Potential lower extremity amputation-induced mechanisms of chronic low back pain: role for focused resistance exercise.

Approximately 185 000 individuals undergo limb amputations every year. Of this population, 40% experience lower extremity amputations. A common musculoskeletal condition that develops after amputation is chronic low back pain (LBP). LBP may be a consequence of one or combined mechanical factors including muscle atrophy, strength loss, level of amputation, kinematic traits of movement, mechanical loading and forces, prosthetic design/use and leg length discrepancy. Secondary consequences of LBP may collectively include the dependence of pain medications, impaired physical function, and diminished quality of life (QOL). A systematic literature search using PubMed was conducted to identify articles of low back pain in lower limb amputees. Long-term interventions are needed to reduce the incidence, prevalence, and secondary impacts of LBP in amputees. Resistance exercise has strong potential to help correct mechanical deficits in lower limb amputees. Resistance exercise adaptations that can be beneficial for this population include improved neuromuscular control, increases in lumbar and core muscle strength cross-sectional area, and improved gait motion parameters. This narrative review provides an overview of the key mechanical and physiological factors which may contribute to chronic LBP in amputees, and discusses the use of resistance exercise training to combat these mechanical factors to improve pain symptoms.IMPLICATIONS FOR REHABILITATIONLow back pain is more prevalent in the amputee population compared to the general population.Low back pain may be due several mechanical factors that develop after a unilateral amputation.Lower extremity amputees with chronic low back pain experience compounded physical activity avoidance and functional limitations.Chronic low back pain in amputees erodes quality of life more than people with back pain or amputation alone.Therapeutic interventions, such as core strengthening and stabilization exercises, have strong potential to provide low back pain relief for amputees.