Motor Control Training Improves Function After Disc Herniation

In the short-term, motor control training (MCT) improves pain and function better than transcutaneous electrical nerve stimulation (TENS) for patients with lumbar disc herniation (LDH) who’ve not had surgery, a new study finds.

The research, “Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials,” was published online on June 14, 2022, in the British Journal of Sports Medicine.

The study authors conducted a review of all available research on the effectiveness of motor control training compared with other physical-therapist-led intervention. They used eight databases and the ClinicalTrials.gov from inception to April 2021 to search for studies.

The primary outcomes were pain intensity and functional status expressed as mean difference (MD) and standardized mean difference (SMD).

The final analysis included 16 clinical trials with a total of 861 participants. The researchers noted that 14 of them had a high risk of bias and the other two had some risk of bias.

Overall, motor control training led to the most pain reduction at short term (MD –28.85, –40.04 to −17.66, n=69, studies=2). However, the researchers questioned the robustness of the finding.

Motor control training also was superior when it came to functional outcomes when compared with general exercises (SMD −0.83 to –1.35 to −0.31, n=63, studies=1) and other physical-therapist-led interventions (at short-term (SMD −1.43 to –2.41 to −0.46, n=69, studies=2).

None of the studies compared motor control training to surgery. Patients who were treated with surgery had large SMDs.

“At short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies,” the researchers wrote.

Study authors include Mohammadreza Pourahmadi, Somayeh Delavari, Maryam Ahmadi, and Maryarn Nazemipour of Iran University of Medical Science in Tehran, Iran.

Jill A. Hayden of Dalhousie University in Canada and Sidney M. Rubinstein of Vrije Universiteit, Amsterdam, The Netherlands also contributed to the research, as well as Abbasali Keshtkar, Azadeh Aletaha, Mohammad Ali Mansournia of Tehran University of Medical Sciences in Tehran Iran.