Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis.
Marco Ranzani, Andrea Pozzi, Daniele Fornasari and 2 others
PMID 41356326WHAT IT FOUND
Adding external load to exercise for chronic low back pain did not clearly reduce pain or disability compared to unloaded exercise.
While loaded training improved back muscle endurance, these physical gains did not consistently translate into better symptom relief for patients.
Key findings
01The certainty of evidence for the primary outcomes of pain and disability was rated as very low due to methodological limitations and inconsistency across studies.
02Back muscle endurance showed moderate certainty evidence of improvement with loaded resistance training compared to unloaded exercise at short and extended follow-ups.
03Between-group differences in pain and disability were generally modest and inconsistent, with loaded training showing only a small, statistically significant advantage in pain at extended follow-up that did not exceed the minimal clinically important difference.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The overall certainty of evidence for pain and disability was rated as very low. There was considerable heterogeneity across studies in terms of exercise type, loading modalities, and intensity, making it difficult to draw firm conclusions. The included studies had imbalanced sex distribution, with men comprising the majority of participants, which limits applicability to women. The age range of participants was limited (20.2 to 52 years), so results may not generalize to older adults. Adverse event reporting was inconsistent and largely descriptive, preventing a reliable estimate of safety. Subgroup and sensitivity analyses were conducted post hoc and were not based on predefined hypotheses.
Declared interests
The authors declared no conflicts of interest and received no funding for this project. ChatGPT was used for language editing.
The easy way to misread this
Do not interpret the significant improvement in back muscle endurance as evidence that loaded training is superior for managing pain or disability. The review found that physical capacity gains did not consistently translate into meaningful clinical symptom relief, and the evidence for the primary outcomes of pain and disability was rated as very low certainty.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →