Modifying patterns of movement in people with low back pain

On returning home from a recent Pilates class I wondered to myself as to what effect, if any, the exercises had on my movement and posture. I reflected also on the fact that nearly every exercise class that I had been to recently seemed to emphasise the importance of having a good ‘core’. Physiotherapists are often quite keen when treating people with low back pain to try to modify their ingrained movement patterns; but can these patterns be altered, and does this result in any change in pain and activity limitation? These were the questions that were posed in a systematic review by Laird et al in the online open access BMC Musculoskeletal Disorders journal.

Here’s what they did

Eight databases were searched until January 2012. The authors sought randomised controlled trials or controlled clinical trials of people with low back pain with interventions that were designed to influence muscle activity patterns, lumbo-pelvic patterns, or postural patterns. They looked in particular at the effect of the interventions such as trunk stabilisation or core stabilising exercises on lumbo-pelvic movement. Studies were quality assessed using the PEDro scale.

Here’s what they found

The search identified 9,288 potentially relevant articles and 24 other articles were identified through other sources. Following screening of title and abstract, 47 full text articles were retrieved; however, only 12 trials (25% of retrieved studies) met the inclusion criteria.

The authors concluded

Little consistent relationship exists between changes to pain
and/or activity level and changes to muscle activity.

“The available evidence on muscle activity pattern changes following movement-based interventions indicates little difference in outcomes between a general exercise programme and specific interventions that aim to change the activity of trunk muscles such as Transversus Abdominus and Lumbar Multifidus. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed.“

The Musculoskeletal Elf’s view

It appears at this point in time that our ability to change movement patterns with specific interventions is not well supported by the research currently available. A key challenge presented by the authors was that clinicians and researchers need to consider carefully how movement patterns can be reliably measured, and how changes in how people move are associated with other health indicators such as activity limitation and quality of life.

In what ways do you measure a patient’s movement patterns? How reliable do you feel that your current measurement methods are? What quality of life measure(s) do you use currently?

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The Musculoskeletal Elf