Motor control exercise for chronic non-specific low-back pain

Abstract

There is very low to moderate quality evidence that MCE has a clinically important effect compared with a minimal intervention for chronic low back pain. There is very low to low quality evidence that MCE has a clinically important effect compared with exercise plus EPA. There is moderate to high quality evidence that MCE provides similar outcomes to manual therapies and low to moderate quality evidence that it provides similar outcomes to other forms of exercises. Given the evidence that MCE is not superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.

Recommendations of the Polish Society of Physiotherapy, the Polish Society of Family Medicine and the College of Family Physicians in Poland in the field of physiotherapy of back pain syndromes in primary health care

“…high energy laser, shock wave or electrostimulation) is not indicated. it is recommended supervised motor therapy, behavioral therapy, massage aimed at normalizing the resting tension of the muscles and improvement of their trophics [26][27][28][29][30][31][32][33][34].…”

Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes

“…The PA&E in this trial were based and modified from previous studies [193,216] which reported improvements in pain intensity and strength for women with pain in the neck-and shoulder muscles. PA&E in various combinations are often used for the treatment of chronic pain [3,[33][34][35][36][37][38][39]. However, despite the large amount of research on PA&E as treatment for chronic pain, there is still a lack of knowledge on physiological effects mechanisms behind the positive effects.…”

“…However, in accordance with the suggestion that chronification of pain might be related to an imbalance between facilitating and inhibitory neurobiological systems [47,236], it is important to highlight the potential of PA&E to impact both ascending pain inducing activities as well as pain modulatory and descending activities in the nervous system. In future studies, the clinical effect on pain intensity and function as a result of different types of PA&E might not be of main interest to evaluate further, as several reviews [3,33,34,[36][37][38][39] and a metaanalyse [35] consistently shows that PA&E of different types are beneficial for chronic pain. To advance the research field, it might instead be interesting to add a focus on the physiological and neurobiological effect mechanisms associated to acute and long-term effects of PA&E in chronic pain.…”

“…Adherence to prescribed PA&E are often troublesome [7,172], which also were shown in paper 1 and paper 4. Because PA&E are beneficial for chronic pain [3,[33][34][35][36][37][38][39], and that the physiological responses of the PA&E normally are depending on the dose and frequency [137], it should reasonably be important to strive after higher adherence to prescribed PA&E in order to optimize the effect of the PA&E. Adherence is targeted in models of health behaviour change, but such models are seldom included in research on PA&E interventions for chronic pain. In future studies and clinical application of PA&E as treatment, it is therefore interesting to further emphasize behavioural strategies for increased adherence to the prescribed PA&E, separate from and parallel to behavioural approaches focusing on the chronic pain.…”

“…Management of chronic pain is instead aiming at increase bodily and vocational functioning, increase psychological well-being, and limit pain intensity [15]. The effects of the best available chronic pain treatment, such as pharmacological treatment [20,30], multimodal rehabilitation [31,32], PA&E [3,[33][34][35][36][37][38][39] and psychological treatment [40][41][42] have in general been weak to moderate. Thus, it is important to improve the treatment for chronic pain.…”