Analysis of motor control in low-back pain patients: a key to personalized care?

Synopsis Motor control exercise has been shown to be effective in the management of low-back pain (LBP), but effect sizes are modest, possibly due to the fact that studies have used a one-size-fits-all approach, whereas literature suggests that patients may differ in presence or type of motor control issues. In this commentary, we address the question whether consideration of such variation in motor control issues might contribute to more personalized motor control exercise for patients with LBP. Such an approach is plausible, since motor control changes may play a role in persistence of pain through effects on tissue loading that may cause nociceptive afference in particular in case of peripheral sensitization. Subgrouping systems used in clinical practice which comprise motor control aspects allow reliable classification that is in part aligned with findings in studies on motor control in patients with LBP. Motor control issues may have heuristic value for treatment allocation, as the different presentations observed suggest different targets for motor control exercise, but this remains to be proven. Finally, clinical assessment of patients with LBP should take into account more aspects than motor control alone, including pain mechanisms, musculoskeletal health and psychosocial factors, and may need to be embedded in a stratification approach based on prognosis to avoid undue diagnostic procedures