DOES MOTOR CONTROL EXERCISE DECREASES LUMBAR PAIN, IMPROVES MUSCLE ACTIVITY AND REGIONAL FUNCTION IN INDIVIDUALS WITH ACUTE AND SUB ACUTE NON-SPECIFIC LOW BACK PAIN
DOI:
https://doi.org/10.15621/ijphy/2019/v6i6/190220Keywords:
MCE, EMG, acute and sub-acute LBP, Lumbar muscle strengthAbstract
Background: Non-specific low back pain (LBP) is defined as LBP that poses signs and symptoms which cannot be related to a recognizable cause, and Motor Control Exercise (MCE) usually is the choice of treatment for conditioning lumbar muscles for chronic LBP group. Limited information is available regarding their clinical application for participants with acute and sub-acute LBP. Hence, the main aim of this study is to find out this clinical utility.
Methods: A quasi-experimental study with 30 participants of less than six weeks and twelve weeks duration of LBP were included in the study and are divided into an experimental and control group. Pain intensity using numeric pain rating scale (NPRS), lumbar range using modified Schober’s test, muscle function using surface electromyography (EMG) and functional disability using Roland Morris Disability Questionnaire (RMDQ) were recorded pre and post-treatment. The experimental group received lumbar MCE with general exercises and the control group received only general low back exercises aiming to improve lumbar range and muscle efficiency for six-session spread over three weeks duration along with therapy for pain reduction.
Results: Subjects in both experimental & control groups had significant improvement in pain (p<.001) and RMD
Questionnaire (P<.001), Lumbar range of motion had improved significantly only in the experimental group (Flexion p<.001, Extension p<.001) compared to control group. Though lumbar muscle activation had improved in both the groups, subjects in the experimental group showed significant and uniform improvement in lumbar muscle activation following MCE than the control group.
Conclusion: Motor Control Exercise provides better clinical improvement in pain, lumbar muscle activation and regional functional ability without exacerbating symptoms in subjects with LBP during the acute and sub-acute phase.
References
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380 (9859): 2163-2196.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380 (9859): 2197-2223.
Maurits van Tulder, Annette Becker, Trudy Bekkering, Alan Breen, Maria Teresa Gil del Real, Allen Hutchinson, et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006; 15(2): s169– s191.
Cholewicki J, Silfies SP, Shah RA, Greene HS, Reeves NP, Alvi K, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine (Phila Pa 1976). 2005; 30(23):2614-20.
Radebold A, Cholewicki J, Panjabi MM, Patel TC. Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine (Phila Pa 1976). 2000;25(8):947-54.
van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003; 13(4):333-51.
Newcomer K, Laskowski ER, Yu B, Larson DR, An KN. Repositioning error in low back pain Comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine (Phila Pa 1976). 2000; 25(2):245-50.
Silfies SP, Squillante D, Maurer P, Westcott S, Karduna AR. Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech (Bristol, Avon). 2005; 20(5):465-73.
Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic following resolution of acute first‐episode low back pain. Spine. 1996; 21:2763–9.
Richardson C, Hodges P, Hides J. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. London: Churchill Livingstone; 2004.
Shirley Sahrmann, Daniel C. Azevedo, Linda Van Dillen . Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017; 21(6): 391–399.
Bart W. Koes, Maurits van Tulder, Chung-Wei Christine Lin, Luciana G. Macedo, James McAuley, Chris Maher. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010; 19(12): 2075–2094.
Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005; 20(3):CD000335.
Macedo LG, Saragiotto BT, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW, et al. Motor control exercise for acute non-specific low back pain. Cochrane Database Syst Rev. 2016; 10 (2):CD012085.
Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976). 1996; 21(22):2640-50.
Macedo LG, Latimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2012; 92(3):363-77.
Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009; 89(12):1275-86.
Jean-François Chenot, Bernhard Greitemann, Bernd Kladny, Frank Petzke, Michael Pfingsten, Susanne Gabriele Schorr. Non-Specific Low Back Pain. Dtsch Arztebl Int. 2017; 114(51-52): 883–890.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976). 2001;26(11):E243-8.
Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010; 24(6):769-81.
Supreet Bindra , Sinha A.G.K., Benjamin A.I, Epidemiology of low back pain in indian population: a review. International Journal of Basic and Applied Medical Sciences. 2015; 5 (1) : 166-179.
Nina Goossens, Lotte Janssens, Karen Caeyenberghs, Geneviève Albouy, Simon Brumagne. Differences in brain processing of proprioception related to postural control in patients with recurrent non-specific low back pain and healthy controls. Neuroimage Clin. 2019; 23: 101881.
Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther. 2009; 89(1):9-25.
Majid Artus, Danielle A. van der Windt, Kelvin P. Jordan, Elaine M. Hay. Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials. Rheumatology. 2010; 49 (12) : 2346–2356.
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