Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain

Hides, Julie; Donelson, Ronald; Lee, Diane; Prather, Heidi; Sahrmann, Shirley A.; Hodges, Paul W.

doi:10.2519/jospt.2019.8451

Cited by 42 publications

(37 citation statements)

References 148 publications

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“…Over the last three decades, changes to key recommendations in clinical practice guidelines for management of LBP have placed greater emphasis on self-management and exercise programs targeting functional improvement (Foster et al, 2018). Many approaches for management of LBP focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement (Hides et al, 2019). A common assumption of motor control training (MCT) is that the manner in which an individual loads their spine (e.g.…”

Section: Exercise and Low Back Painmentioning

confidence: 99%

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

2019

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Low back pain (LBP) is the leading cause of disability worldwide. Over the last three decades, changes to key recommendations in clinical practice guidelines for management of LBP have placed greater emphasis on self-management and utilization of exercise programs targeting improvements in function. Recommendations have also suggested that physical treatments for persistent LBP should be tailored to the individual. This mini review will draw parallels between changes, which occur to the neuromuscular system in microgravity and conditions such as LBP which occur on Earth. Prolonged exposure to microgravity is associated with both LBP and muscle atrophy of the intrinsic muscles of the spine, including the lumbar multifidus. The finding of atrophy of spinal muscles has also commonly been reported in terrestrial LBP sufferers. Studying astronauts provides a unique perspective and valuable model for testing the effectiveness of exercise interventions, which have been developed on Earth. One such approach is motor control training, which is a broad term that can include all the sensory and motor aspects of spinal motor function. There is evidence to support the use of this exercise approach, but unlike changes seen in muscles of LBP sufferers on Earth, the changes induced by exposure to microgravity are rapid, and are relatively consistent in nature. Drawing parallels between changes which occur to the neuromuscular system in the absence of gravity and which exercises best restore size and function could help health professionals tailor improved interventions for terrestrial populations.

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Section: Exercise and Low Back Painmentioning

confidence: 99%

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

2019

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“…LBP is significantly associated with high levels of disability, decreased function and participation in life as well as decreased sleep quality and increased depressive symptoms [ 7 – 9 ]. Currently, exercise therapy is the most common conservative treatment for LBP as it is easily accessible and can be individually tailored to patient’s needs [ 10 ]. Exercise has been bound to improve pain, quality of life and psychosocial aspects of pain such as pain-related fear (catastrophizing), kinesiophobia, depression, and anxiety [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: a randomised controlled trial protocol

Fortin

Rye

Roussac

et al. 2021

BMC Musculoskelet Disord

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Background Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. Methods A total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 individually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week; self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. Discussion The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP. Trial registration NTCT04257253, registered prospectively on February 5, 2020.

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“…The value of movement is central to the Physical Therapy profession and exploring the varying characteristics of human movement is the focus of clinicians and researchers (Sahrmann, 2002, Hides et al, 2019, Everard et al, 2018, Shield and Bourne, 2018. Exploration of motor control, prevalent in the last 25 years, has led to numerous terms being advocated, for example neuromuscular control, neuromotor control, and core stability, leading to debates over terminology and conceptual explanations in clinical practice, education, and research (Low, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…A recent commentary presented key principles of four clinical physical therapy approaches, Movement Systems Approach, Mechanical Diagnosis and Therapy, Motor Control Training, and the Integrated Systems Model (Hides et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of movement coordination strategies to inform health of movement and guide retraining interventions

Mottram

Blandford

2020

Musculoskeletal Science and Practice

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Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain

Cited by 42 publications

References 148 publications

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: a randomised controlled trial protocol

Assessment of movement coordination strategies to inform health of movement and guide retraining interventions

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