Core Exercises Don't Always Spell Relief for Back Pain

A systematic review of clinical studies evaluating the effectiveness of motor control exercises (MCE) to reduce low back pain, shows that motor control exercises can offer some relief for patients with chronic low back pain, but they are not necessarily better than other exercises, says a newly published review in the Cochrane Library.

Motor control exercises were developed to restore the coordination, control and capacity of trunk muscles – and it’s been working, to some degree, the authors write. The exercises are hoped to correct impairments in the control of deep trunk muscles (transversus abdominis and multifidus) that stabilize the spine.

The review, published in January, is based on 29 randomized controlled trials with trial groups ranging in size from 20 to 323 participants (2,431 in total) with non-specific low back pain. The participants, who were between 22 and 55 years old, were enrolled in treatment programs lasting 20 days to 12 weeks. They participated in exercise sessions one to five times per week.

Led by Bruno Saragiotto, a doctoral candidate at The George Institute for Global Health Sydney Medical School in Australia, the researchers ranked the clinical trials by the quality of the data as either:  low, moderate or high in terms of having a clinically important impact on patient outcomes.

The results were surprising, he wrote, but partly because of small sample sizes in same cases and in others, limitations imposed by trial designs.

"In terms of corresponding risk, motor control exercise was 7.43 points (in a 0 to 100 scale) better than other exercises with a 95% confidence interval of 4.40  to 10.47, which is statistically significant, but not clinically important, which is why we did not consider motor control better than other exercises," he said in an interview with Rheumatology Network.

How motor control exercises (MCE) compare to other exercise therapies:

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Other exercises:  There is high quality evidence showing that MCE offers no clinically important effect on pain and disability in the intermediate and long-term as compared to other exercises, such as general or conventional exercises, stretching, strengthening and graded activity.

Manual therapy:  There is high quality evidence showing that MCE offers no clinically important effect on pain and disability in the intermediate and long-term as compared to manual therapy, such as manipulation, mobilization and massage. In fact, the evidence shows that MCE and manual therapies have similar outcomes.

Minimal interventions:  There is low to moderate quality evidence showing a clinically important effect of MCE to reduce pain as compared to minimal interventions, which included no treatment, education and a placebo physical therapy intervention.

"Given the evidence that MCE (motor control exercise) is not superior to other forms of exercise, the choice of exercise for chronic LBP (lower back pain) should probably depend on patient or therapist preferences, therapist training, costs and safety,” the authors wrote.

The authors recommend studies with larger sample sizes and more specifics.

“Future randomized controlled trials in chronic non-specific low back pain should include more complete descriptions of the exercise interventions so that interpretation of the results would be more transparent,” the wrote.

The study exclusively focused on low back pain that was not traced to a specific pathology. “Chronic low back pain” is usually defined as pain lasting longer than 12 weeks. Acute low back pain usually eases within six weeks, but for 40 percent of patients, the pain will become a chronic constant issue.

The MCE study excluded pilates because a 2015 review of pilates clinical trials published in the Cochrane Library concluded that while pilates offers some relief from pain, it doesn’t seem to be more effective than other forms of exercise for relief from pain and disability.

“Pilates is probably more effective than minimal intervention in the short and intermediate term for pain and disability outcomes, and more effective than minimal intervention for improvement in function and global impression of recovery in the short-term,” the authors wrote. But, “pilates is probably not more effective than other exercises for pain and disability in the short and intermediate term. For function, other exercises were more effective than pilates at intermediate-term follow-up, but not at short-term follow-up. Thus, while there is some evidence for the effectiveness of pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercise.”

References:

Saragiotto BT, Maher C, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG.

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

Cochrane Library. Jan. 8, 2016. Yamato TP, Maher C, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC, Costa LOP.

"Pilates for low back pain,"

Cochrane Library. July 2, 2015.