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Motor skill training versus strength and flexibility exercise in people with chronic low back pain: Preplanned analysis of effects on kinematics during a functional activity

  • Quenten L. Hooker
    Affiliations
    Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Vanessa M. Lanier
    Affiliations
    Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America

    Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Kristen Roles
    Affiliations
    Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Linda R. van Dillen
    Correspondence
    Corresponding author at: 4444 Forest Park Boulevard, Campus Box 8502, Program in Physical Therapy, Washington University in St. Louis, School of Medicine, St. Louis, MO 63108, United States of America.
    Affiliations
    Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America

    Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
    Search for articles by this author

      Highlights

      • Motor skill training improved the altered movement pattern during a functional test.
      • Strength and flexibility exercise did not change the altered movement pattern.
      • Improvements in the pattern within motor skill training were maintained 6 months after treatment.

      Abstract

      Background

      People with chronic low back pain display the altered movement pattern where the lumbar spine moves more readily into its available range of motion relative to other joints. A logical approach to treatment, therefore, would be to improve this pattern during functional activities.

      Methods

      154 participants were randomized to receive 6 weeks of motor skill training or strength and flexibility exercise. Participants in the motor skill training group received person-specific training to modify their altered movement pattern during functional activities. Participants in the strength and flexibility group received exercises for trunk strength and trunk and lower-limb flexibility. At baseline, post-treatment and 6-months after treatment participants performed a test of picking up an object using their preferred pattern. Three-dimensional marker co-ordinate data were collected. A mixed-model repeated measures analysis of variance was used to examine the treatment group and time effects.

      Findings

      Motor skill training: Baseline early excursion values [mean (confidence interval)] were as follows: knee = 11.1°(8.0,4.1), hip = 21.2°(19.2,23.1), lumbar = 11.3°(10.4,12.3). From baseline to post-treatment significant improvements in early excursion included: knee = +18.6°(15.4,21.8), hip = +10.8°(8.8,12.8), and lumbar = −2.0°(−0.1,-4.0). There were no significant changes from post-treatment to 6-month follow-up. Strength and flexibility exercise: Baseline early excursion values were as follows: knee = 8.9°(5.8,11.9), hip = 20.8°(18.9,22.8), and lumbar = 11.2°(10.3,12.2) early excursion. There were no significant changes for knee, hip, and lumbar early excursion.

      Interpretation

      Motor skill training was more effective than strength and flexibility exercise at changing and maintaining change to the altered movement pattern during a functional activity test of picking up an object.

      Keywords

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