University of Oulu

Pinto SM, Boghra SB, Macedo LG, Zheng YP, Pang MY, Cheung JP, Karppinen J, Samartzis D, Wong AY. Does Motor Control Exercise Restore Normal Morphology of Lumbar Multifidus Muscle in People with Low Back Pain? – A Systematic Review. J Pain Res. 2021;14:2543-2562.

Does motor control exercise restore normal morphology of lumbar multifidus muscle in people with low back pain? : a systematic review

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Author: Pinto, Sabina M1; Boghra, Sweta B1; Macedo, Luciana G2;
Organizations: 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
2School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
3Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
4Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Finnish Institute of Occupational Health, Helsinki, Finland
7Department of Orthopaedics Surgery, Rush University Medical Center, Chicago, IL, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.9 MB)
Persistent link:
Language: English
Published: Dove Medical Press, 2021
Publish Date: 2021-10-28


Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very low- to low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.

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Series: Journal of pain research
ISSN: 1178-7090
ISSN-E: 1178-7090
ISSN-L: 1178-7090
Volume: 14
Pages: 2543 - 2562
DOI: 10.2147/JPR.S314971
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was funded by Early Career Scheme (251018/17M).
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