PAIN+ CPN

Pinto SM, Boghra SB, Macedo LG, et al. Does Motor Control Exercise Restore Normal Morphology of Lumbar Multifidus Muscle in People with Low Back Pain? - A Systematic Review. J Pain Res. 2021 Aug 20;14:2543-2562. doi: 10.2147/JPR.S314971. eCollection 2021. (Systematic review)
Abstract

Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very low- to low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.

Ratings
Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Physician rater

Chronic low back pain has been associated with brain mechanisms. So subjects of MCE must be limited to patients experiencing pain due to mechanical causes; although, the biomarkers that indicate these patients are not established.

Rehab Clinician (OT/PT) rater

The information in this article is contrary to what we would like to believe about the multifidus muscle. It reminds me of my early days as a PT when all of this specific knowledge about multifidus and transverse abdominus was not yet known. We simply got low back patients stronger with general exercise programs and we were quite successful. Fancy technology is not always better and we should not give up on the basics that we learned.
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