title: Can specific loading through exercise impart healing or regeneration of the intervertebral disc?
abstract: BACKGROUND
  Low back pain (LBP) is highly prevalent and presents an enormous cost both through direct health care and indirectly through significant work and production loss. Low back pain is acknowledged widely to be a multifactorial pathology with a variety of symptoms, dysfunctions, and a number of possible sources of pain. One source that has been suspected and evidenced for some time is the intervertebral disc. Some degree of disc degeneration is a physiologic process associated with aging, however, more severe degeneration and/or structural abnormality may be indicative of a pathologic process or injury and is more commonly present in those suffering from LBP. Much like other tissues (ie, muscle, bone, etc.), it has been suspected that there exists an optimal loading strategy to promote the health of the disc. Exercise is often prescribed for LBP and effectively reduces pain and disability. However, whether specific loading through exercise might plausibly heal or regenerate the intervertebral discs is unknown.
  
  
  OBJECTIVE
  To examine the effects of loading on regenerative processes in the intervertebral disc and consider the potential for specific exercise to apply loading to the lumbar spine to produce these effects.
  
  
  METHODS
  A brief narrative literature review.
  
  
  METHODS
  Studies examining the effects of loading on the intervertebral discs were reviewed to examine the plausibility of using loading through exercise to induce regeneration or healing of the intervertebral disc.
  
  
  RESULTS
  Research from animal model studies suggests the existence of a dose-response relationship between loading and regenerative processes. Although high loading at high volumes and frequencies might accelerate degeneration or produce disc injury, high loading, yet of low volume and at low frequency appears to induce potentially regenerative mechanisms, including improvements in disc proteoglycan content, matrix gene expression, rate of cell apoptosis, and improved fluid flow and solute transport.
  
  
  CONCLUSIONS
  Research suggests a dose-response relationship between loading and disc regenerative processes and that the loading pattern typically used in the lumbar extension resistance exercise interventions (high load, low volume, and low frequency) might impart healing or regeneration of the intervertebral discs. Future research should examine an exercise intervention with in vivo measurement of changes in disc condition. This may provide further evidence for the "black box" of treatment mechanisms associated with exercise interventions.
authors.affiliation: Centre for Health, Exercise and Sport Science, Southampton Solent University, East Park Terrace, Southampton, Hampshire SO14 0YN, United Kingdom. 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, East Park Terrace, Southampton, Hampshire SO14 0YN, United Kingdom.
authors.forename: Stewart
authors.initials: S
authors.lastname: Bruce-Low
authors.affiliation: Department of Exercise & Sport Science, Manchester Metropolitan University, Cheshire Campus, Crewe Green Road, Crewe, Cheshire CW1 5DU, United Kingdom.
authors.forename: Dave
authors.initials: D
authors.lastname: Smith
authors.affiliation: Anglo European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, Dorset BH5 2DF, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Osborne
authors.affiliation: Anglo European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, Dorset BH5 2DF, United Kingdom.
authors.forename: Arvid
authors.initials: A
authors.lastname: Thorkeldsen
mesh_terms: D000818:Animals; D015444:Exercise; D005081:Exercise Therapy; D006801:Humans; D007403:Intervertebral Disc / Q000502:physiology* / Q000503:physiopathology; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D012038:Regeneration
keywords: Disc; Injury; Low back pain; MRI; Resistance training; Review; Strength training; Therapy