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Exercise for the intervertebral disc: a 6-month randomised controlled trial in chronic low back pain

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Abstract

Background context

Muscle, bone and tendon respond anabolically to mechanical forces. Whether the intervertebral disc (IVD) can benefit from exercise is unclear.

Purpose

To examine whether exercise can beneficially affect IVD characteristics.

Study design/setting

This is a single-blinded 6-month randomised controlled trial (ACTRN12615001270505) in an exercise and physiotherapy clinic.

Patient sample

Forty patients with chronic non-specific low back pain (NSCLBP) are included in this study.

Outcome measures

The primary outcome was lumbar IVD T2 time (MRI). Secondary outcomes included IVD diffusion coefficient and IVD expansion with short-duration lying.

Methods

Twenty patients progressively loaded their lumbar IVDs (exercise) via an exercise programme involving progressive upright aerobic and resistance exercises targeting the trunk and major muscle groups and were compared to twenty patients who performed motor control training and manual therapy (control). Testing occurred at baseline, 3 months and 6 months.

Results

Seventeen exercise and fifteen control patients completed the interventions. There were no group-by-time differences in T2 time of the entire IVD (exercise 94.1 ± 10.0 ms vs. control 96.5 ± 9.3 ms, p = 0.549). Exercise patients had shorter T2 time in the posterior annulus at 6 months (82.7 ± 6.8 ms vs. 85.1 ± 8.0 ms, p = 0.028). Exercise patients showed higher L5/S1 apparent diffusion coefficients and decreased IVD height at 3 months (both p ≤ 0.050). After adjustments for multiple comparisons, differences lost statistical significance. Per-protocol and intent-to-treat analyses yielded similar findings.

Conclusions

This trial found that 6 months of exercise did not benefit the IVD of people with NSCLBP. Based on this index study, future studies could investigate the effect of exercise on IVD in different populations, with different types, durations and/or intensities of exercise, and using different IVD markers.

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Acknowledgements

The authors thank the participants for taking part in this study and the staff of Imaging@Olympic Park for their support implementing this study. Gerontology Research Center is a joint effort between the University of Jyvaskyla and the University of Tampere.

Funding

This study was supported by internal institutional funding (Deakin University School of Exercise and Nutrition Sciences, reference number Belavy 2014–2017).

Author information

Authors and Affiliations

  1. Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia

    Patrick J. Owen, Timo Rantalainen & Daniel L. Belavy

  2. Deakin University, School of Exercise and Nutrition Sciences, Geelong, Australia

    Clint T. Miller & Katherine J. Simson

  3. Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland

    Timo Rantalainen

  4. Imaging@Olympic Park, Melbourne, Australia

    David Connell

  5. Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Australia

    Andrew J. Hahne & Jon J. Ford

  6. Bone and Joint Research Laboratory, Division of Physical Medicine and Rehabilitation, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

    Guy Trudel

  7. Advance HealthCare, Boronia, Australia

    Jon J. Ford

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  1. Patrick J. Owen
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Correspondence to Patrick J. Owen or Daniel L. Belavy.

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Owen, P.J., Miller, C.T., Rantalainen, T. et al. Exercise for the intervertebral disc: a 6-month randomised controlled trial in chronic low back pain. Eur Spine J 29, 1887–1899 (2020). https://doi.org/10.1007/s00586-020-06379-7

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  • DOI: https://doi.org/10.1007/s00586-020-06379-7

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