Grant: Project Grant

Exercise therapy is the most recommended form of treatment for chronic low back pain. A key finding in people with chronic low back pain is an increase in fat within the back spinal muscles, which can be a possible biological mechanism that may affect the onset, persistence and recovery of low back pain. While many current exercise programs for individuals with chronic low back pain focus on retraining and improving overall back muscle health, it remains unclear whether improvement in back muscle quality are linked to improvements in disability. This is likely due to the heterogeneity of patients presenting to clinical care, high variability in exercise protocol and dose prescriptions, and lack of tailored treatment. Recent pilot work from our investigators suggests that combined motor control+isolated lumbar extension strengthening exercises can improve back muscle health, and that simple risk assessment tools (Pain and Disability Drivers Model and the Lumbar Spine Instability Questionnaire) can help identify which patients would best respond to exercise interventions. This project will use a targeted-care approach and multi-dimensional risk-stratifying tools/questionnaires to best match participants to the interventions based on their clinical symptoms and biopsychosocial profile. Specifically, this clinical trial aims to compare the effect of two commonly used forms of exercises for chronic low back pain (motor control+isolated lumbar extension strengthening exercises versus free-weight resistance training) to improve disability and back muscle quality in patients with chronic low back pain. This study will also compare the effect of each intervention on back muscle size, back muscle strength, pain, quality of life and sleep quality. The results of this novel study will have important clinical implications and the potential to increase the effects of exercise in low back pain and consequently lead to better patient outcomes and decreased health related costs.