range of motion (ROM) and limited ROM isolated lumbar extension exercise upon full ROM lumbar extension strength, ROM, perceived pain and disability. SUMMARY OF BACKGROUND DATA: Limited ROM is common in chronic low back pain as is lumbar extensor deconditioning. Limited ROM exercise is a common prescription but is yet to be empirically tested. METHODS: Male (n = 21) and females (n = 17) with non-specific CLBP were initially recruited. Participants were randomised to either a full ROM (fullROM) or limited ROM (limROM) training group, or a control group. Twenty four participants (males n = 14, females n = 10) completed the study and were included in analysis. The intervention lasted 12 weeks. FullROM and limROM completed isolated lumbar extension resistance training 1x/week, performing 1x/set of exercise at 80% of their maximal tested functional torque to failure. FullROM group trained through a full ROM. LimROM group trained through the mid 50% of their full ROM. Full ROM isolated lumbar extension strength, lumbar, and standing ROM (Schobers test), and perceived pain (visual analogue scale) and disability (Revised Oswestry Disability Index) were measured pre and post intervention. RESULTS: FullROM and Lim ROM significantly improved in full ROM lumbar extension strength, perceived pain and disability compared with the control group. No changes occurred in lumbar or standing ROM. No significant differences were found between either FullROM or LimROM for any outcome measure. Changes in perceived pain and disability met minimal clinically important change values for fullROM (VAS -30.3 +/- 25.76mm and ODI -18.2 +/- 6.63pts) and limROM (VAS -16.29 +/- 10.97mm and ODI -12 +/- 5.16pts). CONCLUSIONS: The results suggest that both fullROM and limROM are equally effective in increasing full ROM lumbar extension strength and producing clinically meaningful improvement in perceived pain and disability. LEVEL OF EVIDENCE: 2.
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