Motor control in chronic low back pain

Chronic non-specific low back pain (NSLBP) is one of the most common musculoskeletal related issues faced by therapists. Motor control exercise (MCE) is commonly utilized to help activate and coordinate the deep and global trunk muscles to mitigate symptoms and manage pain. The authors of the current study systematically investigated the most current literature to determine the efficacy of MCE on NSLBP. Overall, it was shown that, when compared to minimal intervention (control or sham), MCE had low evidence of a clinically important difference. When comparing MCE to exercise plus electrophysical agents there was minimal evidence and when comparing MCE to manual therapy there was moderate to high evidence that there was no clinically importance difference.

Systematic reviews were identified from several online databases including but not limited to: CENTRAL, MEDLINE and EMBASE. 29 trials were included in this review that compared the effectiveness of MCE on NSLBP with no treatment or with other interventions as a supplement.

Motor control exercise is often employed as an intervention, based on the assumption that patients presenting with NSLBP have altered control and stability of the spine. By restoring the activation and coordination of the deep trunk muscles, we can reduce the randomized pain in the low back and gluteal region. Due to the popularity of MCE being utilized in our treatment strategies for LBP, this study was produced to fill a knowledge gap incorporating new and existing literature.

Using pain and disability as an outcome, it was shown that there was little difference between MCE and electrophysical agents, general exercise and control interventions. It is interesting to note that there was moderate to strong evidence that MCE and manual therapy had similar outcomes. Despite the shortcomings in available literature, the current investigation emphasizes the point that, given the lack of conclusive evidence surrounding MCE, our treatment approach should be guided by our patients, experience, education and expertise.

> From: Saragiotto et al., Cochrane Database Syst Rev (2016) . All rights reserved to The Cochrane Collaboration. Click here for the Pubmed summary.