Chronic back pain continues to be a widespread clinical problem. Innovative therapeutic approaches that focus on strengthening the deep back muscles, especially the multifidus muscle (MF), are becoming increasingly important. Isolated lumbar extension resistance exercise (ILEX) enables targeted activation and strengthening of the lumbar spine muscles and is being used more and more frequently, especially in German-speaking countries.
Although the clinical success of ILEX therapy has been known for some time, the underlying changes in muscle morphology and function have not yet been sufficiently investigated. It is also unclear what role ILEX plays in multimodal therapy programs and to what extent the method can be used effectively and safely for specific spinal pathologies – as opposed to nonspecific back pain.
In a recent study published in October 2025 in the renowned journal Scientific Reports, 58 patients with chronic back pain were examined. All had specific spinal complaints, and the majority had radicular symptoms radiating to the lower extremities or relative indications for surgery. Participants could choose between a standalone ILEX program and a multimodal approach that also included manual therapy and general strengthening exercises (e. g., latissimus pull and abdominal crunch on equipment, as well as back and core training on the cable pulley). The program consisted of 25 sessions over a period of 16 weeks. The intensity and range of motion were individually adjusted to the symptoms and diagnosis, based on a systematic training protocol with gradual load increase. The primary outcome parameters were muscle thickness and cross-sectional area of the MF, as well as echogenicity, an indicator of muscle quality. In addition, pain intensity, disability, and health-related quality of life were regularly recorded, as was the maximum strength of the spinal extensors.
Results
The results showed clear therapeutic effects in both groups: pain and functional limitations decreased significantly, quality of life increased, and the maximum strength of the back muscles improved significantly.
Particularly noteworthy was the increase in the cross-sectional area of the MF, which was accompanied by a parallel increase lumbar strength. However, no changes in echogenicity could be detected. It is also interesting to note that changes in almost all parameters were already apparent in the early stages of therapy (after three weeks). A comparison between ILEX training alone and the multimodal approach showed no significant differences in terms of clinical improvements and the increase in maximum strength and cross-sectional area of the MF. Although the curves flattened towards the end of the intervention period, the data suggest that the development was not yet complete and that a longer duration of therapy could lead to further progress.
Conclusion
Targeted ILEX training is an effective measure for reducing pain, restoring function, and improving quality of life in chronic back pain and muscle size – both as a standalone program and as part of multimodal therapy approaches. The linear progress in muscle cross-sectional area and strength underscores the importance of continuous, individually tailored therapy for sustainable results. This study is the first to demonstrate the efficacy and safety of this specific method for specific spinal complaints with relative indications for surgery. Further studies on specific clinical pictures of the lumbar and cervical spine are currently underway or already in the planning stage.
Original paper: Isolated lumbar extension exercise alone or in a multimodal program for low back pain and radiculopathy: a non-randomized controlled trial
Bruno Domokos, Julia Domokos, Gustav Andersson, Stefan Mannel, Linda May Weigel, Horst Josef Koch, Birgit Wallmann-Sperlich, Christoph Raschka & Christoph Spang
ClinicalTrials.gov Identifier NCT06890052 (03/20/2025) https://clinicaltrials.gov/study/NCT06890052?cond=
NCT06890052%20&rank=1
Autoren
» Sportwissenschaftler (B.A., M.Ed.)
» Zuständig bei der Powerspine GmbH für Qualitätsmanagement und wissenschaftliche Entwicklung
» Wissenschaftler und Experte für tiefenmuskuläre Diagnostik am Institut für Sportwissenschaft, Universität Würzburg
(Stand 2026)
» Neurobiologe (Univ. Dipl.) sowie Sportwissenschaftler (Univ. Dipl.)
» Wissenschaftler im Bereich chronische Schmerzen und Gewebsveränderungen & leitender Trainingstherapeut im Privaten Wirbelsäulenzentrum Dr. Alfen Würzburg
» Geschäftsführer der Gesellschaft für Medizinische Kräftigungstherapie (GMKT-D)
(Stand 2026)
