Sammanfattning: Bakgrund: Långvarig ospecifik ländryggssmärta medför stora problem och lidande på ett individuellt plan, men påverkar även samhället då det medför stora kostnader för sjukvården. Dynamisk styrketräning av rygg och bål är ett vanligt behandlingsalternativ. Under de senaste fem åren har det ej genomförts någon litteraturstudie som sammanställer denna träningens effekt på upplevd smärtintensitet. Därmed finns det ett kliniskt värde för fysioterapeuter att litteratur sammanställs.  Syfte: Syftet med denna litteraturstudie var att sammanställa, värdera och jämföra forskningsresultat av dynamisk styrketräning för bål och rygg som behandling för personer med långvarig ospecifik ländryggssmärta och dess effekt på upplevd smärta. Metod: En litteraturstudie genomfördes i databaserna PubMed och PEDro. Samtliga sökträffars titel och abstrakt granskades, studier med potential att möta inklusionskriterier granskades därefter i fulltext varefter relevanta studier slutgiltigen inkluderades. Studier kvalitetsgranskades enligt PEDro-scale och resultatets tillförlitlighet sammanvägdes med GRADEstud. Resultat: 12 RCT-studier identifierades och granskades. Kvalitetsgranskning visade att 9 studier höll hög kvalitet. Studier med hög kvalitet evidensgraderades enligt GRADEstud, där två subgrupperingar identifierades. Dynamisk träning håller en låg (++) tillförlitlighet avseende effekt på upplevd smärta. Resultaten varierade avseende effekt på smärta, utfall och studierna hade olika upplägg vilket har bidragit till att tillförlitligheten bedöms som låg.  Konklusion: Dynamisk styrketräning av rygg och bål tycks inte vara mer effektiv än annan träning för att minska upplevd smärta för personer med långvarig ospecifik ländryggssmärta. / Abstract: Background: Chronic non-specific low back pain causes major problems and suffering for individuals, but also affects society as it entails large costs for healthcare. Dynamic strength-training of the core is a common treatment. In the last five years, no literature study has been conducted. There is a clinical value for physiotherapists in compiling literature for this treatment method. Objective: The purpose of this literature study was to compile, evaluate and compare research results of dynamic strength training for the core as a treatment for people with long-term non-specific low back pain and its effect on perceived pain. Method: A literature study was conducted in the databases PubMed and PEDro. Title and abstract of all studies were examined, studies that met inclusion criteria were examined in full text, after which relevant studies were included.  Studies were quality reviewed according to PEDro-scale and the result reliability was weighed with GRADEstud. Results: 12-RCT studies were included. Quality review showed that 9 studies maintained a high level. High quality studies were graded with GRADEstud, two subgroups were identified. Dynamic strength-training maintains a low (++) reliability regarding the effect on perceived pain. The results varied regarding effect on perceived pain and the studies had different setups which contributed to the low reliability. Conclusion: Dynamic strength-training of the back and core does not seem to be more effective than other training to reduce perceived pain for persons with chronic non-specific low back pain.

Low back pain (LBP) is regarded as a major health and economic problem in western industrialised countries even at this time in the twenty-first century. Researchers estimate that it has increased to affect about 45% of the population in 2011. This increase creates a major burden on the health care services, social structures and the economy in terms of absenteeism from work. CNSLBP is still poorly understood. Main reasons for the poor understanding of CNSLBP discussed in this study are the limited understanding of the effect of the spine as kinetic chain which includes the head and pelvic girdle and with its attachments to the scapulae . The process of development of ISMS dysfunction are discussed as a combination of abnormal spinal loading, soft and neural tissue plasticity that result in biomechanical malalignment, adaptive and maladaptive movement patterns, pain processing integrated with psychosocial factors that influence the biomechanical, pain processing and psychological responses are discussed as possible mechanisms in the development of CNSLBP. The researcher developed a multidimensional manual therapy model to manage patients with CNSLBP based on metacognitive reflection on her clinical reasoning over a period of 40 years as the research methodology. The metacognitive reflection has been performed within the interpretive paradigm The model that resulted from the metacognitive reflection is dialectic in nature because it entails the understanding of the patient‘s problem from an interpretive as well as from an empirico-analytical perspective. The model is conceptualised in three stages: Firstly the conceptualisation of the integrated spinal movement system (ISMS), to indicate that the spine, head, shoulder and pelvic girdles function as a closed kinematic chain. Secondly the process of the development of ISMS dysfunction as a major concept in the clinical picture of patients with CNSLBP is based on functional anatomy of the ISMS and the researcher‘s clinical observation in clinical practice. The researcher indicates how the development of ISMS dysfunction and characteristic adaptive behaviour are integrated components of the patient‘s complex heterogenic clinical picture. The underlying process for the development of ISMS dysfunction as a possible mechanism for CNSLBP is described as plasticity of soft and neural tissues (including the brain) which result in chronicity over time. Thirdly a multidimensional manual therapy model to manage patients with CNSLBP‘s heterogenic condition is discussed. The model indicates how the mechanisms underlying the development of ISMS dysfunction is addressed in a multidimensional approach to patient management. Finally the multidimensional manual therapy model is discussed in relation to other relevant intervention approaches. The model finally serves as a point of departure for planning and conducting appropriate research in basic and clinical sciences. The multidimensional manual therapy model for the management of patients with CNSLBP has been developed in clinical practice and is presented as a practicetheory in the form of a model. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiotherapy / Unrestricted