Cognitive muscular therapy for low back pain

Preece, S.J.; Smith, J.; Brookes, N.; Ghio, D.

Abstract

Purpose: Cognitive Muscular Therapy (CMT) is a new treatment for low back pain which integrates psychological techniques for pain management alongside training to improve postural control. Rather than focus on postural alignment or strength, CMT aims to improve the regulation of postural tone (low-level activity which supports the body against gravity). This is achieved by teaching patients an awareness of compensatory paraspinal activation, which can be triggered by overactivity of the abdominal muscles. The aim of this study was to understand whether CMT could reduce symptoms associated with low back pain and improve paraspinal muscle activation.

Methods and results: Fifteen patients with chronic low back pain received seven weekly sessions of CMT from a physiotherapist. Clinical data was captured at baseline and two weeks after the intervention using the Roland-Morris questionnaire and the pain catastrophising scale. Activation of the erector spinae muscle during walking was also measured at baseline and after the final intervention session. Change data were analysed using paired t-tests. There was a 75% reduction (p<0.001) in the Roland-Morris score from a mean (SD) of 9.3(2.9) to 2.3(2.6), along with a 78% reduction in pain catastrophising (p<0.002) from 16.6(13) to 3.7(4.8). Activation of the contralateral erector spinae muscles reduced by 30% (p<0.01) during the contralateral swing phase of walking.

Conclusion: In this small sample, CMT delivered large clinical improvements and reduced activation of the low back muscles during walking. Larger randomised trials are now required to confirm whether CMT could outperform existing physiotherapy treatments for chronic back pain.

• Presentation Conference Type: Conference Paper (published)
• Conference Name: The Society for Back Pain Research (SBPR) 2024 Annual General Meeting: “Innovation in Research and Management of Spine Pain”
• Online Publication Date: Aug 7, 2024
• Publication Date: Aug 7, 2024
• Deposit Date: Dec 13, 2024
• Journal: Orthopaedic Proceedings
• Print ISSN: 1358-992X
• Electronic ISSN: 2049-4416
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 106-B
• Issue: SUPP_15
• Pages: 30
• DOI: https://doi.org/10.1302/1358-992x.2024.15.030