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

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 degrees(8.0,4.1), hip = 21.2 degrees(19.2,23.1), lumbar = 11.3 degrees (10.4,12.3). From baseline to post-treatment significant improvements in early excursion included: knee = +18.6 degrees(15.4,21.8), hip = +10.8 degrees(8.8,12.8), and lumbar = 2.0 degrees (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 degrees (5.8,11.9), hip = 20.8 degrees (18.9,22.8), and lumbar = 11.2 degrees (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.