Back pain: The research project "Ran Rücken" is intended to help

About eight in ten Germans suffer from back pain during their lifetime. Too much or the wrong movements can also cause problems. "Ran Rücken", the interdisciplinary research project aims to determine the right minimum dose of exercise that proves effective. (Explanatory note: “Ran Rücken” can be loosely translated as "Target the Back")

In this MEDICA.de interview, project director and sports medicine specialist Professor Frank Mayer M.D. talks about non-specific back pain, sensorimotor training and the creation of successful synergies.

Why do so many people have back problems?

Prof. Frank Mayer: Lack of exercise can certainly be an important factor, though there is a number of possible reasons. It’s crucial to counterbalance the external forces that are acting on the trunk and spine, which is generally handled by well-trained muscles. Back pain is more likely if this is not the case.

What is the objective of the "Ran Rücken" interdisciplinary project?

Mayer: Our task is to develop a training program and relevant diagnostic approach for the prevention and rehabilitation of chronic non-specific back pain. This necessitates specific training. And this, in turn, requires a more detailed study of the dose and effect relationship to be able to personalize the exercise intensity for the individual patient to feel better. We are targeting the minimal level of physical activity. To do this, research findings from the fields of sports, sports medicine and sports science are transferred to the general population.

Who are the targets of this program?

Mayer: It is aimed at both active athletes and those who are active in organized sports and the general public, i.e., those who suffer from mostly temporary pain.

Professional athletes are normally in shape and embark on regular physical activities.

Mayer: Needless to say, it’s a well-known fact that exercise is beneficial and helps. In this setting, the intensity level, the extent and the type of exercise certainly play a role. Generally speaking, even though discomfort is related to the type and intensity of the sport, it can by no means be 100% attributed to these factors. An assessment must always be made by taking the individual athlete into consideration.

How is "Ran Rücken" meant to offer support?

Mayer: The idea is to integrate our concept into existing programs and teach the customized exercises. The concept focuses on perturbation-based training. We study the interaction between nerves and muscles and discovered that this so-called perturbation training – the exposure to perturbations – prompts the human organism to learn how to compensate for these external stimuli. When you practice this exposure, you get into the very settings that may cause the discomfort. You are on the right track if you manage to counterbalance these events. We want to help professional athletes to integrate this sensorimotor training into existing routines. For the average person, we have developed exercises that feature different levels of intensity, require hardly any tools and can be well incorporated into everyday life.

What makes "Ran Rücken" different from earlier research on back pain?

Mayer: Large amounts of exercise don’t always help. That’s why we look for the minimum amount of activity that provides relief. After all, it's not about continuously inventing new ways and changing everything we have learned so far. It’s about incorporating evident and effective aspects based on known facts.

The key takeaway is that we don’t recommend or impart anything that is not scientifically proven and published. In fact, that’s also the mission of our University. We tend to be more conservative and university-driven, but well-substantiated.

What was your course of action?

Mayer: Scientific baseline experiments have been carried out since mid-2011 to solve individual problems. In the next step, we tested the findings in a multicenter diagnostic accuracy study of 1,000 test subjects and a therapeutic feasibility study of 750 patients since it was unclear whether these could be applied as clinical evidence. We got an affirmative answer. We have subsequently worked with 1,600 test subjects from all over Germany on a central proof-of-concept study since the start of 2015. Each person was monitored for a year. Everyone started an assisted training program, which they subsequently continued as an at-home training program. This major study is now being evaluated.

What have the findings been so far?

Mayer: The perturbation-based training is effective and works. It was also determined that it makes sense to embark on these exercises with assistance for about three weeks in a respective center and then continue the exercises at home. For most patients, the minimum amount of exercise is two 30-minute units a week. However, this requires a pre-exercise screening, since this statement cannot be made for all patients across the board. In addition to a functional status assessment of the lumbar spine and a training readiness assessment, this includes an analysis of the biopsychosocial factors. Likewise, motivation plays a major role, also during training sessions.

Thirteen clinical and non-clinical centers participated in this project. How successful was this collaboration?

Mayer: "Ran Rücken" is funded by the German Federal Institute of Sports Science. The "MiSpEx -National Research Network for Medicine in Spine Exercise" research network includes clinical facilities, universities and research centers. The collaboration between the participants was very successful. What’s more, central organizations, Olympic training centers, rehabilitation clinics and physicians have also joined the project. In a manner of speaking, this has now become a German network.

Now you are finally on the home stretch.

Mayer: Over the past years we have conducted 34 individual studies and 3 additional major multicenter projects. The goal now is to sort, transcribe and publish these large volumes of data. In addition, the transfer concept, which has been completed for the past few weeks, is supported by the respective data and summarized. Previously, we didn’t know what type of exercise is helpful and the minimum amount that’s required, when you overshoot the mark and how much is really good for the body. These are the specific concerns we aim to address and finally assess with this project.