The effect of a multimodal exercise program on paraspinal muscle morphology and clinical outcomes in chronic low back pain
Isokinet Exerc Sci. 2026 Mar 19;34(2):127-144. doi: 10.1177/09593020261419928. eCollection 2026 May.
ABSTRACT
BACKGROUND: Multimodal exercise programs do not specifically target lumbar paraspinal musculature, but incorporate aspects of different exercises to have an overall benefit.
OBJECTIVE: To investigate the effect of a multimodal exercise program on paraspinal muscle volume and composition, and patient outcomes in individuals with chronic low back pain (CLBP).
METHODS: Thirty-four participants with CLBP either completed a 14-week high-intensity training program (n = 8) including cardiorespiratory and resistance exercises 3 sessions per week or were waitlisted (n = 26). Participants underwent magnetic resonance imaging at baseline and post-intervention to assess paraspinal muscle volume (cm3) and fatty infiltration (% FI) at L3-L4, L4-L5, and L5-S1. Pain, disability, quality of life, pain-related fear (catastrophizing and Kinesiophobia), and anxiety were assessed via validated self-reported questionnaires.
RESULTS: Mixed-design ANOVA revealed no significant time × group interactions for paraspinal muscle volume and %FI. An exploratory analysis revealed a significant increase in multifidus %FI in the control group at L3-L4, L4-L5, and L5-S1, with a concomitant increase in multifidus volume at L3-L4 and L5-S1. The exercise group had a significant increase in multifidus %FI and volume at L5-S1. Significant time × group interactions for pain, disability, catastrophizing and kinesiophobia, and a main effect of group in physical and mental health were found. Significant correlations were found between changes in patient-reported and functional outcomes with paraspinal muscle morphology.
CONCLUSION: Multimodal exercise programs may help prevent LBP-related paraspinal muscle atrophy and %FI, and lead to concomitant improvements in pain, disability and pain-related fear in individuals with CLBP.
PMID:42093855 | PMC:PMC13143176 | DOI:10.1177/09593020261419928