Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review (original) (raw)
Related papers
Motor Control Exercises Reduces Pain and Disability in Chronic and Recurrent Low Back Pain
Spine, 2013
Study Design. Meta-analysis of randomized, controlled trials. Objective. To determine the short-term, intermediate, and longterm effectiveness of MCE, with regard to pain and disability, in patients with chronic and recurrent low-back pain. Summary of Background Data. Previous meta-analyses have shown no difference between the effects of MCE and general exercise in the treatment of low back pain. Several high quality studies on this topic have been published lately, warranting a new meta-analysis. Methods. We searched electronic databases up to October 2011 for randomized controlled trials clearly distinguishing MCE from other treatments. We extracted pain and disability outcomes and converted them to a 0 to 100 scale. We used the RevMan5 (Nordic Cochrane Centre, Copenhagen, Denmark) software to perform pooled analyses to determine the weighted mean differences (WMDs) between MCE and 5 different control interventions.
BMC Musculoskeletal Disorders, 2012
Background: Practice guidelines recommend various types of exercise for chronic back pain but there have been few head-to-head comparisons of these interventions. General exercise seems to be an effective option for management of chronic low back pain (LBP) but very little is known about the management of a sub-acute LBP within subgroups. Recent research has developed clinical tests to identify a subgroup of patients with chronic non-specific LBP who have movement control dysfunction (MD). Method/Design: We are conducting a randomized controlled trial (RCT) to compare the effects of general exercise and specific movement control exercise (SMCE) on disability and function in patients with MD within recurrent sub-acute LBP. The main outcome measure is the Roland Morris Disability Questionnaire. Discussion: European clinical guideline for management of chronic LBP recommends that more research is required to develop tools to improve the classification and identification of specific clinical subgroups of chronic LBP patients. Good quality RCTs are then needed to determine the effectiveness of specific interventions aimed at these specific target groups. This RCT aims to test the hypothesis whether patients within a subgroup of MD benefit more through a specific individually tailored movement control exercise program than through general exercises.
Motor Control or Graded activity exercises for chronic low back pain? A randomised controlled trial
2008
Background: Chronic low back pain remains a major health problem in Australia and around the world. Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25-50% of patients respond to exercise. The two most popular types of exercise for low back pain are graded activity and motor control exercises. At present however, there are no guidelines to help clinicians select the best treatment for a patient. As a result, time and money are wasted on treatments which ultimately fail to help the patient.
BMC Musculoskeletal Disorders, 2011
Background: Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises. Methods/Design: In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 -75 will be recruited in 5 outpatient hospital departments and 7 private practices. Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 -18 treatments and will be instructed to do additional exercises at home. The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity.
Journal of Orthopaedic & Sports Physical Therapy
M any physical approaches to managing low back pain (LBP) include exercise that aims to change motor control. In this context, motor control refers to motor, sensory, and central processes involved in control of posture and movement. Although different approaches share the underlying assumption that the manner in which individuals use their body and load their tissues is related to the development and maintenance of their conditions, there are differences in how motor control is assessed and trained, as well as differences in proposed mechanisms for its efficacy. This commentary aims to describe how motor control is used in 4 clinical approaches commonly used in physical therapy, and to consider areas of convergence and divergence between these approaches and how these approaches interface with nonsurgical medical management of patients with LBP. Clinical Approaches That Focus on Motor Control The clinical approaches included in this U U SYNOPSIS: Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient.
2021
Development of chronic pain after a low back pain episode is associated with increased pain sensitivity, altered pain processing mechanisms and the influence of psychosocial factors. Although there is some evidence that multimodal therapy (such as behavioral or motor control therapy) may be an important therapeutic strategy, its long-term effect on pain reduction and psychosocial load is still unclear. Prospective longitudinal designs providing information about the extent of such possible long-term effects are missing. This study aims to investigate the long-term effects of a homebased uni- and multidisciplinary motor control exercise program on low back pain intensity, disability and psychosocial variables. 14 months after completion of a multicenter study comparing uni- and multidisciplinary exercise interventions, a sample of one study center (n = 154) was assessed once more. Participants filled in questionnaires regarding their low back pain symptoms (characteristic pain intens...
Journal of Orthopaedic & Sports Physical Therapy, 2019
M any physical approaches to managing low back pain (LBP) include exercise that aims to change motor control. In this context, motor control refers to motor, sensory, and central processes involved in control of posture and movement. Although different approaches share the underlying assumption that the manner in which individuals use their body and load their tissues is related to the development and maintenance of their conditions, there are differences in how motor control is assessed and trained, as well as differences in proposed mechanisms for its efficacy. This commentary aims to describe how motor control is used in 4 clinical approaches commonly used in physical therapy, and to consider areas of convergence and divergence between these approaches and how these approaches interface with nonsurgical medical management of patients with LBP. Clinical Approaches That Focus on Motor Control The clinical approaches included in this U U SYNOPSIS: Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient.
Journal of Manual & Manipulative Therapy, 2018
Objectives: Clinical practice guidelines recommend a focus on regional interdependence for the management of chronic low back pain (CLBP). This study investigated the additive effect of regional manual therapy (RMT) when combined with standard physical therapy (SPT) in a subgroup with CLBP. Methods: Forty-six participants with CLBP and movement coordination impairments were randomly assigned to receive SPT consisting of a motor control exercise program and lumbar spine manual therapy, or SPT with the addition of RMT to the hips, pelvis, and thoracic spine. Outcome measures included disability level, pain intensity, pain catastrophizing, fear avoidance beliefs, and perceived effect of treatment. Appropriate parametric and non-parametric testing was used for analysis. Results: Both groups demonstrated improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs across time (P < 0.001). There was no difference between groups for any variable over 12 weeks, although a significantly greater proportion of participants in the RMT group exceeded the minimal clinically important difference (MCID) for disability. The perceived effect of treatment also was significantly higher in the group receiving RMT at two weeks and four weeks, but not 12 weeks. Discussion: SPT with or without RMT resulted in significant improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs over 12 weeks in persons with CLBP and movement coordination impairments. RMT resulted in greater perceived effect of treatment, and a clinically meaningful improvement in disability, across four weeks compared to SPT alone.
2020
Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or...