Does Motor Control Exercise Restore Normal Morphology of Lumbar Multifidus Muscle in People with Low Back Pain? – A Systematic Review

Sabina M Pinto,1 Sweta B Boghra,1 Luciana G Macedo,2 Yong-Ping Zheng,3 Marco YC Pang,1 Jason PY Cheung,4 Jaro Karppinen,5,6 Dino Samartzis,7 Arnold YL Wong1 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; 2School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; 3Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; 4Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China; 5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; 6Finnish Institute of Occupational Health, Helsinki, Finland; 7Department of Orthopaedics Surgery, Rush University Medical Center, Chicago, IL, USACorrespondence: Arnold YL WongDepartment of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, ChinaTel +852 2766-6741Fax +852 2330-8656Email arnold.wong@polyu.edu.hkAbstract: Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very low- to low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.Keywords: imaging, LMM, LBP, morphometr