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Motor control exercises for back pain no better than manual therapy or other exercise

PainSci » bibliography » Macedo et al 2009
Tags: back pain, exercise, treatment, pain problems, spine, self-treatment

Two articles on PainSci cite Macedo 2009: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Neck Pain & Cricks

PainSci commentary on Macedo 2009: ?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 wherever possible.

This is a review of all the research done up to 2008 on the treatment of back pain with “motor control exercises,” which are one approach to improving core stability. The fourteen experiments reviewed produced no compelling evidence. The authors conclude that “motor control exercise is superior to minimal intervention,” but a more candid way of putting it would be, “Motor control exercises are better than nothing.” Which they undoubtedly are. But guess what? They are also “not more effective than manual therapy or other forms of exercise”! So, in other words, you could have done any kind of exercise — as opposed to “advanced” motor control exercises — and gotten about the same benefit. Whoop-de-do.

~ 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: Previous systematic reviews have concluded that the effectiveness of motor control exercise for persistent low back pain has not been clearly established.

OBJECTIVE: The objective of this study was to systematically review randomized controlled trials evaluating the effectiveness of motor control exercises for persistent low back pain.

METHODS: Electronic databases were searched to June 2008. Pain, disability, and quality-of-life outcomes were extracted and converted to a common 0 to 100 scale. Where possible, trials were pooled using Revman 4.2.

RESULTS: Fourteen trials were included. Seven trials compared motor control exercise with minimal intervention or evaluated it as a supplement to another treatment. Four trials compared motor control exercise with manual therapy. Five trials compared motor control exercise with another form of exercise. One trial compared motor control exercise with lumbar fusion surgery. The pooling revealed that motor control exercise was better than minimal intervention in reducing pain at short-term follow-up (weighted mean difference=-14.3 points, 95% confidence interval [CI]=-20.4 to -8.1), at intermediate follow-up (weighted mean difference=-13.6 points, 95% CI=-22.4 to -4.1), and at long-term follow-up (weighted mean difference=-14.4 points, 95% CI=-23.1 to -5.7) and in reducing disability at long-term follow-up (weighted mean difference=-10.8 points, 95% CI=-18.7 to -2.8). Motor control exercise was better than manual therapy for pain (weighted mean difference=-5.7 points, 95% CI=-10.7 to -0.8), disability (weighted mean difference=-4.0 points, 95% CI=-7.6 to -0.4), and quality-of-life outcomes (weighted mean difference=-6.0 points, 95% CI=-11.2 to -0.8) at intermediate follow-up and better than other forms of exercise in reducing disability at short-term follow-up (weighted mean difference=-5.1 points, 95% CI=-8.7 to -1.4).

CONCLUSIONS: Motor control exercise is superior to minimal intervention and confers benefit when added to another therapy for pain at all time points and for disability at long-term follow-up. Motor control exercise is not more effective than manual therapy or other forms of exercise.

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