Bruce-Low, Stewart

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LETTER TO THE EDITOR
Steiger et al. 2011: relationships and specificity in CLBP
rehabilitation through exercise
James Steele • Stewart Bruce-Low
Received: 23 May 2012 / Accepted: 14 July 2012 / Published online: 26 July 2012
 Springer-Verlag 2012
Dear Editor,
Stieger et al. [1] have recently published an important
review article concerning the relationship between changes
in musculoskeletal performance factors and changes in
pain as a result of active exercise interventions with regard
to which we would like to highlight some important points
to take away and consider.
The authors questioned as to whether reductions in pain
and disability are in anyway attributable to corresponding
improvements in muscular function [1]. This study [1],
however, did not consider any of the existing research using
isolated lumbar extension resistance exercise (using devices
such as the MedX lumbar extension or backup dynamometer
[2]) as is evident from their absence in the article’s reference
list. It may well be that the exercise used in the studies
considered was not specific enough in terms of addressing
the lumbar extensors. Smith et al. [3] have shown that,
without the use of appropriate restraint mechanisms for the
pelvis to isolate the lumbar extensors, lumbar extension
strength, pain, or disability did not show improvement as a
result of training. Indeed, Nelson et al. [4] showed that
greater improvements in lumbar extension strength were
seen in the groups that showed greater global perceived
outcomes after training. Other recent research has shown that
an exercise commonly considered to be a ‘lower back
exercise’—the stiff legged deadlift—does not in fact provide
sufficient stimulation to enhance lumbar extension strength,
despite enhancing hip extensors strength [5].
A complaint by the authors within their article [1] was that
many studies have not in fact used, or in some cases even
reported, correlations between change in strength, pain and
disability. As such we will be considering this within our
own research utilising isolated lumbar extension exercise in
chronic lower back pain to seek to further clarify if the results
reported by Steiger et al. [1] may in fact be due to the lack of
specificity in the exercises used from the studies considered.
We hope in the future that other researchers will also report
the relationships between changing variables of musculo-
skeletal performance, pain and disability as a result of their
intervention research and also consider the specificity of the
exercises that they are utilising when drawing conclusions.
Conflict of interest None of the authors has any potential conflict of
interest.
References
1. Steiger F, Wirth B, de Bruin ED, Mannion AF (2011) Is a positive
clinical outcome after exercise therapy for chronic non-specific
low back pain contingent upon a corresponding improvement in
targeted aspects(s) of performance? A systematic review. Eur
Spine J 21(4):575–598
2. Udermann BE, Reineke DM, Martinez RD, Gibson MH, Gillette
CM, Doberstein ST, Mayer JM, Murray SR, Reeder MT (2006)
The effect of resistance training on lumbar muscular strength and
endurance. Gundersen Lutheran Med J 4(1):8–13
3. Smith D, Bissell G, Bruce-Low S, Wakefield C (2011) The effect
of lumbar extension training with and without pelvic stabilization
on lumbar strength and low back pain. J Back Musculoskelet
Rehabil 24:1–9
4. Nelson BW, O’Reilly E, Miller M (1995) The clinical effects of
intensive, specific exercise on low back pain: a controlled study of
895 consecutive patients with a one year follow-up. Orthopedics
18(10):971–981
5. Fisher J, Bruce-Low S, Smith D (2012) A randomized trial to
consider the effect of romanian deadlift exercise on the develop-
ment of lumbar extension strength. Phys Ther Sport (in press)
J. Steele (&)  S. Bruce-Low
Centre for Health, Exercise and Sport Science,
Southampton Solent University, East Park Terrace,
Southampton SO14 0YN, UK
e-mail: James.Steele@Solent.ac.uk
123
Eur Spine J (2012) 21:1887
DOI 10.1007/s00586-012-2449-y


Steiger et al. 2011: relationships and specificity in CLBP rehabilitation through exercise.

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Steiger et al. 2011: relationships and specificity in CLBP rehabilitation through exercise.

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