Motor control problems in patients with spinal pain: a new direction for therapeutic exercise☆

Recent research into muscle dysfunction in patients with low back pain has led to discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing spinal segmental support and control. The muscle impairments are not those of strength but rather problems in motor control. These findings call for a different approach in therapeutic exercise. namely a motor learning exercise protocol. The specific exercise approach has an initial focus on retraining the cocontraetion of the deep muscles (ie, the transversus abdominis and lumbar multifidus). Initial clinical trials point to the effectiveness of the approach in patients with both acute and chronic low back pain in terms of reducing the neuromuseular impairment and in control of pain. (J Manipulative Physiol 2000;23:115–7)