Effects of external focus and motor control training in comparison with motor control training alone on pain, thickness of trunk muscles and function of people with recurrent low back pain: a single blinded, randomized control trial.

Document Type : RESEARCH PAPER

Authors

1 Department of physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, IRAN

2 Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

3 Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.

4 Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background
Recurrent low back pain (RLBP) affects different structures in the lumbar spine. Exercise therapy is highly recommended as one of the first lines of the treatment. One of the important variables that has been introduced to enhance it, is external focus. The aim of this study was to investigate the effects of external focus training on pain, thickness of transverse abdominis (TrA), internal oblique (IO), external oblique (EO) and lumbar multifidus (LM) muscles, kinesiophobia, fear-avoidance beliefs and disability of people with RLBP.
Method
The randomized-controlled trial included a total of 38 RLBP patient. Patients were randomly divided into two groups as the treatment group (n=19) that received external focus training in addition to motor control training and control group (n=19) that received motor control training alone. The primary outcome was pain intensity and secondary outcomes were thickness of TrA, IO, EO and LM muscles, kinesiophobia, fear-avoidance beliefs and disability that were measured at the baseline and after 16 sessions of intervention. The interventions were performed three sessions weekly.
Results
Improvement of pain intensity was obtained in the intervention group, significantly more than control group (P value< 0.001, Cohen’s d = -1.47). Thickness of TrA muscle in contraction condition of intervention group was significantly more on the left side (P value< 0.001, Cohen’s d = 1.05) and the right side (P value = 0.03, Cohen’s d = 0.44). Other outcomes didn't show significant difference. But the Cohen’s d effect size for the left IO (Cohen’s d = 0.57) and also TKS (Cohen’s d = -0.53) was moderate.
Conclusion
In RLBP patients, external focus training with motor control training could be effective to pain improvement. This intervention could increase the thickness of TrA muscle of RLBP, but has no significant effect on thickness of IO, EO and LM muscles. Results also indicated this intervention hasn’t significant effect on kinesiophobia, fear-avoidance beliefs and disability.
Level of evidence: Іb

Keywords



Articles in Press, Accepted Manuscript
Available Online from 26 February 2022
  • Receive Date: 12 April 2021
  • Revise Date: 16 January 2022
  • Accept Date: 22 February 2022
  • First Publish Date: 26 February 2022