An update of stabilisation exercises for low back pain: a systematic review with meta-analysis – Benjamin E Smith

Hi All
Welcome to CPDO at Home live forum. Please feel free to ask any question regarding my study – An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. Remember that at the end of the session you can claim 1 CPD credit Learning With Others. This certificate can be downloaded from here:
http://www.cpdoathome.com

Ben
In a recent talk you mentioned that core stability training is still the most popular treatment modality for LBP by physiotherapists in the UK. This is despite your study and all previous systematic reviews showing that such training is no better than any other exercise:
1. Lomond KV et al Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. Man Ther. 2014 Apr 24. pii: S1356-689X(14)00068-X. doi: 10.1016/j.math.2014.04.007. [Epub ahead of print]
2. Wang XQ et al A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17.
3. Kriese M et al Segmental stabilization in low back pain: a systematic review. Sportverletz Sportschaden. 2010 Mar;24(1):17-25. Epub 2010 Mar 16.
4. Macedo LG, Maher CG, Latimer J et al 2009 Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review PHYS THER Vol. 89, No. 1, January, pp. 9-25
5. Rackwitz B et al Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehabil. 2006 Jul;20(7):553-67.
6. May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy.2008;94(3):179-189
7. Ferreira PH, Ferreira ML, Maher CG, et al. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother 2006;52:79–88.

Is it possible that this information has not filtered down to clinical practice? Does it reflect outdated education or simply practitioners choose to ignore it?

Good question.
Yes, I think this information hasn’t filtered fully down to clinical practice. My experience is that core stability training is still the default position that young graduates seem to take, and many experienced therapists seem to take.

• This reply was modified 10 years, 1 month ago by Smith Littlewood May.

Hi Ben
Am I correct in saying that this study isn’t stating that stability exercises aren’t beneficial, just no more beneficial than other forms of exercise?

Hi HannahM. Yes, that’s correct. It’s not saying core stability isn’t beneficial .It’s saying it’s as beneficial as any other form of active, supervised activity. E.G a progressive walking programme, spin classes, mat based exercises etc etc.

What it is saying is that core stability is the great cure as was initially thought.

Do you feel that there is a place for core stability exercises in clinical practice? Perhaps at an entry level to exercise or in those with comorbidities preventing other types of exercise, or as an adjunct to an exercise programme?

Wondered about short-term pain relief & reduction of potential disability anxiety with stabilisation exercises vs. long term.

Personally; no not really. I think there are far better entry levels exercises that can be used. There are some potential iatrogenic effects with core stability exercises that aren’t yet fully understood.

That said, if someone really enjoys these type of exercises, pilates or gym ball exercise classes for example, then I certainly wouldn’t tell someone not to do them. The best form of exercise is the one the patient is more likely to follow.

John, there was a very small statistical difference in favour of core stability at short term. About 7 points on a scale of 0-100. However this is demonstrated as clinically insignificant.

COULDNT YOU SAY ANY EXERCISE THATS ENCOURAGES LOW BACK MUSCLE STRENGTH TECHNICALLY IS STABILISING THE AREA IN SOME FORM ?

Perhaps. But who’s to say we actually need to ‘strengthen’ any muscles at all. There’s a lot of uncertainty surrounding the therapeutic effect of exercise intervention; graded exposure, impact on the nervous system, the use of exercise to promote self-efficacy expectations, or adherence. It’s difficult to say why an exercise regime works. It’s likely not to work in the way we traditionally think it does, I would say.

Hi Ben, very interested in your thoughts regarding ref. 101 – patients attitude & beliefs regarding chronic MSK pain key to applying effective treatment (Man Ther). Concerned that stabilisation exercises could encourage unhealthy thoughts & beliefs on pain & movement?

Yes, John. That is one of my fears with core stability. Research has shown that patients treated within a purely biomedical model of pain do have worse fear avoidance. O’Sullivan, for example, has done lot of work. We know that patients with long term persistent pain show signs of higher levels of EMG activity, and increased trunk muscle activation. They often show an inability to relax. These maladaptive movements/beliefs/behaviours often make the pain worse. This coupled with the large emotional factors that coincide with LBP, fear/anxiety/ catastrophizing, fear of movement hyper vigilance further enhancing the pain and disability levels. Core stability could increase these features, not help.

Thanks very much everyone for an interesting discussion.