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Can #exercise “strengthen” the intervertebral disc?
A brief history of research from 2013 to 2020:
Review: http://dx.doi.org/10.1007/s40279-015-0444-2
Cross-section: http://dx.doi.org/10.1038/srep45975
RCT: http://dx.doi.org/10.1007/s00586-020-06379-7
collaborators
Thread
#backpain
A brief history of research from 2013 to 2020:
Review: http://dx.doi.org/10.1007/s40279-015-0444-2
Cross-section: http://dx.doi.org/10.1038/srep45975
RCT: http://dx.doi.org/10.1007/s00586-020-06379-7
collaboratorsThread
#backpain
First, we did a review of the literature (narrative, not a #systematicreview. This was back in my pre-systematic review days!) http://dx.doi.org/10.1007/s40279-015-0444-2 in @SportsMedicineJ
@DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
@DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
It has been well established that exercise and loading can impact IVD height. E.g. https://doi.org/10.1097/00007632-198503000-00011 https://doi.org/10.1249/mss.0b013e318260dbc1
So, exercise and movement protocols can at least ‘influence’ the IVD
So, exercise and movement protocols can at least ‘influence’ the IVD
But what about actual exercise training?
Animal studies showed that exercise can ‘overload’ the IVD e.g. https://doi.org/10.1002/jor.1100110516
However, one study in dogs showed that long-term exercise can improve IVD nutrition. https://doi.org/10.1097/00007632-198311000-00009
Animal studies showed that exercise can ‘overload’ the IVD e.g. https://doi.org/10.1002/jor.1100110516
However, one study in dogs showed that long-term exercise can improve IVD nutrition. https://doi.org/10.1097/00007632-198311000-00009
Another key study by Prof. Helena Brisby and @DrAshishDiwan showed that 3 weeks of “moderate” treadmill exercise in rats and improved the disc https://doi.org/10.1097/brs.0b013e3181e0f5bc
@K_Sheldrick
@K_Sheldrick
In a very nice study, Mike Hangai (Japan Institute of Sports Sciences) and Koji Kaneoka (from @waseda_univ_WUL) showed that college athletes who were swimmers had worse IVDs, but interestingly runners had, on average, better IVDs
http://dx.doi.org/10.1177/0363546508323252
http://dx.doi.org/10.1177/0363546508323252
so, maybe running might be good for the spineSo we ran this study http://dx.doi.org/10.1038/srep45975 in @SciReports
Matt Quittner, @NickyRidgers, Dr. Ling and Connell @tjrantalWe hypothesized that people who perform regular upright running activity will show better discs
Methods:
> cross-sectional study
> people aged 25-35 without a history of spine pathology
> people who, in past five years: ran 20-40km per week (n=30), ran 50+km per week (n=25), who were sedentary (n=24)
> measured “T2” of the IVDs
> cross-sectional study
> people aged 25-35 without a history of spine pathology
> people who, in past five years: ran 20-40km per week (n=30), ran 50+km per week (n=25), who were sedentary (n=24)
> measured “T2” of the IVDs
We found: Runners had ‘better’ intervertebral discs, as shown by longer T2-time in the disc.
This T2-time correlates with water and glyocosaminoglycan content in the IVD https://doi.org/10.1097/brs.0b013e318195dd44
This T2-time correlates with water and glyocosaminoglycan content in the IVD https://doi.org/10.1097/brs.0b013e318195dd44
Interestingly: total physical activity was NOT associated with disc characteristics
Rather: loading in specific ranges.
The strongest association to higher IVD T2-times were seen between 0.44 and 0.59g.
This corresponds to fast #walking and slow #jogging.
The strongest association to higher IVD T2-times were seen between 0.44 and 0.59g.
This corresponds to fast #walking and slow #jogging.
Beyond the composition, there was evidence of disc hypertrophy in the long-distance runners.
The height of the IVD relative to that of the vertebral body, which serves as an internal control for body size, was greater in the long-distance runners
The height of the IVD relative to that of the vertebral body, which serves as an internal control for body size, was greater in the long-distance runners
This study provided the first ever cross-sectional evidence in humans that exercise may well favourably impact the IVD
This is nice: but can we actually improve the intervertebral disc with exercise in an interventional study?
This is nice: but can we actually improve the intervertebral disc with exercise in an interventional study?
So we ran this RCT: http://dx.doi.org/10.1007/s00586-020-06379-7
@stopsbackpain @_clintmiller @PatrickOwenPhD @tjrantal Katherine Simson Drs Connell and Hahne Prof. Trudel
@stopsbackpain @_clintmiller @PatrickOwenPhD @tjrantal Katherine Simson Drs Connell and Hahne Prof. Trudel
Methods: RCT, 40 participants with chronic #backpain, 2 groups, main outcome = IVD T2-time. Powered to detect a ~2% difference between groups.
Exercise: a specially developed #exercise program
Control: no/low-load motor control training and manual therapy
Exercise: a specially developed #exercise program
Control: no/low-load motor control training and manual therapy
Findings: overall no real differences to speak of in the discs between the group with the targetted exercise program and the control group
There were some differences between groups (favouring exercise) for posterior annulus and higher L5/S1 IVD apparent diffusion coefficients.
But these did not persist after adjusting p-values for false positives.
But these did not persist after adjusting p-values for false positives.
Overall, the RCT http://dx.doi.org/10.1007/s00586-020-06379-7 did not provide evidence that the exercise as performed could have a positive effect on the IVD in people with chronic back pain
Could look at other exercise types (e.g. running), larger volume of exercise, longer follow-up.
Could look at other exercise types (e.g. running), larger volume of exercise, longer follow-up.
Summary:
exercise could/can 'improve' the IVD
we found evidence that running exercise is associated with better IVD characteristics
but the very first RCT (in #backpain) was inconclusive
future work could look at different exercise, populations, durations
exercise could/can 'improve' the IVD we found evidence that running exercise is associated with better IVD characteristicsbut the very first RCT (in #backpain) was inconclusivefuture work could look at different exercise, populations, durations
to all the collaborators over the years on these and related projects -- not all mentioned above!! And ESPECIALLY very big
to the people who took part in the studiesWithout you these works would not have happened!
