Motor Control Training in Chronic Low Back Pain

Introduction: Chronic Low Back Pain (CLBP) is the most disabling musculoskeletal disorder with altered functioning of the lumbar core muscles. Movement impairment and control impairment syndromes are present in CLBP. Control impairment is the loss of the ability of the core muscles to prevent excessive movement that happens at the lumbar spine. The concept of motor control training is very limited. Many protocols of motor control exercises have used stabilisation exercises. Motor control training has specific exercises for the type of impairment present. Aim: This study intends to design a motor control training program for CLBP and to measure its effectiveness using pressure biofeedback. Materials and Methods: Quasi Experimental (pre-post-test design) study design was conducted on 30 subjects fulfilling the inclusion criteria. They were divided into 2 groups-controls and experimental. Motor control tests were performed to find out the type of control impairments-flexion control, extension control and rotation control. The control group received conventional therapy with the basic core stabilisation exercises and flexibility exercises. The experimental group received specific control impairment exercises (flexion/extension/rotation) with specific dosages. The outcome measures used were lumbar core muscle strength (Chattanooga's pressure biofeedback), pain severity and Roland Morris Disability Questionnaire. The outcomes were measured at baseline and after two weeks of treatment sessions. Independent t-test was used to compare between the groups. Results: The results showed statistically significant pain reduction (p=0.01), improvement in the lumbar core muscle strength (p=0.01) and functional outcome (p=0.03) was noted in the experimental group. The level of significance was set at p-value <0.05. There was a positive correlation of Fear Avoidance Beliefs Questionnaire (FABQ) physical activity subscale with baseline pain and transversus abdominis activation. Conclusion: The motor control training was found to improve the strength of lumbar core muscles, reduction in pain severity and enhanced functional outcome.