Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis.

Study Summary

13 randomized controlled trials including 778 patients with chronic non-specific low back pain were included in this systematic review and meta-analysis comparing resistance training with external loads vs unloaded exercise. Pooled outcomes of interest included pain intensity, disability, back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Loaded resistance training showed a small statistically significant improvement in pain at follow-up periods beyond 7 weeks, but this effect was modest and not clearly clinically meaningful. Disability findings were inconsistent, and psychosocial outcomes did not meaningfully differ between groups. Overall, these findings suggest that external loading is safe and feasible, but it does not appear clearly superior to unloaded exercise for most clinically important outcomes.