Which Exercise for Low Back Pain? Predicting Response to Exercise for Patients With Low Back Pain
Non-specific Low Back Pain
About this trial
This is an interventional treatment trial for Non-specific Low Back Pain
Eligibility Criteria
Inclusion Criteria:
- chronic non-specific LBP (>3 months) with or without leg pain
- back pain being the primary musculoskeletal complaint of the patient
- between 18 to 80 years of age,
- English speaking (to allow response to questionnaires and communication with physiotherapist),
- moderate or greater pain or disability measured using question 7 and 8 of the SF-36,34
- moderate or high risk classification on the STarT Back Tool indicating appropriateness of physiotherapy and thus an exercise program.
Exclusion Criteria:
- nerve root compromise (2 strength, reflex or sensation affected for the same nerve root)
- suspected or confirmed serious pathology (e.g. infection, fracture, cancer, inflammatory arthritis, cauda equina syndrome)
- pregnancy
- scheduled or on the wait list for surgery during trial period
- cognitive impairment that precludes participant from completing study questionnaires or comply with exercise recommendations (e.g. dementia, Alzheimers)
- severe neuromuscular condition (e.g. spinal cord injury) that precludes participant from engaging in activity exercise.
- clinical assessment indicating that the participant is not suitable for active exercises (by a family physician, or using the Physical Activity Readiness Questionnaire).
Sites / Locations
- McMaster UniversityRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Motor Control Exercise
Graded Activity
The primary goal of motor control exercises is to retrain optimal control and coordination of the spine. It uses principles of motor learning such as segmentation, simplification and task-specific practice to retrain control of trunk muscles activation, alignment and movement. The first stage of the treatment involves assessment of the postures, movement patterns and muscle activation associated with symptoms and a retraining program designed to improve activity of muscles assessed to have poor control (usually the deep trunk muscles). Participants are taught how to contract these muscles independently. During this stage additional exercises for breathing control, posture of spine and movement are performed. The second stage of the treatment involves the progression of the exercises towards functional activities, firstly using static then dynamic tasks. Education is also included.
The primary goal of graded activity is to address individual modifiable contextual factors associated with the pain experience such as self-efficacy, pain-related fear, kinesiophobia and unhelpful beliefs/behaviors about back pain while at the same time addressing physical impairments such as endurance, muscle strength and balance. A primary goal of the program is to increase activity tolerance by performing individualized and submaximal exercises in addition to ignoring illness behaviors and reinforcing well behaviors. Activities in the program are progressed in a time-contingent manner from the baseline assessed ability to a target goal set jointly by patient and therapist. Cognitive-behavioral principles are used to help patients overcome the natural anxiety associated with pain and activities.