Archives 2017

Motor Control for Low Back Pain

For patients with sub-acute low back pain, exercise is a common intervention with recommendations published in several guidelines (1-4), meta-analysis (5), and systematic reviews (6, 7). However, the type of exercise used in individual randomized controlled trials (RCTs) often varies and the breadth of research comparing different types of exercise for this population is limited. Populations with chronic low back pain have demonstrated positive results with exercises targeting motor control (8-10). These kinds of exercises teach patients with low back pain how to become more aware of the position of their low back in relation to the rest of their body. Since dysfunction in motor planning can occur at any stage of rehabilitation, one RCT (11) looked at the effects of motor control exercises versus a general exercise program in patients with sub-acute low back pain. The researchers’ aim was to determine if earlier intervention with motor control exercises would have similar effects to those found in the chronic low back pain population.

Seventy participants were randomized to receive either specific motor control exercises or general exercises. Both treatments were combined with manual therapy delivered by a physiotherapist. Participants received the intervention five times over a period of three months, with each physiotherapy session lasting 45 minutes and a prescribed home exercise program performed in between sessions. At the end of the intervention, just over half of the general exercise group had achieved a 50% reduction in their disability as measured by the Roland Morris Disability Questionnaire. In contrast, almost 90% of the motor control exercise group demonstrated the same 50% reduction in disability. At a year follow up, the motor control exercise group continued to demonstrate a significant decrease in their level of disability compared to the general exercise group.

Both groups in this study showed significant reduction in their disability levels, however a program that utilizes motor control exercises was shown to be superior to a general exercise program both at the end of the intervention and at long term follow up. Physiotherapists have the training to deliver motor control exercises to their patients and can tailor these exercises specifically to the directions the patient has difficulty moving in. Referring patients with sub-acute low back pain to physiotherapy for motor control based exercises offers an effective, lasting, and low-cost option for treatment.

1. Delitto et al. Low Back Pain. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health for the Orthopaedic Section of the American Phyiscal Therapy Association. JOSPT. 2012;42(4):A1-A57

2. Chou et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147(7):478-91.

3. Airaksinen et al. Chapter 4: European Guidelines for the Management of Chronic Nonspecific Low Back Pain. Eur Spine. 2004;15 Suppl 2:S192-300.

4. Bekkering et al. Dutch Physiotherapy Guidelines for Low Back Pain. Physiotherapy. 2003;89(2):82-96.

5. Hayden et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3).

6. Hayden et al. Systematic Reviews: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-85.

7. Pengel et al. Systematic review of conservative interventions for subacute low back pain. Clin Rehabil. 2002l16(8):811-20.

8. Aasa et all. Individualised low-load motor control exercises and education versus a high low lifting exercises and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. JOSPT. 2015;45(2):77-85.

9. Vibe et al. Efficacy of classification bases cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013;17(6):916-28.

10. Suni et al. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12 month randomized controlled study. Spine. 2006;31(18)E611-20.

11. Lehtola et al. Sub-classification based specific movement control exercises are superior to general exercise in sub-acute low back pain when both are combined with manual therapy: a randomized controlled trial. BMC Musculoskelet Disord. 2016;17:135.