Comparison of Female Geriatric Lumbar-Extension Strength: Asymptomatic Versus Chronic Low Back Pain Patients and Their Response to Active Rehabilitation

Bryon Holmes, Scott Leggett, Vert Mooney, Jean Nichols*, Scott Negri, and An Hoeyberghs

We compared lumbarextension strength between healthy asymptomatic geriatric females (HEAL) and symptomatic geriatric females (INJ) seeking medical attention for chronic low back pain. The INJ group used the MedX lumbarextension machine to perform isotonic exercise two times per week and were eventually reduced to one time per week, Range of motion (ROM) and strength were significantly different between groups before beginning the program. After the program, ROM and strength improved significantly and were not different from those of the HEAL group.

The average length of treatment was 97 days and 20 visits. Subjective pain ratings were significantly reduced (60%) and exercise weights significantly increased (71%). This reconfirms the notion that many back pain sufferers have weaker lumbarextension strength and that some symptomatic geriatric women can increase strength with progressive resistance exercise, which leads to decrease in low back pain.

Pelvic Stabilization During Resistance Training: Its Effect on the Development of Lumbar Extension Strength

James E. Graves, PhD, Dina C. Webb, MS, PT, Michael L. Pollock, PhD, Jan Matkozich, Scott H. Leggett, MS, David M. Carpenter, MS, Dan N. Foster, MS, Joseph Cirulli

The purpose of this study was to evaluate and compare resistance exercise training with and without pelvic stabilization on the development of isolated lumbar extension strength. Isometric torque of the isolated lumbar extensor muscles was measured at seven positions through a 72° rangeofmotion on 47 men and 30 women before and after 12 weeks of variable resistance lumbar extension training. Subjects were assigned to either a group that trained with pelvic stabilization (PSTAB, n = 21), a group that trained without pelvic stabilization (NOSTAB, n = 41), or a control group that did not train (n = 15). Subjects trained once a week with 8 to 12 repetitions to volitional exhaustion.

The PSTAB and NOSTAB groups showed significant (p 0.05) and similar increases in the weight load used for training (PSTAB = 24.1 ± 9.4 kg; NOSTAB = 19.4 ± 11.0 kg) during the 12week training period. In contrast, posttraining isometric torque values describing isolated lumbar extension strength improved only for the PSTAB group (23.5%, p 0.05) and not for the NOSTAB group (1.2%, p > 0.05) relative to controls. These data indicate that pelvic stabilization is required to effectively train the lumbar extensor muscles. The increased training load for the NOSTAB group is probably the result of exercising the muscles involved in pelvic rotation (hamstring and buttock muscles).

The Effect of Workplace Based Strengthening on Low Back Injury Rates: A Case Study in the Strip Mining Industry

Vert Mooney 1,3 Marvin Kron 2 Patrick Rummerfield 2 Bryon Holmes 1

The purpose of this study was to demonstrate the effect of a once a week exercise program focused specially at lumbar extensor strengthening. This is a comparative study where workers volunteered to exercise were compared to workers who did not exercise.
Low back claims for one year were noted to document efficacy of the training program. Change in strength was also noted. There was a 54% to 104% increase in strength during a 20 week program. The incidence of back injuries in the exercise group was .52 injuries per 200,000 employee hours versus the industry average of 1.09 back injuries per 200,000 employee hours.

The average incidence of injury for the previous nine years at the company participating in the program was 2.94 injuries per 200,000 employee hours. The injury incidence in the workers not exercising was 2.55 injuries for 200,000 employee hours.
The average workers’ compensation liability dropped from $14,430.00 per month to $380.00 per month for the study year. The significant increase in strength associated with the exercise program correlated with the greatly reduced incidence of back claims.

 Research on Advanced Strength Training

By Wayne L. Westcott, PhD
Posted on NaturalStrength.com on April 15, 2000

Several studies have shown that single-set strength training is just as effective as multiple-set strength training for beginning exercisers (Starkey et al., 1994; Westcott, 1995a). However, Kraemer (1996) has indicated that the rate of strength gain slows considerably after four months of a single-set training program. At this point, strength plateaus may be prevented by performing multiple sets of exercise in a periodized manner. Unfortunately, changing to a multiple-set strength program requires considerably more training time. Whereas doing one set of 15 exercises takes about 30 minutes per work-out, completing three sets of 15 exercise requires at least 90 minutes per workout. Fortunately, for time-pressured people there are some advanced training alternatives to exercising with multiple sets. These techniques are typically referred to as high-intensity strength training.

High Intensity Training Techniques

There are basically two means for increasing the strength-building stimulus without adding much training time. One procedure is to increase the length of each exercise repetition by slowing down the movement speed. Slower movement speeds produce more muscle force and more muscle tension than faster movement speeds. For example, the maximum effort isokinetic leg extension performed at 60 degrees per second produced 174 foot-pounds of muscle force, whereas the maximum effort isokinetic leg extension performed at 120 degrees per second produced only 132 foot-pounds of muscle force (Westcott, 1995a). Another procedure to enhance the training stimulus is to increase the length of each exercise set by reducing the resistance upon muscle failure and completing a few additional repetitions. A typical set of strength exercise fatigues fast-twitch muscle fibers but not slow-twitch fibers. By immediately lessening the weightload and performing 2 to 4 more repetitions, the more enduring slow-twitch muscle fibers may also be pushed to the point of fatigue.

High Intensity Training Research

We have conducted research studies on several types of high intensity strength training, including slow positive emphasis, slow negative emphasis, breakdown, assisted, and pre-exhaustion techniques.

Slow Training

In one high-intensity research study we examined 8 weeks of Nautilus exercise using standard or slow positive emphasis training (Westcott, 1994a). The 117 beginner level subjects in the standard training group performed 8-12 repetitions per set, taking 2 seconds for each lifting movement and 4 seconds for each lowering movement ( seconds per rep). The 35 beginner-level subjects in the slow positive emphasis training group completed 4-6 repetitions per set, taking 10 seconds for each lifting movement and 4 seconds for each lowering movement (14 seconds per rep). The slow positive emphasis training group increased their average exercise weightloads by 27 poundscompared to 22 pounds for the standard training group. Another high-intensity research project evaluated slow positive emphasis training and slow negative emphasis training (Westcott, 1995b). The 15 intermediate-level subjects did 4-6 slow positive emphasis repetitions (10 seconds lifting, 4 seconds lowering) on the leg extension, biceps curl, and chin-up exercises, and 4-6 slow negative emphasis repetitions (4 seconds lifting and 10 seconds lowering) on the leg curl, triceps extension, and bar-dip exercises. After 6 weeks of training, the slow positive emphasis exercise weightloads increased by an average of 22 pounds, and the slow negative emphasis exercise weightloads increased an average of 26 pounds.

Breakdown Training

In our first study on breakdown training, all 45 beginner-level participants performed standard Nautilus training for the first month (Westcott, 1994b). During the second month, half of the subjects continued standard training and half of the subjects did breakdown training. That is, upon reaching muscle failure they immediately reduced the weightload by 10 pounds and did between 2 and 4 additional repetitions to reach a second level of muscle failure. The breakdown training group increased their average weightloads by 25 pounds compared to 18 pounds for the standard training group.

Assisted Training

This study compared 6 weeks of breakdown training or assisted training on strength development in 7 intermediate-level subjects (Westcott, 1995b). All of the participants performed breakdown training on the leg extension, biceps curl, and chin-up exercises, and assisted training on the leg curl, triceps extension, and bar-dip exercises. Assisted training involved instructor assistance with the lifting phase of 2-4 additional repetitions upon reaching muscle failure. The breakdown exercise weightloads increased by an average of 15 pounds, and the assisted exercise weightloads increased b an average of 17 pounds.

Pre-Exhaustion Training

Another means for increasing the muscle stimulus is to perform two successive exercises for the same muscle group. This is typically accomplished by first doing a rotary exercise to fatigue the target muscle, followed immediately by a linear exercise to further fatigue the target muscle with the help of a nonfatigued muscle. In this study (Westcott, 1996), the 14 subjects did preexhaustion training for the chest (chest cross followed immediately by chest press) and for the triceps (triceps extension followed immediately by bar-dips). For comparison purposes they performed double sets (with 90 seconds rest) for the upper back (super pullover) and biceps (biceps curl). After 6 weeks of training both the pre-exhaustion group and the double-set group increased their average exercise weightloads by 9 pounds.

Combination Training

We completed a 6-week study with 10 subjects who performed one week each of slow positive emphasis training, slow negative emphasis training, breakdown training, assisted training, preexhaustion training, and a repeat training technique of their choice. The trainees increased their average exercise weightloads by 21 pounds using a combination of high-intensity training techniques.

Summary of High Intensity Training Studies

Combining the data from our studies with intermediate-level participants, we have 68 subjects who experienced an average exercise weightload increase of 17 pounds after 6 weeks of highintensity strength training. The 24 intermediate-level exercisers who were also assessed for body composition changes over the 6-week training period added 3.2 pounds of lean (muscle) weight and lost 3.7 pounds of fat weight. Although it is tempting to attribute all of the strength improvement to high-intensity training techniques, just having an instructor present during each workout appears to be a significant factor. A control group of 22 intermediate subjects experienced a 12-pound weightload improvement in exercises performed in the standard manner with an instructor watching (Westcott, 1995b). Apparently the study participants used better exercise form, trained harder, or both when an instructor was observing them. Nonetheless, it would seem that a variety of training methods is effective for increasing strength in beginner and intermediate-level exercisers. While multiple-set training may be equally productive, high-intensity training is more time- efficient. For this reason, high-intensity training techniques may be preferred by people who would like to further develop their muscle strength but don’t have a lot of time to do so. Due to the greater muscle demands, we recommend high-intensity training no more than twice a week for 6 to 8-week sessions.

References:
Kraemer, W. (1996). Everything you wanted to know about strength training but were afraid to ask. General Session, IDEA Personal Trainer Conference, Anaheim, CA, March 23.
Starkey, D. B., Welsh, M. A., Pollock, M. L., et al. (1994). Equivalent improvements in strength following high-intensity, low and high volume training. Medicine and Science in Sports and Exercise, 26 (5): S116.
Westcott, W. (1994a). Exercise speed and strength development. American Fitness Quarterly, 13 (3): 20-21.
Westcott, W. (1994b). High-intensity training. Nautilus, 4 (1): 5-8.
Westcott, W. (1995a). Strength Fitness: Fourth Edition. Dubuque, IA: Brown and Benchmark.
Westcott, W. (1995b). High intensity strength training. IDEA Personal Trainer, 6 (7): 9.
Westcott, W. (1996). Make your method count. Nautilus, 5 (2): 3-5.

The Effect of Lumbar Extension Training With and Without Pelvic Stabilization on Lumbar Strength and Low Back Pain

M a n c h e s t e r   R T C

“The Effect of Lumbar Extension Training With and Without Pelvic Stabilization on Lumbar Strength and Low Back Pain”

Smith et al, Journal of Back and Musculoskeletal Rehabilitation, 24 (2011) 241-249/BMR-2011-0301

 Strong Clinical PerformanceQuantitatively better clinical outcomes.  A just published randomized clinical trial (RCT) undertaken in the UK concludes that pelvic stabilization in the treatment of chronic low back pain, a foundation principle in the Dynamic protocol, results in significantly improved outcomes.  (Study attached).

         Study Excerpts:

Results: After the [controlled] exercise program, the STAB group [with pelvic stabilization] increased significantly in lumbar strength at all joint angles, and decreased significantly in visual analogue [pain] and Oswestry scores [disability related to low back pain].  However, there were no significant changes in these variables in the non-pelvic stabilized (NO-STAB) and control groups [conventional physical therapy].”

Discussion: Isolated lumbar extension exercise is very effective in reducing LBP [low back pain] in chronic patients.  When the pelvis is not stabilized, otherwise identical exercises appear ineffective in reducing LBP.”

In conclusion, pelvic stabilization during lumbar extension exercise is essential to produce meaningful results.  This is true both in terms of increasing the strength of the lumbar muscles and, more importantly from a clinical point of view, reducing the intensity of LBP [low back pain] and associated disability.

(Emphasis added.  Again, please see study by clicking here).

Smith et al. The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain, Journal of Back and Musculoskeletal Rehabilitation, 24 (2011) 241-249/BMR-2011-0301

 


Note: Additionally, this randomized controlled trial complements and enhances related similar findings of some 70 prior clinical studies of specialized lumbar extension therapy in the treatment of low back pain.

Study Review

 Additionally, Dynamic asked Dr. Shlomo Sawilowsky, Professor of Educational Statistics and Distinguished Faculty Fellow at Wayne State University (WSU), to review this paper and to comment critically on the robustness of the study and its statistical validity.

In 2008 Dr. Sawilowsky served as president of the American Educational Research Association Special Interest Group/Educational Statisticians. He is Assistant Dean in the College of Education at WSU.

http://coe.wayne.edu/faculty-staff/bio.php?id=60321

http://en.wikipedia.org/wiki/Shlomo_Sawilowsky

Dr. Sawilowsky concludes: “The study is of excellent quality, has all of the elements of the highest grade statistical analysis, with extremely high reliability test and retest capabilities stable over time.  The study is impeccable.”

For the full scientific report – Click Here

Gulfshore Life – The Feel Good Report

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Collier Citizen 5-Q

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No-sweat workout? 20 minutes will do it, says Naples gym

Zlobl2-1024x680By Kelly Farrell
Naples Daily News
October 25, 2011

It’s a curious concept: a workout regimen touting that you can get fit by committing to as little as 20 minutes a week.

You’re not dripping with sweat. You haven’t done traditional cardio work and no stretching is required. No warm up. No cool down.

It’s often curiosity that brings people into the Concept 10 10 fitness center in North Naples.

It’s the results that keep Dr. Tracye Zlobl, OB/GYN, of Naples coming back, she said.

“Within three weeks of starting I could see a difference in muscle tone,” said Zlobl, who has been working out regularly the majority of her 52 years in life.

“Three months later and difference in muscle tone is phenomenal,” she said.

The lack of sweating, stretching and jogging doesn’t necessarily make it easy.

“This is the hardest, most unpleasant, brutal workout,” said Concept 10 10 owner and founder Jorgen Albrechtsen.

Yet it’s only 20 minutes.

See The Complete Story (Click Here)

No sweat, no problem

New exercise concept takes just 20 minutes per week

News-Press – November 21, 2011

Reporter Amy Sowder recently tried out the Concept 10 10 workout routine as part of Coastal Life’s Feeling Good series.

Concept 10 10 sounds too good to be true: a fitness routine that takes 20 minutes once a week, and you don’t break a sweat doing it.

But the Naples fitness center’s clients – from those who’ve never consistently worked out to dedicated fitness buffs – swear by the results.

“I have muscles where I never realized I had them,” said Debbie Picone, 53, of Bonita Springs, who started her weekly sessions two months ago. “I’m continuing, which is a big deal for me because I usually don’t exercise. But you can do almost anything for 20 minutes once a week.”

A free 1-hour introductory session available to the public meant we didn’t have to take someone else’s word for it.

Click Here for the rest of the story.

Pregnancy and Concept 10 10

PregnancyConcept 10 10 Training is not only “OK” to perform during pregnancy; in my opinion it is the perfect preparation for pregnancy. It is so well suited to prepare for pregnancy that I feel it should become the “standard of care” for pre-partum and perinatal preparation.

In certain exceptions such as pre-eclampsia or preterm labor the training would have to be discontinued; but in the vast majority of cases it is neglectful to not train. To go into pregnancy not availing yourself of this prenatal care, in my opinion, is much worse than having the occasional glass of wine or cup of coffee.

The risk to the fetus and mother from a difficult labor as a result of poor muscular condition are much greater than the risks that all mothers currently take much more seriously. Someday I hope it will be considered medically and socially unacceptable to not perform High Intensity Training in preparation for pregnancy and labor.

See what Yeal Low, pregnant member of Concept 10 10, has to say about her experience.