Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Effects of running on intervertebral disc health in adults with chronic low back pain: the ASTEROID randomised control trial (115409)

Claire L Samanna 1 , Chris Neason 1 , Scott D Tagliaferri 2 3 , Daniel L Belavy 4 , Steven J Bowe 5 , Matthew J Clarkson 6 , David Connell 7 , Emma A Craige 8 , Romina Gollan 9 , Clint T Miller 9 , Ulrike H Mitchell 10 , Niamh L Mundell 9 , David Scott 9 , Jamie L Tait 9 , Grace E Vincent 8 , Hana R Nez 11 , Patrick J Owen 1 12
  1. Monash University, Box Hill, VIC, Australia
  2. Orygen, Parkville, Vic, Australia
  3. Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
  4. Department of Applied Health Sciences, Hochschule für Gesundheit , Gesundheitscampus, Bochum, Germany
  5. Victoria University of Wellington, Wellington, New Zealand
  6. Institute for Health and Sport, Victoria University, Footscray, VIC, Australia
  7. Imaging @ Olympic Park, Melbourne, VIC, Australia
  8. Appleton Institute, School of Health, Medical, and Applied Sciences, Central Queensland University, Adelaide , South Australia, Australia
  9. Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
  10. Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States of America
  11. Integrated Pain Specialists, South Jordan, Utah, United States of America
  12. Eastern Health Emergency Medicine Program, Eastern Health, Box Hill, VIC, Australia

Introduction: Low back pain is the primary cause of global disability with up to 40% of cases attributed to intervertebral disc degeneration. Cross-sectional studies showed running is associated with better magnetic resonance imaging (MRI)-derived intervertebral disc health, yet no randomised controlled trials have assessed the effect of running. Therefore, we examined the effects of running on intervertebral disc health in adults with chronic low back pain.

Methods: This 12-week parallel (1:1) randomised control trial allocated 40 adults aged 18–45 years (mean [SD] age: 33 [6] years, female: 50%) with non-specific chronic low back pain to a running intervention or waitlist control. The running intervention involved a digitally delivered, progressive run-walk interval exercise intervention (3 days/week, 30 minutes/session). Progression was self-directed by participants and in consultation with an accredited exercise physiologist. MRI of spinal levels T11/T12 to L5/S1 was performed at baseline, 6 and 12 weeks. Two outcomes were analysed: (1) T2 (ms), an objective assessment of intervertebral disc hydration, with higher values indicating better intervertebral disc health, and (2) Pfirrmann grade (points), a subjective assessment of intervertebral disc degeneration on a 5-point scale, with lower values indicating better intervertebral disc health.

Results: There was no attrition or study-related serious adverse events. Mean (SD) intervention adherence was 70% (20%) and total run distance was 50 km (32 km, range: 2–110 km). At 12 weeks, intervention led to improved Pfirrmann grade compared to control at: [1] average lumbar (estimated marginal mean net difference [95%CI]: -0.15 [-0.25, -0.05] points, P=0.004), [2] T11/T12 (-0.26 [-0.45, -0.06] points, P=0.009) and [3] L3/L4 (-0.26 [-0.51, -0.01] points, P=0.041). Intervention also led to improved T2 at T11/T12 (4.54 [0.42, 8.66] ms, P=0.031), yet not at average lumbar spine (-0.13 [-1.74, 1.48] ms, P=0.873).

Conclusion: Running may improve intervertebral disc health in adults with chronic low back pain, although it appears to be level-specific. We demonstrated evidence to suggest delayed IVD degeneration with running however results should be interpreted with caution due the subjective nature of Pfirrmann grade. Importantly, no deleterious effects or adverse events were observed. Exploring the effect of interventions with higher running volume and longer running duration on intervertebral disc health warrants investigation.