Low load motor control vs. high load lifting exercise for patients with mechanical LBP

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
70 patients with mechanical low back pain (LBP) were randomized to receive either an 8-week high load lifting exercise program or a low load motor control exercise program. The purpose of this study was to compare the effects of the two aforementioned treatments with regards to pain intensity, disability, and health-related patient quality of life after 12 sessions. After 24-month follow-up, Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Visare Norr, Sweden and Norrbottens County Council, Sweden
Conflicts: None disclosed
Why was this study needed now?
Low back pain (LBP) is a frequent symptom in the general population that is associated with numerous etiologies. One type of LBP has been reported to be caused by noxious chemical, mechanical, or thermal activation of peripheral nociceptive neurons, and can be triggered by motor movement. Therefore, injuries can be aggravated by a suboptimal range of motion. The conventional method of restoring motor control is low load motor control (LMC), and recent studies have reported the pain reduction efficacy of LMC compared to general exercises. There is a lack of evidence on the efficacy of other treatment methods on improving function and reducing pain caused by nociceptive neurons and alternative treatments, such as high load lifting (HLL) exercises, have been suggested. A previous study was conducted on the comparative efficacy of LMC and HLL and resulted in the superiority results of LMC for activity and movement control. However, this study did not evaluate pain intensity, disability or health-related quality of life with a 24-month follow-up between the two groups, thus warranting the present study.
What was the principal research question?
In the treatment of mechanical low back pain, what is the comparative efficacy of a high load lifting exercise regimen compared to a low load motor control exercise program on pain intensity, disability, and health-related quality of life, as assessed up to 24-months?
Population: 70 patients with nociceptive mechanical LBP for more than 3 months were included. Eligible patients were 25 to 60 years of age, with the exception of 2 patients under the age of 25, who met all other inclusion criteria. All patients were instructed to complete 12 sessions of their allocated treatment over a course of 8 weeks, with 2 sessions in the first 2 weeks, and 1 weekly session for the remaining weeks.
Intervention: High load lifting (HLL) exercise group: Patients were instructed to perform deadlift exercises starting at a low-load (10kg) with the spine held in a neutral position by the physiotherapist. Loads were increased incrementally by adding weight or increasing the number of repetitions with a goal of achieving a greater total weight compared to the previous session. (n=35, 27 completed follow-up; Mean age: 41.9 +/- 9.9; 15M/20F)
Comparison: Low load motor control (LMC) exercise group: Low load exercises were prescribed based on anamnesis and physical examination. Treatment was divided into 3 stages: patient's ability to control the lumbar spine stabilizing muscles in neutral, supine, four-point-kneeling-and standing positions; provocative and relieving movements using correction exercises and static control, which included specific training to reduce over-activity and stiffness of superficial mobilizing muscles; and an implementation of the preferred movement into various dynamic tasks and functional positions. Patients also received 1 to 3 home exercises to be completed after every session. (n=35, 31 completed follow-up; Mean age: 42.2 +/- 10.4; 16M/19F)
Outcomes: the primary outcomes of this study were mean pain intensity, measured using the visual analogue scale (VAS) and reported for the last 7 days (VAS 7 days); and self-rated physical disability, measured using the 24-item Roland-Morrison Disability Questionnaire (RMDQ). Secondary outcomes were health-related quality of life, measured using the 36-item Short-Form Health Survey (SF-36) with physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health (MH) subcategories. An individual reduction of at least 30% was considered clinically significant for all outcomes and was reported as the minimal important change (MIC).
Methods: Follow-up of a previous RCT
Time: Outcomes were assessed at 2-, 12-, and 24-month follow-ups.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.