Motor Control Exercises vs. Graded Activity in treatment of LBP

Two commonly used approaches to the treatment of nonspecific LBP, motor control exercises and graded activity exercises, were recently compared in a RCT published in Physical Therapy
Motor control exercises are often used by physical therapists and are based upon the rationale that individuals with LBP have impaired functioning of the transervus abdominis and multifidis, which work together to add stability to the spine. The thinking is that through teaching an individual how to make these muscles fire, the spine is more stable and pain diminishes.
Graded (exposure) activity exercises were developed based upon a series of studies which suggested that cognitive-behavioral  aspects, such as mood and cognition, are important factors associated with delayed recovery from LBP and increased levels of disability. This model assumes that disability is not only determined by the tissues of our body, but also due to social, cognitive, emotional and behavior factors. When using this model, clinicians attempt to address pain-related fear, kinesiophobia (fear of movement), and unhelpful beliefs.
This study prospectively assessed the outcomes of 172 individuals with chronic, nonspecific LBP who were randomized to receieve either motor control exercises or graded activities.  The outcomes measured included pain (numeric pain scale) and function (patient specific functional scale).  Secondary outcomes were disability (Roland-Morris Disability Questionairre), global impression of change (global percieved effect scale), and quality of life (SF-36).   These were taken at baseline, 2, 6 and 12 months.
Check out the results
Overall, the results indicated that both approaches were effective in decreasing pain and disability in individuals with chronic LBP.  These results further support the notion which is emerging that no exercise approach to therapy is superior. 
Macedo LG, Latimer J, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy 2012: 92; 363-377.

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  • I am confused by the last line in this post. “These results further support the notion which is emerging that no exercise approach to therapy is superior”. No exercise approach?

    Andy Lodato June 2, 2012 10:08 am Reply
  • Exercise and movement are key in the treatment of nonspecific LBP; the approach to doing this is not key. This study demonstrated that two totally different exercise approaches were equally effective in the treatment of LBP.

    josephbrence June 3, 2012 1:42 pm Reply

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