This type of rehabilitation is heavily criticized. There are numerous reasons for this such as the non functional nature of the exercises and the results of results of systemic reviews.
I have over a dozen systematic reviews and or meta-analysis in my personal library. In general the results say that these specific motor control stability exercises (SMCSE) are better than no / minimal intervention, but not better than other active interventions.
I have done one systematic review as part of the course work for my PhD (see reference below) and I have updated it for my thesis.
https://www.researchgate.net/publication/339362910_Specific_Motor_Control_Exercise_for_Lumbo-pelvic_Pain_of_Articular_Origin_A_Systematic_Review
First, there is evidence to support these exercises when a subgroup of non specific low back is used (when there is evidence of articular related low back pain). I guess this could be argued that it isn't actually "non-specific low back pain", but that's a separate discussion. Only one of all these systematic reviews did actually bother to separately look at "more specific" low back pain.
Second, there are actually conflicting results in these reviews. This is when short term outcomes are compared, and when meta-analyses are considered.
Thirdly, there is considerable difficulty in analyzing these studies and
putting them into groups (e.g. specific exercise on its own or + other intervention
(active and or passive, and or education). Comparison groups are quite variable (active intervention, passive intervention, education, combinations of etc). This
highlights the problem of the lack of a standard therapy for research
use.
The "pundits" will state that the supporters of SMCSE will cry about "the exercises weren't done right". Is this an issue? Well, when I lectured to a group of MSc students on the UK (who were all meant to be very experienced), only one actually knew how to palpate a contraction of an exercise biased for transversus abdominus. This is actually worse than normal when I give lectures. In general, between 40% - 50% of clinicians do not know how to do this. Some of these people are physiotherapy specialists and a few even teach continuing education courses. There are a lot of professional issues here of course. As echoed in the literature, it takes a high degree of skill by the therapist to know how to properly implement SMCSE.
I have no idea of course how this equates to the exercises used in clinical trials. Certainly the instructions used in many seem suspect. This highlights the need for standardized instructions and reporting in exercises used in clinical trials.
There is also a considerable body of evidence to support the rationale
for the use of SMCSE which tends to be forgotten and misrepresented. Too often, some of the early research is quoted and misrepresented.
Let's not forget, there are of course numerous agendas, biases and other issues related to this topic. So no, the case is not closed. In fact, with the current evidence SMCSE are not guilty and in fact play a role in the rehabilitation of articular related low back pain.
We know who to use the exercises with and we have preliminary evidence to predict who will respond.
Rule in:
- Articular related low back pain
- Good motor skill learning (assessed with the Motor Control Abilities Questionnaire)https://www.researchgate.net/publication/339363667_O27_The_development_initial_reliability_and_construct_validity_of_the_motor_control_abilities_questionnaire?_
Rule out:
- Behavioral Factors
- Non mechanical pain
- Chronic Low Grade Systemic Inflammation https://www.researchgate.net/publication/339127713_Are_co-morbid_medical_symptoms_associated_with_poor_response_to_sub-classification_based_management_of_chronic_low_back_pain_A_retrospective_case-control_study
So we need a clinical trial with articular related low back pain due to similar causes and compared to an exercise intervention that does not cognitively alter or control movement.
I also want to do research work on this topic
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