Motor control exercise is safe and as effective as other exercises for reducing lower back pain, Cochrane review finds

When treating chronic nonspecific low back pain, motor control exercise (MCE) is likely more effective than minimal intervention, but there is probably little to no difference between MCE and other forms of exercise, according to a recent Cochrane review.

The review included 29 randomized controlled trials (n=2,431) that examined the effectiveness of MCE, a form of exercise that targets the muscles that control and support the spine, in patients with chronic nonspecific low back pain (median age, 40.9 years). Findings were published online on Jan. 6 by the Cochrane Library.

Trials compared MCE with no treatment or another treatment or added MCE as a supplementary intervention. Primary outcomes were pain intensity and disability, and minimal adverse events were reported in the trials.

Compared to minimal intervention, low- to moderate-quality evidence suggested that MCE is effective for improving pain at all follow-up periods (long-term mean difference, −12.97; 95% CI, −18.51 to −7.42).However, low- to high-quality evidence showed that MCE is not clinically more effective than other exercises for all follow-up periods and outcomes. “As MCE appears to be a safe form of exercise and none of the other types of exercise stands out, the choice of exercise for chronic low back pain should depend on patient or therapist preferences, therapist training, costs and safety,” the review authors wrote.

Moderate- to high-quality evidence showed similar outcomes between MCE and manual therapy for all outcomes and follow-up periods. In addition, very low- to low-quality evidence suggested that MCE is clinically more effective than exercise plus electrophysical agents (EPAs) for pain and other outcomes (pain at short-term mean difference, −30.18; 95% CI, −35.32 to −25.05).

The authors noted that they did not expect the effect of MCE versus exercise plus EPAs to be this much greater than MCE versus minimal intervention. “One explanation may be that the combination of exercise and EPA is harmful, which seems unlikely,” they wrote. “It is perhaps more likely that these results might be explained by the small sample sizes and limitations in the trials' designs for this comparison.”

They noted that a limitation of the review is the presence of publication bias in comparisons assessed with funnel plots. In addition, they acknowledged concerns about the quality of evidence for some outcomes but noted that most comparisons had at least moderate-quality evidence for the primary outcomes tested.

Another study, published online on Jan. 11 by JAMA Internal Medicine, evaluated 21 randomized controlled trials (n=30,850) on the effectiveness of interventions for the prevention of lower back pain and the related use of sick leave. The 6 prevention strategies in the review were exercise, education, exercise and education, back belts, shoe insoles, and other prevention strategies.

The review's findings indicated that exercise plus education likely reduces the risk of low back pain and that exercise alone may reduce the risk of an episode of low back pain and sick leave (although it is uncertain whether the effects persist beyond 1 year). Education alone, back belts, shoe insoles, and ergonomic adjustments probably do not prevent an episode of low back pain or associated sick leave, the authors noted.