The effectiveness of motor control training in lumbar disc herniation patients remains uncertain

1. In patients with symptomatic lumbar disc herniation (LDH) and no surgery, motor control training (MCT) is neither statistically nor clinically superior at improving function to traditional exercises in the short term.

2. In patients with LDH who had surgery, motor control training may provide better function than traditional exercises; although, studies had a high risk of bias.

Evidence Rating Level: 2 (Good)

Patients suffering from LDH lose on average 5.3 hours of time at work per week due to the debilitating pain and neurological dysfunction – making it an important condition to manage by clinicians. MCT may provide greater benefits than general exercise in the realm of flexibility, posture and balance; however, no review has assessed the potential of this treatment option. As a result, the objective of the present systematic review and meta-analysis was to evaluate the effectiveness of MCT in comparison to other treatments in patients with symptomatic LDH.

Of 22 418 screened records, 16 clinical trials (n=861) were included from inception to April 2021. Studies were eligible if they assessed the effect of MCT compared to other physical therapy interventions, surgery, or placebo/sham treatment. Studies were excluded if participants suffered from lower back pain of other etiologies (e.g. inflammatory, malignant, infectious, etc.). Risk of bias was assessed using the Cochrane risk of bias tool for randomized trials. Random-effects models were used for all meta-analyses based on the DerSimionian and Laird model.

Results demonstrated that in patients with symptomatic lumbar disc herniation (LDH) and no surgery, motor control training (MCT) was neither statistically nor clinically superior at improving function to traditional exercises in the short term. Furthermore, in patients with LDH who had surgery, motor control training may provide better function than traditional exercises, although studies evaluating this relationship had a high risk of bias.The present study was limited by the inclusion of studies with a high risk of bias (14 high risk of bias, 2 studies with some risk of bias) . Given the quality of evidence, the improvements demonstrated by MCT should be interpreted cautiously until more robust evidence is published.

Click to read the study in British Journal of Sports Medicine

Image: PD

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