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8 weeks of core strengthening, coordination exercise for chronic low back pain


Tags: back pain, abdominals, exercise, pain problems, spine, movement, strength, self-treatment, treatment

Three articles on PainSci cite Unsgaard-Tøndel 2010: (1) Complete Guide to Low Back Pain(2) Your Back Is Not Out of Alignment(3) The Functional Movement Screen (FMS)

PainSci summary of Unsgaard-Tøndel 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This study tested two popular exercise options for chronic low back pain — core coordination, core strengthening — and compared them to a neutral third type, general exercise. Over a hundred participants worked with “experienced physical therapists” once a week for eight weeks. This is a particularly good test, because it is a good approximation of what a motivated patient might do: paying for eight weekly sessions of training is a greater and more disciplined effort than many people make, and yet still reasonably affordable and achievable.

Pain and disability were measured before and after, and at a one year follow-up. Unfortunately, there were no differences: “This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.”

Perhaps more training would have yielded better results, but it’s hard to imagine that it would be worth the additional expense and effort for what would surely be a minor difference. And perhaps a different exercise therapy would have performed better, but the ones tested here are exactly the kind of thing that is almost always recommended to patients — so if there’s a better kind of exercise therapy, it’s certainly unknown and unproven.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Exercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown.

OBJECTIVE: This study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain.

DESIGN: This was a randomized controlled trial with 1-year follow-up.

SETTING: The study was conducted in a primary care setting in Norway.

PATIENTS: The participants were patients with chronic nonspecific low back pain (n=109).

INTERVENTIONS: The interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks.

MEASUREMENTS: The primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention.

RESULTS: The postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (-0.7 to 1.3) and 0.4 (-0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (-0.6 to 2.0) and 0.3 (-0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (-0.1 to 2.0) and 0.7 (-0.3 to 1.7) for motor control exercises versus general exercises. Limitations The nature of the interventions made blinding impossible.

CONCLUSIONS: This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: