title: A review of the clinical value of isolated lumbar extension resistance training for chronic low back pain.
abstract: OBJECTIVE
  Chronic low back pain (CLBP) is prevalent, costly, and acknowledged as multifactorial in nature. However, deconditioning of the lumbar extensor musculature may be a common factor. Thus specific resistance exercise is often recommended. Many resistance exercises for the lumbar extensors exist, although recent evidence suggests that isolated lumbar extension (ILEX) resistance training may best for conditioning these muscles. Thus this review aimed to examine the use of ILEX resistance training in participants with CLBP to provide a best-evidence synthesis for practitioners and clinicians.
  
  
  METHODS
  Reference lists from previous reviews were searched in addition to SPORTDiscus, PubMed, and Google Scholar databases up to May 2014 using search terms including combinations and synonyms of "isolation," "lumbar extension," "lumbar exercise," "lumbar strength," "lumbar endurance," "lumbar spine," "low back exercise," "CLBP," "pain," and "disability."
  
  
  METHODS
  A "snowballing"-style literature search was used that involved an emergent approach. Studies examining ILEX resistance training as an intervention in symptomatic CLBP populations reporting pain, disability, or global perceived outcomes (GPO) as outcomes were examined. Pain and disability were outcomes and were compared to consensus guidelines for minimal clinically important changes. Single case reports were excluded.
  
  
  RESULTS
  Results suggest that ILEX resistance training produces significant and meaningful improvements in perceived pain, disability, and GPOs, as part of a multiple intervention or stand-alone approach. A low frequency (once per week) yet high intensity of effort (to momentary muscular failure) approach using either full or limited range-of-motion ILEX resistance training appears to be sufficient and best for significant and meaningful outcomes. Limited comparative studies between ILEX resistance training and other specific exercise approaches exist; however, only limited evidence supports ILEX resistance training as being more effective.
  
  
  CONCLUSIONS
  These findings highlight ILEX resistance training as effective for significant and meaningful improvements in perceived pain, disability, and GPOs for CLBP participants. Further research should elucidate comparisons between ILEX resistance training and other specific exercise approaches and should clarify whether lumbar extensor conditioning is the mechanism responsible for the improvements reported.
authors.affiliation: Centre for Health, Exercise and Sport Science, Southampton Solent University, East Park Terrace, Southampton, Hampshire SO14 0YN, UK∗. Electronic address: james.steele@solent.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Steele
authors.affiliation: Centre for Health, Exercise and Sport Science, Southampton Solent University, Southampton, Hampshire, UK(†).
authors.forename: Stewart
authors.initials: S
authors.lastname: Bruce-Low
authors.affiliation: Centre for Health, Exercise and Sport Science, Southampton Solent University, Southampton, Hampshire, UK; Department of Exercise and Sport Science, Manchester Metropolitan University, Crewe, Cheshire, UK(‡).
authors.forename: Dave
authors.initials: D
authors.lastname: Smith
mesh_terms: D064131:Back Muscles; D059350:Chronic Pain / Q000534:rehabilitation*; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008159:Lumbar Vertebrae; D055070:Resistance Training; D016896:Treatment Outcome