Diagnostic accuracy and reliability of muscle strength and endurance measurements in patients with chronic low back pain

Published on January 1, 2009 by Gruther W, Wick F, Paul B, Leitner C, Posch M, Matzner M, Crevenna R, Ebenbichler G

Key Takeaway

While dynamometric trunk tests are common, learning effects limit their value for tracking progress; the simple Biering-Sørensen endurance test offers superior diagnostic accuracy and reliability.

Gruther W., Wick F., Paul B., Leitner C., Posch M., Matzner M., Crevenna R., Ebenbichler G.. (2009). Diagnostic accuracy and reliability of muscle strength and endurance measurements in patients with chronic low back pain. https://doi.org/10.2340/16501977-0391

Read the original publication →

What this study found

This study evaluated the diagnostic accuracy and long-term reliability of common trunk muscle strength and endurance tests in patients with chronic low back pain (CLBP). Researchers compared isokinetic and isometric dynamometer testing against the Biering-Sørensen test (a clinical test for back muscle endurance) across CLBP patients, healthy controls, and chronic headache controls. While dynamometric measurements successfully distinguished CLBP patients from healthy controls, they demonstrated significant learning effects upon retesting three weeks later. Conversely, the Biering-Sørensen test showed outstanding diagnostic accuracy (AUC = 0.93) and remained highly stable over time with no learning effects.

Why it matters

For rehabilitation clinicians, tracking objective progress is vital. However, these findings suggest that serial dynamometric testing may artificially inflate progress reports because patients simply get better at performing the test itself. In contrast, the Biering-Sørensen test emerges as a highly reliable, accessible, and cost-effective alternative. It allows clinicians to:

  • Accurately assess baseline lumbar extensor endurance without expensive equipment.
  • Reliably monitor rehabilitation progress over time, free from the confounding influence of learning effects.
  • Confidently design targeted trunk stabilization and endurance protocols.

Limitations

While the findings strongly support the Biering-Sørensen test, the study’s sample size was relatively small (66 participants total). Additionally, because the Biering-Sørensen test requires holding a static position to exhaustion, clinicians must still account for subjective factors like pain tolerance, fear-avoidance, and patient motivation during testing.

Continue your learning

Therapeutic apheresis: An effective strategy for a combined targeting of circulating lipoproteins, inflammatory markers, PFAS, and microplastics in cardiometabolic and neurodegenerative disease?

Therapeutic apheresis shows promise as a multi-target therapy to reduce circulating lipoproteins, inflammatory markers, and environmental toxins like PFAS and microplastics in chronic disease.
Result: Therapeutic apheresis shows promise as a multi-target therapy to reduce circulating lipoproteins, inflammatory markers, and environmental toxins like PFAS and microplastics in chronic disease.

Myostatin and markers of bone metabolism in dermatomyositis

Patients with dermatomyositis exhibit altered biochemical markers of muscle and bone metabolism alongside functional deficits, highlighting the need for targeted, multi-modal rehabilitation.
Result: Patients with dermatomyositis exhibit altered biochemical markers of muscle and bone metabolism alongside functional deficits, highlighting the need for targeted, multi-modal rehabilitation.

Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers

Male soldiers with tibial bone stress injuries exhibit significant deficits in bone microarchitecture, including reduced cortical density and thinner, more irregular trabecular networks.
Result: Male soldiers with tibial bone stress injuries exhibit significant deficits in bone microarchitecture, including reduced cortical density and thinner, more irregular trabecular networks.

View all studies

Start your recovery today

Contact us