Impaired movement control may result in chronic lower back pain. A new study from the University of Eastern Finland shows that the combination of manual therapy and exercise is an excellent way to combat movement control impairment in the lower back. This combination reduced the disability experienced by patients and significantly improved their functional ability. A personally tailored exercise programme was more beneficial for patients than a generic one, and the treatment results also persisted at a 12-month follow-up.
Movement control impairment is a common cause of lower back pain
Only 15% of patients suffering from lower back pain get a specific diagnosis, meaning that up to 85% of patients have to settle for a non-specific one.. Many international care guidelines call for further research addressing the different subgroups of patients with lower back pain.
Patients with movement control impairment constitute one such subgroup. These patients have difficulties in controlling the position of their back when sitting down, standing or doing back bending. Impaired movement control is often caused by an earlier episode of back pain. The situation is problematic because patients don't realise that their incorrect back position is provoking pain.
So far, it has been unclear which specific exercises should be recommended to which patient groups. The study analysed which form of treatment better alleviates non-specific lower back disability: a personally tailored exercise programme targeting movement control impairment, or a generic exercise programme. Patients' situation was analysed after a three-month physical therapy period, and again after 12 months. Patients had five physical therapy sessions, including either personally tailored or generic exercises. Each session also included a brief manual therapy. After the physical therapy sessions, patients filled out a questionnaire charting the level of disability caused by their back pain.
Combination of manual therapy and exercise works
A total of 70 patients with diagnosed movement control impairment participated in the study. The results indicate that a three-month physical therapy period significantly improved the functional ability of both groups, and the results persisted at a 12-month follow-up. Compared to the onset of the study, the results of the group doing personally tailored exercises were statistically and clinically better than the results of the group doing generic exercises both with regard to the level of disability and improvement of functional ability.
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Vesa Lehtola et al. Sub-classification based specific movement control exercises are superior to general exercise in sub-acute low back pain when both are combined with manual therapy: A randomized controlled trial, BMC Musculoskeletal Disorders (2016). DOI: 10.1186/s12891-016-0986-y