Effectiveness of motor control exercises in regards to pain and functionality in

low back pain

Abstract
Background/Objective
This study reviewed the current evidence on the effectiveness of motor control
exercises in regards to pain and functionality in low back pain
Methodology
A systematic review was conducted on studies published in English from 2003–
2023, retrieved from eight electronic databases: Medline, PubMed, google
scholar, CINAHL, Psychlnfo, Science Direct, Cochrane and TBI Rehabilitation.
Only articles that focused on the effects of motor control exercises to pain and
functionality in low back pain. The methodological quality of the studies was
appraised using the Physiotherapy Evidence Database Scale (PEDro).
Inclusive Criteria were for narrative review Published 2010 to 2023,
Randomized Controlled Trials (RCTs) and Systematic Review and English
Language (Full Text)
Exclusive Criteria were studies that were not before 2010 , language other than
English and any narrative review
Results
The literature search yielded 32 studies that satisfied the selection criteria, of
which thirteen (6 randomised controlled trials and 7 systemic review) were
reviewed after screening. Despite the heterogeneity of the studies, they showed
MT to be effective in improving some of the motor functions of the LE at
different stages of stroke. However, they offered little evidence on MT's long-
term effects and for when is the optimal stage to start MT after stroke onset.

Introduction
Low back pain is the leading cause of activity limitation and work absence
throughout the world1It is a highly debilitating health condition characterized as
pain and discomfort localized below the costal margin and above the inferior
gluteal folds, with or without leg pain2LBP is common, well documented, and
most prevalent amid musculoskeletal conditions 3The point prevalence of low
back pain (LBP) in 2017 was estimated to be about 7.5% of the global
population, or around 577.0 million people4
The management of LBP encompasses a wide range of therapeutic
interventions, including pharmacological treatments, physical therapy, and
lifestyle modifications. Among these, physiotherapy has gained prominence as a
non-invasive and conservative approach to alleviate pain, improve function, and
enhance the quality of life for individuals grappling with LBP 5 Conservative
management of common MSKDs often includes pharmacological treatments
and rehabilitation involving exercises, education, and psychological

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Vrbanić TS. Low back pain--from definition to diagnosis. Reumatizam 2011; 58:105-107
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Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81:646-656.
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Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth FM, Smith E, Buchbinder R, Hoy D. Global low back
pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease
Study 2017. Ann Trans Med 2020; 8(6): 299-313.

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interventions.4–76789 Within the realm of physiotherapy, motor control exercises
(MCE) have emerged as a promising intervention strategy 10111213Motor control
exercises utilize principles of motor learning to retrain control of the trunk
muscles, posture, and movement pattern14
MCE is rooted in the principle of enhancing the body's innate ability to control
and stabilize the lumbar spine and pelvis through specific exercises that target
the deep stabilizing muscles15These exercises focus on retraining the
neuromuscular system and improving coordination, aiming to rectify
dysfunctional movement patterns often associated with LBP 16
The rationale behind MCE lies in its potential to address the root causes of LBP,
as opposed to merely alleviating symptoms. By targeting the underlying motor
control deficits and muscular imbalances, MCE seeks to not only reduce pain
but also enhance functionality and prevent the recurrence of LBP 15This
literature review delves into the effectiveness of motor control exercises as a
viable treatment option for individuals suffering from LBP, exploring their
principles, mechanisms, and the evidence supporting their role in pain reduction
and functional improvement.
6
Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017: clinical practice guidelines linked to the
international classification of functioning, disability and health from the Orthopaedic Section of the American
Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47:A1–A83.
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Chou R, Qaseem A, Snow V, Clinical Efficacy Assessment Subcommittee of the American College of Physicians;
American College of Physicians; American Pain Society Low Back Pain Guidelines Panel, et al. Diagnosis and
treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the
American Pain Society. Ann Intern Med. 2007;147:478–491.
8
Hopman K, Krahe L, Lukersmith S, McColl A, Vine K. Clinical Practice Guidelines for the Management of Rotator
Cuff Syndrome in the Workplace. Port Macquarie, Australia: University of New South Wales; 2013:80:1

9
McAlindon TE, Bannuru RR, Sullivan M, et al. OARSI guidelines for the non-surgical management of knee
osteoarthritis. OsteoarthrCartil. 2014;22:363–388.
10
Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a
systematic review. Br J Sports Med. 2013;47:207–214.
11
Clausen MB, Witten A, Holm K, et al. Glenohumeral and scapulothoracic strength impairments exists in
patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index.
BMC MusculoskeletDisord. 2017;18:–302.
12
. Harris-Hayes M, Mueller MJ, Sahrmann SA, et al. Persons with chronic hip joint pain exhibit reduced hip
muscle strength. J Orthop Sports Phys Ther. 2014;44:890–898.

13
Rathleff M, Rathleff C, Crossley K, Barton C. Is hip strength a risk factor for patellofemoral pain? A systematic
review and metaanalysis. Br J Sports Med. 2014;48:1088–1088
14
Hodges PW, Ferreira PH, Ferreira M. Lumbar spine: treatment of instability and disorders of movement
control. In: Magee DJ, Zachazewski JE, Quillen WS, eds. Pathology and Intervention in Musculoskeletal
Rehabilitation. Amsterdam, the Netherlands: Elsevier Science BV; 2007:389 – 425
15
Hodges, P. W., & Richardson, C. A. (1999). Transversus abdominis and the superficial abdominal muscles are controlled
independently in a postural task. Neuroscience letters, 265(2), 91–94. https://doi.org/10.1016/s0304-3940(99)00216-5
16
Gregory E. Hicks; Julie M. Fritz; Anthony Delitto; Stuart M. McGill (2005). Preliminary Development of a
Clinical Prediction Rule for Determining Which Patients With Low Back Pain Will Respond to a Stabilization
Exercise Program. , 86(9), 0–1762. doi:10.1016/j.apmr.2005.03.033
In the pages that follow, we will scrutinize a wide array of research studies,
clinical trials, and expert opinions to ascertain the efficacy of motor control
exercises and their place in the therapeutic armamentarium for low back pain.
Through a comprehensive analysis of the existing literature, we aim to shed
light on the potential benefits and limitations of MCE in the management of
LBP, ultimately contributing to a deeper understanding of how this intervention
can enhance the lives of those affected by this prevalent and debilitating
condition.

Method:

1. Search Strategy:
- A systematic search of relevant articles published between 2003 and 2023 will
be conducted in electronic databases such as PubMed, Scopus, and Web of Scie
nce.
Keywords and Medical Subject Headings (MeSH) terms related to low back
pain, motor control exercises , functional mobility,
will be used in various combinations to maximize search results.

2. Inclusion Criteria:
- Articles published in peer-reviewed journals between 2010 and 2023.
Studies investigating the Effectiveness of motor control exercises in regards to
pain and functionality in low back pain
.
- Research articles, randomized controlled trials, longitudinal studies, observatio
nal studies, and systematic reviews will be included.
- Articles published in English.

3. Exclusion Criteria:
- Non-English articles.
- Articles published before 2010
- Studies focusing solely on low back pain or motor control exercises .
- Review articles without primary research data.
This methodology outlines a systematic approach to identify, select, and synthes
ize relevant articles published between 2010 and 2023 to conduct a comprehensi
ve narrative review on the Effectiveness of motor control exercises in regards to
pain and functionality in low back pain