Heavy resistance training with weekly undulating periodization for individuals with chronic non-specific low back pain - A mixed methods feasibility study
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Purpose: To investigate if heavy resistance training with weekly undulating periodization is a feasible training method for individuals with chronic non-specific low-back pain (LBP). Methods: A linear mixed model was used to assess change in pain, function and strength and was carried out in STATA/MP version 15.1 for Mac, 2017. The qualitative data was assessed using systematic text condensation and was carried out in a qualitative research software Nvivo version 11 for Mac. 25 participants with chronic non-specific LBP were recruited to participate in the study and divided into 6 training groups with 3 – 5 participants in each group. Prior to the study all participants were assessed through standardized and validated questionnaires and a clinical examination. Repetition maximum (1RM), pain and function were tested at baseline, 8 weeks and 16 weeks. Focus group interviews were conducted at the conclusion of the study. The participants trained 2 times a week with heavy periodized resistance training using squat, bench press, deadlift and pendlay row with a pronated grip. Results: The mean difference in Numerical Pain Rating Scale (NPRS) current from baseline to posttest was 1.3, NPRS the last two weeks 3.4 and NPRS the last four weeks 3.2 respectively. Regarding function, the change in mean difference from baseline to posttest in Oswestrey Low Back Disability Questionnaire (ODI) was 3.9 and in Pain Self Efficacy Questionnaire (PSEQ) it was 7.7. The change in mean difference from baseline to posttest in squat was 35.4 kg, in bench press 17.1 kg, in deadlift 27.7 kg and in pendlay row 12.7 kg respectively. According to the qualitative results it suggests that the study had a positive influence on several aspects on everyday life such as pain, function, sleep, energy level and social interaction. Discussion: This is the first study to use a powerlifter approach in the management of LBP. In comparison to other studies no other studies have used weekly undulating periodization as well as intensities reaching 90% of 1RM. The mechanisms contributing to the positive indications seen in the present study are multifactorial but could potentially be related to the progressive approach, adaptation phase, exercises, periodization model as well as the high intensity. Conclusion: Heavy resistance training and weekly undulating periodization seemed to be a feasible training method for this group of participants with chronic non-specific LBP. The positive indications seen in this study should be investigated further in a randomized controlled trial.