title: Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial.
abstract: BACKGROUND
  People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs).
  
  
  OBJECTIVE
  To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs.
  
  
  METHODS
  Prospectively registered randomized controlled trial with a blinded assessor.
  
  
  METHODS
  Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics.
  
  
  METHODS
  Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP.
  
  
  METHODS
  Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment-based treatment, for more than 6 weekly 1-hour sessions plus home exercises.
  
  
  METHODS
  Pre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded.
  
  
  RESULTS
  Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task.
  
  
  CONCLUSIONS
  Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure.
  
  
  CONCLUSIONS
  Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment-based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).
authors.affiliation: Division of Health and Exercise Sciences, School of Health Sciences, 1179 Health Professions Building, Central Michigan University, Mount Pleasant, MI 48859, USA. Electronic address: lomon2k@cmich.edu.
authors.forename: Karen V
authors.initials: KV
authors.lastname: Lomond
authors.affiliation: Department of Rehabilitation and Movement Science, College of Nursing and Health Science, 106 Carrigan Drive, University of Vermont, Burlington, VT 05405-0068, USA.
authors.forename: Jesse V
authors.initials: JV
authors.lastname: Jacobs
authors.affiliation: Department of Rehabilitation and Movement Science, College of Nursing and Health Science, 106 Carrigan Drive, University of Vermont, Burlington, VT 05405-0068, USA.
authors.forename: Juvena R
authors.initials: JR
authors.lastname: Hitt
authors.affiliation: Department of Medical Biostatistics, 16 Colchester Ave, University of Vermont, Burlington, VT 05405-0068, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: DeSarno
authors.affiliation: Department of Medical Biostatistics, 16 Colchester Ave, University of Vermont, Burlington, VT 05405-0068, USA.
authors.forename: Janice Y
authors.initials: JY
authors.lastname: Bunn
authors.affiliation: Department of Rehabilitation and Movement Science, College of Nursing and Health Science, 106 Carrigan Drive, University of Vermont, Burlington, VT 05405-0068, USA.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Henry
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009068:Movement; D011187:Posture
keywords: Aberrant movement patterns; Anticipatory postural adjustment (APA); Force application.; Low back pain (LBP); Movement systems impairment (MSI) approach; Stabilization approach