Motor control exercise may help lower back pain

Exercises that target muscles supporting the spine could reduce pain in the lower back, researchers say.

Targeting exercises to muscles that support and control the spine may help to reduce pain and disability caused by lower back pain, says research published in the Cochrane Review.

Lower back pain (LBP) is one of the most common health conditions globally, incurring substantial health and economic costs due to disability, general ill health and lost days at work.

Despite its high prevalence, the source of pain is often unclear, with the result that it is often described as "non-specific LBP."

Previous studies have suggested that LBP involves impairments in the control of the deep trunk muscles. These muscles are responsible for maintaining the coordination and stability of the spine.

Motor control exercise (MCE) was developed with the aim of restoring the coordination, control and capacity of the trunk muscles that support the spine. It is widely prescribed for people with LBP.

MCE involves training the isolated contraction of deep trunk muscles, with further integration of these muscles into more complex static, dynamic and functional tasks. It should also improve coordination and optimal control of the global trunk muscles.

Patients are initially guided by a therapist to practice normal use of the muscles through simple tasks; as their skill increases, more complex exercises are set, including the functional tasks needed to perform work and leisure activities.

In the the new study, researchers, led by Bruno Saragiotto, a physiotherapist from The George Institute, University of Sydney in Australia, gathered data from 29 randomized trials involving a total of 2,431 men and women, aged 22-55 years.

Some improvement with MCE

The team looked at MCE's effectiveness as a treatment for lower back pain compared with other forms of exercise or doing nothing. The treatment programs lasted from 20 days to 12 weeks, with one to five sessions per week.

MCE appeared to bring about some reduction in pain, disability and perceived quality of life, compared with minimal intervention at all follow-up periods.

The researchers describe this as "low to moderate quality evidence that motor control exercise (MCE) is more effective than a minimal intervention for chronic low back pain."

When results were compared for pain and disability between MCE and other types of exercise at intervals between 3-12 months, the difference was not considered clinically significant.

Despite the low quality of evidence, it is thought that MCE might be slightly more effective than exercise plus electrophysical agents (EPA) for pain, disability, global impression of recovery and physical quality of life in the short and intermediate term.

No clinically important difference was observed between MCE and manual therapy for any of the outcomes investigated.

The researchers conclude that despite minimal evidence of MCE being better than other forms of exercise, it appears to be a safe form of exercise.

Saragiotto says:

"Targeting the strength and coordination of muscles that support the spine through motor control exercise offers an alternative approach to treating lower back pain. We can be confident that they are as effective as other types of exercise, so the choice of exercise should take into account factors such as patient or therapist preferences, cost and availability."

It is not yet clear how motor control exercise compares with other forms of exercise in the long term. More research is needed to help patients make more informed choices about this type of therapy.