Low Back Pain – Tailored V’s General Exercise Program

Low back pain is a significant global problem, with a large percentage (60-80%) of the population in developed countries experiencing an acute episode at some point in their lifetime. A significant number of these people go on to experience chronic low back pain (pain lasting longer than 3 months). Chronic low back pain (CLBP) is associated with decreased physical function, reduced social interaction, increased symptoms due to psychological distress and poorer quality of life. Physical activity and exercise therapy are clinically accepted treatments for rehabilitation post injury. They are also recommended as self-management strategies for this condition.


Saner et al (2015) opined that whilst exercise has been proven to be an effective treatment for patients with non-specific low back pain (NSLBP) and movement control impairment (MCI – based on the observation of aberrant movements accompanied by postural pain), with substantial reliability in diagnosis in previous studies, the type of exercises that are most beneficial to this subgroup still remain unclear. To investigate this further, the authors, using a multicentre randomised controlled trial (RCT), with patients (18-75 years of age) recruited from referring hospitals and resident physicians, as well as through advertising amongst the staff and students of the Zurich University of Applied Sciences, Winterthur, Switzerland. Patients were divided into two groups 52 in the Motor Control (MC) group and 54 in the General Exercise (GE) group.


MC treatment consisted of active exercises addressing the pain-provoking postures and control of the impaired movement/s. GE treatment aimed to improve the muscular strength of the lumbar and pelvic region and legs. In a standardised programme, as described in a study manual, all relevant muscle groups (abdominals, erector spinae, gluteals, quadriceps and hamstrings) were addressed in each treatment. Patients in both groups received individual treatment sessions of 30 minutes, preferably twice per week, over a period of 9-12 weeks. Progression of the treatment, in accordance with the treatment protocol, was determined by the physiotherapist. 10 minutes of each session was allowed for other physiotherapy applications, where necessary. The length and type of additional interventions were recorded and monitored. All patients received instructions for a minimum of three home exercises and were encouraged to practice them at least 2 x per week, for up to 1 year after treatment. Patients were contacted by telephone after six months and encouraged to maintain the training.


The primary outcome measurement was the Patient Specific Function Scale (PSFS), which the authors concluded showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly over the course of one year, and therefore indicated that there was no additional benefit of specific exercises targeting MCI.


In general, whist treatment is often recommended and is associated with recovery from low back pain, people who seek to self-manage their condition can achieve similar outcomes. More treatment can often be associated with poorer outcomes and therefore, vigilance with the monitoring of any intervention is imperative.


Ref: Saner J, Kool J, Sieben JM, Luomajoki H, Bastiaenen CHG, de Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up. Manual Therapy 20 (2015) 672e679.


The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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