Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability - A 12-month randomized controlled study

Study Design. A randomized controlled study with 12 months intervention. Objective. To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone (NZ) and behavior modeling as secondary prevention of low back pain (LBP) and disability. Summary of Background Data. Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability. In addition, cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability. Methods. Middle-aged working men with recent LBP but without severe disability were randomly allocated to either a training (TG, n = 52) or control group (CG, n = 54). The aim was to exercise twice a week for 12 months, once guided and once independently. The outcome measures were the changes in intensity of LBP, disability, self-evaluated future work ability, and neuromuscular fitness. Results. The intensity of LBP decreased significantly more (39%) in the TG than in CG at 12 months. The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months; however, the proportion was significantly bigger in TG compared with CG (P = 0.028). There effects on disability indexes and fitness were not statistically significant. Conclusions. Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men.