The Effectiveness of Motor Control Exercises for the Treatment Of

The Effectiveness of Motor Control Exercises for the Treatment of

Non-Specific Low Back Pain: Literature Review

Emily Smith, SPT and Kayla Rackowski, SPT

Clarkson University, Department of Physical Therapy

Purpose/hypothesis: There are many different treatment options for non-specific low back pain (NSLBP), but it is not clear which forms of exercise are more effective. The purpose of this literature review was to determine the most effective motor control exercise, compared to general or no exercise, to reduce pain related disability and improve function in adult patients with NSLBP in an outpatient setting.

Materials/methods:Searches were conducted using the databases PubMed, Google Scholar, and Cochrane. The keywords used included “NSLBP” AND “Exercise”, “Low Back Pain” AND “Exercise”, “Low Back Pain” AND “Motor Control Exercise”, and “NSLBP” and “Motor Control Exercise”. Articles were included if they were in the English language, had at least 20 participants, used motor control exercise as an intervention. Exclusion criteria included being published before 2006 and if the level of Evidence was below 2b. Two reviewers assessed each article for inclusion and exclusion criteria, assessed quality using Level of Evidence, and assessed bias using PEDro scores.

Results: The literature search produced 3057 articles and five articles met inclusion and exclusion criteria. The five articles were randomized control trials and quality of the articles were assessed at either a 2 or 2b for level of evidence.

Conclusions: After review of the literature and data extraction, MCID values of the outcome measures were compared to determine whether the results of the studies showed clinically important change. Four articles found clinically important change in pain related disability and improve function, while one article showed no clinically important change. Motor control exercise was found to be an effective treatment in reducing pain related disability and improving function in patients with NSLBP compared to no exercise or general exercise.

Clinical relevance:Motor control exercise has been shown in the literature to be an effective treatment for patients with NSLBP. The literature reviewed supports the effectiveness of motor control exercise for patients 18 years and older with NSLBP symptoms for 12 weeks or more, being treated in an outpatient setting. Due to having some different, yet specific motor control exercises, a program utilizing motor control exercise for NSLBP can be modified specific to a patient’s functional goal.

References

1. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for Low Back Pain. Cochrane Database of Systematic Reviews. 2015, Issue 9. Art. No.: CD001929. Doi: 10.1002/14651858.CD001929.pub.3.

2.Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Motor Control Exercise for Chronic Non-Specific Low-Back Pain. Cochrane Database of Systematic Reviews. 2016, Issue 1. Art. No.: CD012004. Doi: 10.1002/14651858.CD012004.

3.Ebadi S, Henschke N, Nakhostin Ansari N, Fallah E, van Tulder MW. Therapeutic Ultrasound for Chronic Low-Back Pain.Cochrane Database of Systematic Reviews. 2014, Issue 3. Art. No.: CD009169. Doi: 10.1002/14651858.CD009169.pub.2.

4.French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial Heat or Cold for Low Back Pain. Cochrane Database of Systematic Reviews. 2006, Issue 1. Art. No.: CD004750. Doi: 10.1002/14651858.CD004750.pub2.

5.Costa LO, Maher CG, Latimer J, et al. Motor Control Exercise for chronic low back pain: a randomized placebo-controlled trial. Physther. 2009. 89 (12): 1275-1286. Doi: 10.2522/ptj.20090218.

6.Ferreira M, Ferreira P, Latimer J, et al. Comparison of general exercise, motor control exercise and spinal therapy for chronic low back pain: A randomized trial. Pain. 2007. 131: 31-37. Doi: 10.1016/j.pain.2006.12.008

7.Oh BH, Kim HH, Kim CY, Nam CW. Comparison of physical function according to the lumbar movement method of stabilizing a patient with chronic low back pain. J physther sci. 2015. 27(12): 3655-3658. Doi: 10.1589/jpts.27.3655.

8.Moon HJ, Choi KH, Kim DH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann rehabil med. 2013. 37(1): 110-117. Doi: 10.5535/arm.2013.37.1.110.

9.Goldby LJ, Moore AP, Doust J, Trew M. A Randomized Controlled Trial Investigating the Efficiency of Musculoskeletal Physiotherapy on Chronic Low Back Disorder. Spine. 2006. 31(10): 1-11.

Is Stretching Better at Pain Reduction in Plantar Fasciitis than Dorsiflexion Night Splinting?

Phillips K, Morse K

Clarkson University, Potsdam, NY

Purpose/Hypothesis: The purpose of this literature search was to determine the effectiveness of pain reduction of plantar fasciitis with stretching compared to dorsiflexion night splinting for patients in the orthopedic setting.

Number of Subjects: N/A.

Materials/Methods: A literature search was conducted using PubMed, PTNow, and CINHAL. Studies were included if they involved: (1) a randomized controlled trial (RCT) or systematic review, (2) English language, (3) diagnosis of plantar fasciitis, (4) an interventions of stretching or dorsiflexion night splinting, (5) published between 1996 and 2016, (6) level of evidence of level 2 or above, and PEDro score of 4/10 or higher. Articles were assessed for quality by two reviewers using the Physiotherapy Evidence Database (PEDro) scale and Level of Evidence.

Results: Five full-text articles were selected for inclusion in this review. PEDro scores ranged from 4 to 10 (out of 10). The articles concluded that there was no significant difference in pain reduction between stretching and dorsiflexion night splinting. Batt et al. concluded that dorsiflexion night splinting is effective for pain reduction when used with other treatments.4 Sharma et al. concluded that dorsiflexion splinting and standard treatment including: plantar fascia massage and passive stretching both significantly improved the overall pain rating overtime compared to baseline.5 Radford et al. concluded that there was no significant difference in pain reduction with the gastrocnemius stretching with sham ultrasound group and the sham ultrasound group.6DiGiovanni et al. concluded no significant differences in pain reduction between the plantar fascia stretching and soft insole and celecoxib group, Achilles tendon stretching and soft insole and celecoxib group, and soft insole and celecoxib group.7Landorf et al. concluded that stretching may or may not improve pain in plantar fasciitis without any other treatment methods and there was no significant improvements in pain with dorsiflexion night splinting.2

Conclusion: Stretching and dorsiflexion night splinting are both effective in pain reduction for plantar fasciitis. However, there is no evidence to support one of the treatment modalities as more beneficial for pain reduction.

Clinical Relevance: Stretching and dorsiflexion night splinting are both effective in reducing pain associated with plantar fasciitis, and should be utilized for patients in the orthopedic setting.

References:

1. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799-804.

2. Landorf KB, Menz HB. Plantar heel pain and fasciitis. BMJ ClinEvid. 2008;2008:1111.

3. Barry LD,Barry AN,Chen Y. A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis.J Foot Ankle Surg. 2002;41(4):221-27.

4. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med. 1996;6(3):158-62.

5. Sharma NK, Loudon JK. Static progressive stretch brace as a treatment of pain and functional limitations associated with plantar fasciitis: a pilot study. Foot Ankle Spec. 2010;3(3):117-24.

6. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC MusculoskeletDisord. 2007;8:36.

7. DiGiovanni BF,Nawoczenski DA,Lintal ME, et al.Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. a prospective, randomized study.J Bone Joint Surg Am.2003;85-A(7):1270-7.

8. Simple Search. PEDro Physiotherapy Evidence Database website Updated February 1, 2016. Accessed March 15, 2016

Spinal Manipulation Therapy and Pharmacological Interventions on

Non-Specific Low Back Pain: A Comparison Review

Laura Feneley, SPT and Megan Shaia, SPT

Clarkson University, Department of Physical Therapy

Purpose/Hypothesis: Spinal manipulation therapy (SMT) is a hands-on treatment of the spine involving manipulation and mobilization. This technique has been shown to improve function and alleviate pain in patients with acute symptoms. However, conflicting evidence exists for the long-term benefits in treating non-specific low back pain (NSLBP). The purpose was to perform a review of the literature to determine if SMT is more effective than pharmacological interventions for reducing NSLBP in adults within an outpatient physical therapy setting.

Number of subjects: N/A

Materials/Methods: Searches were performed from January 2016 to February 2016 on the following databases: PubMed, ProQuest, CINAHL, and Cochrane. Inclusion criteria consisted of: individuals age 18 or older, males and females, and articles in English. Exclusion criteria included: PEDro scores below 6/10, women who are pregnant, articles published before the year 2000, studies only on athletes, and articles focusing on a specific pathology (Ex: Spondylolisthesis, disc herniation, etc.). Each article was evaluated by two assessors using the level of evidence, PEDro score, and grade/quality.

Results: The search yielded 36,726 articles. Nineteen articles were assessed for eligibility. Of those articles, 14 were eliminated for not meeting inclusion criteria. The remaining five articles were analyzed and data was extracted for the review. Four systematic reviews were included, all graded an A based on Critical Appraisal reviews and one randomized controlled trial, a 6/10 on the PEDro score. Rubinstein SM, et al., Chou R., and MillanM,et al., all showed that SMT relieved short-term pain. Bialosky JE, et al. determined there was a decrease in pain sensitivity with SMT. Kuijpers T, et al. examined pharmacological interventions on LBP reduction, and concluded NSAIDs and opioids were effective in reducing acute pain.

Conclusions: Research consistently supports SMT as an effective short-term treatment for reducing LBP in individuals within an outpatient setting. There is not enough evidence in the literature to determine if SMT is a more effective treatment when compared to pharmacological interventions.

Clinical relevance: None of the articles included in this review had clinically significant findings for pain reduction. Therefore, further investigations for clinical relevance include effects of SMT on chronic LBP, and in specific patient populations/conditions, including those who had outcome measures of higher pain intensity.

References

1. Moldovan M. Therapeutic Considerations and Recovery in Low Back Pain: Williamsvs McKenzie. Timisoara Phys. Educ. and Rehabil. j. 2012;5(9):58-64.

2. Gurung T, Ellard DR, Mistry D, Patel S, Underwood M. Identifying potential moderators for response to treatment in low back pain: A systematic review. J.Physiother. 2015;101(3):243-51.

3. Chou R, Qaseem A, Snow V, 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(7):478-91.

4. Kuijpers T, van Middelkoop M, Rubinstein SM, et al. A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain.Eur Spine J. 2011;20(1):40-50.

5. Rubinstein SM, vanMiddelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. In: Cochrane Database Syst. Rev. John Wiley & Sons, Ltd; 2011. Accessed February 28, 2016.

6. Joel E Bialosky, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal Manipulative Therapy Specific Changes In Pain Sensitivity In Individuals With Low Back Pain. J Pain. 2014;15(2):136-148.

7. Millan M, Leboeuf-Yde C, Budgell B, Amorim M-A. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr. & Manual Ther.2012;20(1):26.

OKC vs. CKC for Post-Op Anterior Cruciate Ligament Rehab for Return to Sport

Ryan M, Shields J

Department of Physical Therapy, Clarkson University

Purpose/Hypothesis: Open and closed kinetic chain exercise are both commonly used in post-op ACL rehabilitation but it is not certain if one produces better strength and stability affects. The purpose of this review was to compare open and closed kinetic chain exercises on increasing muscular strength and stability in high level athletes.

Number of Subjects: 4

Materials/Methods: Searches were performed on the following databases: PubMed, ScienceDirect, and Google Scholar (2008-Present). Yielded articles were screened for inclusion and exclusion criteria. The PEDro scale was used to assess the level of evidence of the RCT and the systematic reviews were evaluated using the QUADAS criteria.

Results: The 4 articles used included 1 randomised control trial with a 7/10 PEDro score and 3 systematic reviews with grades ranging from A to B. The studies reviewed focussed on ACL post operative reconstruction rehabilitation at 6 and 12-week follow-up measures and evaluated a variety of outcome measures. For CKC exercise a decrease in pain was seen in 2 articles, decrease in laxity in 3 articles, increase in function in 2 articles and increase in strength in 1 article compared to OKC exercise. It was found in 2 articles that a combination of OKC and CKC after 6-week post op was optimal for return to function and sport.

Conclusion: A decrease in anterior translation of the knee was shown to be less in CKC exercise. Though the studies reviewed did not show a direct correlation between pain and anterior translation, subjects with a decreased anterior translation also had lower pain levels than those who had greater translation. Strength was evaluated in 1 article showing CKC to be more effective at increasing knee strength than OKC during the first 6 weeks of rehab. Return to sport and return to ADL’s was quickest with a combination of CKC and OKC after the first 6 weeks or rehab.

Clinical Relevance: Anterior cruciate ligament injury is common in sport as is the prevalence of ACL reconstruction. For the first 6 weeks of rehabilitation it was found to be safer to utilize CKC exercise instead of OKC because it produced less of an anterior translation of the knee comparatively minimizing stress on the new ACL graft. For athletes who desire to return to sport with maximal strength and function, adding in OKC exercise to their rehabilitation regiment after 6 weeks was shown to increase their overall function for return to sport the most.

References

1. Malempati C, Jurjans J, Noehren B, Ireland ML, Johnson DL. Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes. Orthopedics. 2015;38(11):689-696. doi:10.3928/01477447-20151016-07.
2. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: A 10-year study. Knee. 2006;13(3):184-188. doi:10.1016/j.knee.2006.01.005.
3. Uçar M, Koca I, Eroglu M, et al. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J PhysTher Sci. 2014;26(12):1875-1878. doi:10.1589/jpts.26.1875.
4. Escamilla RF, Macleod TD, Wilk KE, Paulos L, Andrews JR. Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection. J Orthop Sports PhysTher. 2012;42(3):208-220. doi:10.2519/jospt.2012.3768.
5. Wright RW, Preston E, Fleming BC, et al. A systematic review of anterior cruciate ligament reconstruction rehabilitation: part II: open versus closed kinetic chain exercises, neuromuscular electrical stimulation, accelerated rehabilitation, and miscellaneous topics. J Knee Surg. 2008;21(3):225-234.
6. Glass R, Waddell J, Hoogenboom B. The Effects of Open versus Closed Kinetic Chain Exercises on Patients with ACL Deficient or Reconstructed Knees: A Systematic Review. N Am J Sports PhysTher. 2010;5(2):74-84.
7. Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Physical Therapy in Sport. 2012;13(4):270-278. doi:10.1016/j.ptsp.2012.05.001.

Effectiveness of Scoliosis Specific Exercises Compared to Bracing in

Reducing Spinal Curvature in Adolescent Patients: A Review of the Literature

Piacente T and Cuddeback D

Department of Physical Therapy, Clarkson University, Potsdam, NY

Purpose: The purpose of this literature review was to compare the effectiveness of scoliosis specific exercises to bracing in reducing spinal curvature in adolescent patients.

Methods: Searches were performed in the following databases: PubMed, Cochrane Library, CINAHL, and PT Now. Inclusion Criteria consisted of (1) Systematic Reviews, (2) Randomized Control Trial (RCT), (3) adolescent patient group, (4) intervention of either exercise or bracing, (5) Cobb angle outcome measure, and (6) English language. Articles were assessed for quality using, Levels of Evidence Oxford Centre for Evidence-Based Medicine (2011), systematic review assessment, and PEDro score. The Cobb angle was used to determine the effectiveness of treatment.

Results: This review included five articles: three were systematic reviews, two were cohort studies. The PEDRO scores ranged from 4-5 (out of 10), levels of evidence ranged from 1-3, and the systematic review grades ranged from A-B. Two articles found that the addition of scoliosis specific exercises were effective in reducing Cobb angles and progression of spinal curvature. One systematic review found that many different forms of therapeutic exercises were effective in reducing spinal curvature. Another article found that the addition of scoliosis specific exercises compared to standard PT and no exercises had more success in decreasing spinal curvature. One systematic review found that bracing was more effective in decreasing spinal curvature compared to no treatment.

Conclusion: Although none of the research directly compared exercise and bracing, there was evidence that the addition of scoliosis specific exercises to standard treatment was effective in decreasing spinal curvature. Further research should aim to examine a direct comparison between exercise and bracing for adolescent patients with scoliosis.

Clinical Relevance: Scoliosis specific exercises decrease the progression of spinal curvature in adolescent patients. This allows physical therapists to consider the use of these exercises when treating scoliosis.

References:

1. Negrini S, Donzelli S, Lusini M, Minnella S, Zaina F. The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study. BMC Musculoskeletal Disorders. 2014;15:263. doi:10.1186/1471-2474-15-263
2. Maruyama T, Grivas TB, Kaspiris A. Effectiveness and outcomes of brace treatment: a systematic review. Physiotherapy Theory & Practice. 2011;27(1):26-42 17p. doi:10.3109/09593985.2010.503989.
3. Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S. Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review. Physiotherapy Theory & Practice. 2011;27(1):80-114 35p. doi:10.3109/09593985.2010.533342.
4. Negrini A, Negrini MG, Donzelli S, Romano M, Zaina F, Negrini S. Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis. 2015;10. doi:10.1186/s13013-015-0044-9.
5. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis and Spinal Disorders. 2006;1(1):2. doi:10.1186/1748-7161-1-2.
6. Romano M. Exercises for adolescent idiopathic scoliosis. Minozzi S, Bettany-Saltikov J, Zaina F, et al., eds. Cochrane Database of Systematic Reviews. 2012;(10). Accessed January 18, 2016.

Most Effective Exercise for Reducing Pain in PFP Syndrome