New review by Cochrane Back and Neck Review Group broadens options for people with low-back pain
Exercise focused on improving motor skills may work as well as other types of physical activity for easing lower back pain, a recent research review suggests.
According to a new Cochrane review, exercises that target the core muscles supporting the spine can reduce pain and disability among sufferers.
These exercises, called motor control exercises, are aimed at restoring control and improving coordination of the deep trunk muscles that support the spine. Patients are asked to practice using these muscles through isolated muscle contractions. As they become more adept, the exercises become more complex, progressing to more functional tasks that patients need to perform in their work or leisure activities.
For example, patients might start off working on balance and flexibility and then progress to more complex exercises that involve lifting, pushing, pulling and rotating the body. These exercises are initially done in one-on-one settings, with the therapist monitoring and correcting the patient for muscle engagement, posture, movement patterns and breathing.
Targeting the strength and coordination of muscles that support the spine through motor control exercises offers an alternative approach to treating lower back pain, says review lead author and physiotherapist Bruno Saragiotto of the George Institute at the University of Sydney, Australia.
We can be confident that motor control exercise are as effective as other types of exercise, so the choice of exercise should take into account factors such as patient and therapist preferences, cost and availability, he adds.
29 studies synthesized
Low-back pain is one of the leading causes of disability and doctor visits for adults worldwide, and has a significant economic impact in lost wages and productivity. The new review, which was published early January in the Cochrane Database of Systematic Reviews (doi:10.1002/14651858.CD012004) synthesized data from 29 randomized control trials involving a total of 2,431 men and women between 22 and 55 years old.
The trials examined the impact of motor control exercises when compared to other forms of exercise or no intervention at all. The review found people who used motor control exercises experienced improvements in pain and disability compared with no intervention. When compared with other types of exercise, motor control exercise produced similar results for pain and disability three to 12 months after the intervention.
The review was conducted by the Cochrane Back and Neck Review Group, one of more than 50 groups that make up Cochrane, a global health research network dedicated to the gathering and summarizing of the best evidence on health-care topics. The Cochrane Back and Neck Review Group, hosted by the Institute for Work & Health (IWH) in Toronto, coordinates the publication of systematic reviews on the diagnosis, prevention and treatment of neck and back pain and other spinal disorders (except inflammatory diseases and fractures).
There is tremendous variety out there in the types of exercises therapists use to help treat low-back pain. Inevitably, that diversity gives rise to some debate about the effectiveness of this or other exercise programs, says Dr. Andrea Furlan, one of the co-ordinating editors of the Cochrane Back and Neck Review Group.
This review should provide both patients and clinicians the reassurance to consider this type of exercise among the other options.
Although the findings add to a growing body of evidence for the importance of physical activity to treat low-back pain, more research is still needed to determine which workout routines might be best suited to specific patients or injuries, Saragiotto and colleagues concluded.
At present, we don’t really know how motor control exercise compares with other forms of exercise in the long term, says Saragiotto.
It’s important we see more research in this field so that patients can make more informed choices about ongoing treatment.
Source: At Work, Issue 83, Winter 2016: Institute for Work & Health, Toronto