Is functional motor control training more effective than general exercises at reducing fear-avoidance and disability in patients with back pain?

This study aims to determine the effectiveness of functional motor control exercise (FMCE) in improving movement control ability, reducing fear-avoidance beliefs, and enhancing other clinical outcomes in patients with chronic LBP.

Fifty-two patients with chronic LBP (CLBP) were randomly assigned to either the FMCE group (n=26, mean age: 44 years) or the general exercise (GE) group (n=26, mean age: 47 years). The FMCE group focused on lumbar spine directional control training, while the GE group received global strength and flexibility training. Both groups underwent an 8-week intervention. Assessments were conducted before the intervention, after 8 weeks, and at a 6-week follow-up. Evaluation tools included the Numeric Rating Scale, Oswestry Disability Index, Low Back Activity Confidence Scale, Fear-Avoidance Beliefs Questionnaire, Patient-Specific Functional Scale, Global Rating of Change Scale, Repeated Sit-to-Stand Test, and a lumbar movement control test battery.

The FMCE group demonstrated significant within-group improvements across all outcome measures. While the GE group showed similar treatment effects, they did not exhibit improvements in the physical activity or work domains of fear-avoidance beliefs. The FMCE group showed better outcomes in movement control ability (p0.001), fear-avoidance beliefs (p=0.003), pain intensity (p=0.025), and disability (p=0.013) compared to the GE group. However, no significant between-group differences were found in low back activity confidence, function, global change, or physical performance.

Functional motor control training was more effective than general exercises in increasing movement control ability, reversing fear-avoidance beliefs, and reducing pain intensity and disability in patients with chronic LBP.

Functional motor control exercise is superior to general exercise for improving movement control, reducing fear-avoidance beliefs, and decreasing pain intensity and disability in patients with chronic LBP. Clinicians should prioritize FMCE to target faulty movement patterns and psychological barriers, such as kinesiophobia, which contribute to the persistence of chronic LBP. FMCE’s greater impact on reversing fear-avoidance behaviors and its sustained long-term benefits highlight its importance in comprehensive LBP management. Personalizing exercise programs to address both physical and psychological factors offers more effective and lasting relief for patients with chronic LBP.