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(Reuters Health) – Exercise focused on improving motor skills may work as well for easing lower back pain as other types of physical activity, a research review suggests.
Based on data from 29 previously conducted trials involving a total of 2,431 adults aged 22 to 55 years, the study team also found that people who exercised generally experienced more improvements in pain and disability than those who didn’t. “The choice of exercise should be based on patient or therapist preferences and costs, as the current evidence suggests that there is no difference among the types of exercises,” said lead study author Bruno Saragiotto of the George Institute for Global Health at Sydney Medical School in Australia. Lower back pain is one of the leading causes of disability and doctor visits for adults worldwide, and the condition also has a significant economic impact in lost wages and productivity. While the findings add to a growing body of evidence for the importance of physical activity to treat lower back pain, more research is still needed to determine which workout routines might be best suited to specific patients or injuries, Saragiotto and colleagues conclude in their report in the Cochrane Library online January 7. Motor control exercise focuses on activation of the deep trunk muscles and targets restoration of control and coordination of these muscles, which support the spine. Workouts can vary, but patients might start off working on balance and flexibility and then progress to more complex exercises that involve lifting, pushing, pulling and rotating the body. For the current analysis, researchers looked at studies ranging in size from 20 to 323 participants, most of whom were middle-aged. The duration of treatment programs ranged from 20 days to 12 weeks, and the number of exercise sessions ranged from one to five per week.

Sixteen of the studies compared motor control exercise to other types of physical activity. Seven studies compared it to minimal intervention, five examined it relative to manual therapy such as massage or chiropractic work, three assessed it as an alternative to exercise paired with treatments such as electrical stimulation, and one looked at whether it worked as well as home exercise. When researchers compared pain and disability outcomes across all of these studies, they found motor control exercises were similar to other activities at intervals between three and 12 months. It’s possible that some patients with structural or behavioral changes in the muscles of the spine might be a subgroup of people who could benefit most from motor control exercises, Saragiotto said. But one shortcoming of the analysis is it didn’t pinpoint precisely who might be the ideal patient for this type of approach.

Researchers also lacked enough quality data to assess whether motor control exercise might be better than electrotherapy paired with other types of activity, Saragiotto noted.

One reason all exercises appeared equal in this analysis might also be tied in part to mental health, noted Julie Fritz, a physical therapy researcher at the University of Utah in Salt Lake City who wasn’t involved in the study. “It may be that the non-specific effects of exercise are responsible for the benefit, in other words, being active, doing something for your back pain helps individuals feel more in control of the condition and has positive physical and psychological benefits regardless of exactly what sort of exercise is being done,” Fritz said by email.

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