An inside look at Dr. Wayne Westcott’s latest study on low back fatigue and pain
PT Aligned had the chance to talk with Dr. Wayne Westcott of the Exercise Science department, Quincy College in Quincy, MA about his in-process research study concerning low back pain and low back fatigue. Dr. Westcott explained how he set up his study and how the muscle stimulation unit, Marc Pro, factored into the testing process as well. Read on for the full interview:
Tell us about the low back pain study you just launched.
We’re working with 90 participants who have varying degrees of severity in low back pain, and we’re also looking at low back fatigue as a related category.
We’re looking to see if it’s better to have at-home Marc Pro Plus®applications of electro stimulus while also strengthening the muscles in a proactive manner through regular resistance exercise.
To test, we created three different sample groups. Group 1 is doing an exercise program only that we’ve tested with before and they’re working with 9 nautilus machines, 3 that work the core, back and abdominal muscles.
Group 2 is using the Marc Pro Plus device. They are not doing an exercise program and they are using the device at home for nine weeks, applying the Marc Pro Plus at least four times a week for roughly an hour per session. Most have been doing more than that but that’s the minimum we ask for and that the College Institutional Review Board accepted it as a requirement.
The 3rd group is doing both of above actions: the strength training exercises and the Marc Pro Plus application. So, we have 3 groups and hopefully all of them will receive benefits, but we’re trying to compare if one method is better than the other regarding easing low back pain with the populations that we are researching right now.
Ideally we’re looking to see if it’s better to have at home Marc Pro applications of electro stimulus while also strengthening the muscles in a proactive manner through regular resistance exercise.
Are all of your studies IRB approved?
Yes, they are.
Of the people you’re testing right now, would you say they’re representative of a certain population group?
We have a variety of people in the study. The most general classification would be adults over age 50, so we do have an older population. These adults are sedentary for the most part, mainly from their low back issues, and they’ve reported that the pain makes it more challenging for them to do physical activity.
So what kind of screening did you conduct prior to the study?
They filled out a medical history form as well as the IRB consent forms. We’re testing each participant for their body composition, resting systolic and diastolic blood pressure, and lower back strength (lumbar extension test).
Establishing a rating scale for low back pain/low back fatigue was important before testing began. We asked participants to provide ratings on a scale of 1 – 9 (1 being least, 9 being worst) during the first week of their program. We asked them for the worst day they had in that first week and we’ll do the same thing at the end of the program so we can compare the two “high” (bad) points. So many of our people have a good day, a bad day, a medium day, that ask for the worst day in the past week and we will compare that to the worst day during the last week of the study.
Have you seen that the majority of your subjects have significant low back issues?
The people that we currently have reported an average score on the pain scale of a 5-6, a small group is 3-4 and we have quite a few in the 7-8 range and even some 9s. There are not too many 9s and again, with the 9 people, it’s not like every day is a 9 but they will experience that level of pain on their worst days.
After we went through the initial testing with the subjects (which takes a good chunk of time), we did find some subjects with so little low back pain they could not really say they were above a 1 in the 1-9 pain threshold scale. We had to ask these individuals to drop out, which they were happy to do because they understood the study’s intent.
What are the results that you’re recording right now indicating as far as Marc Pro Plus® effectiveness? Are they what you expected to record?
We’re just in our first week of testing and we’re still training people how to use the Marc Pro Plus and/or the fitness equipment. I’m going to say that we’ve had about five percent of the people return the Marc Pro Plus; it just didn’t seem to work for them. That hasn’t happened in our previous studies, but these people have more serious back issues than those we worked with before, including arthritic conditions.
Of the remaining 57 that are out there right now, almost all have said that the Marc Pro isn’t hurting them (that’s good!), and most of them said that it’s great … it feels good when they’re using it, and/or really good after they’ve used it. I’ve had a couple of people say to me, “my gosh! I’ve had this pain for years and all of a sudden I don’t have it anymore,” which is really good news.
The same experience is also true for those in the exercise-only group. We’ve had a couple of people say, “you know, I just cant do this because of my other physical conditions” or “can I cut out some of these exercises” and we say yes, we’ll try and work around that and substitute your routine with other exercises. But others in this group say “my goodness, I’ve never felt a moment without pain, and I just went out to mow my lawn and didn’t feel pain, not at least for the first 30-40 minutes.” So we are getting good reports from most of the people in the exercise program.
And of course, in the exercise plus Marc Pro Plus® group, we are getting the same responses. Basically, ninety-five percent of the participants been very favorable to our study interventions.
There’s always going to be a subject population that just doesn’t respond to the study. You’ve got pretty good numbers who have responded well, so that’s encouraging.
We were pleased we had such a large sample size to start with. We’ve done other studies and have had drop offs, people on vacation, those who get hurt chopping wood, stuff like that. You know that there are drop offs in any study.
If we can get seventy to seventy-five people to complete this study, we think we’ll have a pretty good basis for analyzing the data.
You’ve used the Marc Pro® in a low back fatigue study before. Is this research an extension of previous study or are you using the device as a different driver?
We’ve done a few studies with Marc Pro. We did one with eccentric strength training; we did one with hiking, especially the downhill movements, looking at muscle fatigue and delayed-onset muscle soreness. We actually did two studies on calf fatigue. We attained such good results with the first study that we did a second study the following summer to verify our first results. We got the essentially same results in the second study! The Marc Pro proved to be very effective in terms of both enhancing muscle strength and reducing calf fatigue.
We also did a study a few years ago on low back fatigue because at that time we were not allowed to use the word “pain” with the Marc Pro unit. At that time, the Marc Pro was not approved for over the counter pain treatment, so we couldn’t use the word pain. For this particular study the Marc Pro Plus, which has been approved for pain treatment, so we’re now expanding our research from the low back fatigue only. We’re assessing fatigue for comparison as well, but we are mainly interested in low back pain reduction.
What would you like to do with this study when it finishes in August? Are you looking at any journals for publication or plan on further action with Marc Pro®?
We would definitely like to publish the results (assuming these are favorable), we will submit our paper to a research journal because we believe that these results will be important to other professionals.
Personally, I’ve never had any issues with low back pain prior to a week before the study. I was doing bench presses and even though I’ve written 27 books on strength training, I committed the ultimate error that every first week student is told not to do: I was doing bench presses without a spotter and I failed to get the bar back up, so it rolled down my torso and lower body.
I definitely threw something out and I ignored it (like guys tend to do!), and the next time I tried my own strength training I got some serious pain… it was awful, I had low back issues. I couldn’t stand, I couldn’t walk, I couldn’t lie down, I couldn’t sit…and so now I am totally empathetic to my test subjects, because with low back pain you can understand how bad it really can be.
The Marc Pro has definitely helped me with the low back pain. Without it, I’d be in much bigger trouble and I’m starting to get healthier. It’s been a couple of weeks and I’m starting to get pretty good results right now.
That’s great. What a great story for other medical professionals too. The leader of a low back study having low back issues too – it’s so relative to them. It’s a great testimonial to the Marc Pro’s effectiveness.
I’ve used the Marc Pro before with shoulder injuries before. Shoulder injuries are tough because they always hurt when you move in the wrong direction; mine used to keep me awake at night. My wife has also used the Marc Pro and found that it helped her. With my recent lower back pain, I’ve gotten used to saying, “where’s my Marc Pro” and I put on the high frequency to curb or numb the nerves, calm the pain. Then, I can start using the low frequency to get the blood pumping and help the healing process. (Laughing) It’s been a godsend for me!
So I’m hoping for good testing results so the people involved will have some practical benefit from the testing as well – that’s my goal.
Relative to your experience with the Marc Pro® over years and years of use and your recent injury, how would you explain the technology in the Marc Pro versus classic stim units – what’s your explanation for the technology and how it’s different from average e-stim?
I look at the fast twitch and slow twitch fibers – we do a lot of work in that area. We don’t do anything that includes an invasive biopsy; we don’t have that capability in our clinic. But, as I understand, the Marc Pro wave forms tend to specifically address the slow twitch fibers, which are slow to fatigue and quick to recover, So I can use the technology on a participant who still wants to be able to lift, run, cycle while injured without unduly fatiguing their muscles. That’s one of the benefits, especially for people who are active.
A participant using the Marc Pro receives the benefits of increased blood flow without the muscle fatigue associated with running interval sprints or using a technology that affects all of the muscle fibers and not just the slow twitch.
Believe me, with acute low back pain, the 60 cycles per second frequency available with the Marc Pro is much appreciated! The buzzing, nerve-numbing affect takes away the pain. For me, this was a new and welcomed feature in addition to the low frequency stimulus that enhances the tissue healing process.
How did you originally come across this product? Did Marc Pro reach out to you for research?
I’ve worked together with my good friend Gary Reinl for years in mostly strength training, but he asked me a few years ago, “would you see if the Marc Pro helps with muscle recovery?” That’s when we did leg extensions with an eccentric emphasis so we could see the effect on delayed onset of muscle soreness. and that was the first thing that we did. Then, we moved onto the downhill hiking research, and several other studies.
When we did the first calf study, we were very pleased with the outcome, but when we gave Gary the data he actually said the results were too good and that nobody was going to believe us! He thought that something had gone wrong, so he asked us to do it again and we attained almost identical results in the second study. Apparently, the calf muscles respond really well to the Marc Pro®treatments. Hopefully, it will work just as well with low back pain.
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