Motor control exercise for chronic non-specific low-back pain (PEDro synthesis)

Perturbation-based trunk stabilization training in elite rowers: A pilot study

Introduction

Low back pain is a major health issue in elite rowers. High training volume, frequent flexion movements of the lower spine and rotational movement in sweep rowing contribute to increased spinal strain and neuropathological patterns. Perturbation-based trunk stabilization training (PTT) may be effective to treat neuromuscular deficits and low back pain.

Methods

All boat classes (8+, 4+/-, 2-) of the male German national sweep rowing team participated in this non-randomized parallel group study. We included 26 athletes (PTT: n = 12, control group: n = 14) in our analysis. Physical and Sports therapists conducted 16 individualized PTT sessions á 30–40 minutes in 10 weeks, while the control group kept the usual routines. We collected data before and after intervention on back pain intensity and disability, maximum isometric trunk extension and flexion, jump height and postural sway of single-leg stance.

Results

We found less disability (5.3 points, 95% CI [0.4, 10.1], g = 0.42) for PTT compared to control. Pain intensity decreased similar in both groups (-14.4 and -15.4 points), yielding an inconclusive between-group effect (95% CI [-16.3, 14.3]). Postural sway, strength and jump height tend to have no between- and within-group effects.

Conclusion

Perturbation-based trunk stabilization training is possibly effective to improve the physical function of the lower back in elite rowers.

Systematic reviews evaluating the effectiveness of motor control exercises in patients with non-specific low back pain do not consider its principles - A review

BACKGROUND

Motor control exercise (MCEs), spinal stabilization or core stability exercises were developed with the aim of restoring the coordination, control, and capacity of the trunk muscles and systematic reviews (SR) evaluating their effectiveness has shown conflicting results. This we hypothesized was due to the non-consideration of principles of neuroplasticity. The objective of this review was to review the operating definitions used in these reviews for these exercises and evaluate if these reviews have considered and satisfied the principles of these exercises in persons with NSLBP, both acute and chronic.

METHODS

The available evidence to address the research question was sought in the reviews published in English between January 2006 and April 2019 using the population, intervention, comparison, and outcome format. Data were extracted against the following factors: satisfy the principles of specific inclusion criteria; interventions; experience-dependent plasticity; and measure any one of the concepts of motor control. The quality of the evidence obtained was graded using the National Institute for Health and Care Excellence protocol and the quality of SRs evaluated using the R-AMSTAR.

RESULTS

Eleven reviews on core stability/spinal stabilization exercises and four reviews on MCE were considered in this review. The results showed that most of the studies considered by the reviews did not adhere to the principles of these exercises.

CONCLUSION

There is wide heterogeneity in the understanding, administration, and progression of exercises. The exercises were implemented without considering the potential for neuroplasticity of the nervous system and the principles of motor learning.

Effects of Motor Imagery and Action Observation on Lumbo-pelvic Motor Control, Trunk Muscles Strength and Level of Perceived Fatigue: A Randomized Controlled Trial

Purpose: The aim of the study was to evaluate the effects of motor imagery (MI) and action observation (AO) combined with a motor control exercises program for the lumbopelvic region. Method: Forty-five asymptomatic individuals were randomized into three groups: MI (n = 15), AO (n = 15) or control group (CG) (n = 15). The outcome measures included lumbopelvic motor control measured with a stabilizer pressure biofeedback, trunk muscle strength using a dynamometer and the perceived fatigue using a visual analogue scale. Participants were assessed at pre-intervention, at first week of intervention (mid) and post-intervention. Results: Regarding lumbopelvic motor control, we observed significant within-group differences between pre- and the mid and post-intervention assessment in AO group (p < .001, d > 0.80). MI and CG groups showed significant differences between pre- and post-intervention assessment (p < .05, d > 0.80). Regarding the direct comparison in the ΔMid-Pre differences between groups, only the AO group was superior to the CG with a large effect size (d > 0.80). Regarding trunk muscle strength, significant within-group differences between pre- and post-intervention assessments were observed in AO (p < .001, d = -1.25) and MI (p < .05, d = -1.00) groups. In relation to the perceived fatigue, statistically significant within-group differences were found in all groups (p < .05, d > 0.60). Conclusion: AO training caused faster changes in lumbopelvic motor control compared with the CG group. The AO strategy could be used as a guideline for teaching lumbopelvic motor control exercises.