The article that I would like to present today raises a question that everyone that deals with back pain as a physiotherapist or even as a patient asked himself at some point : we know that exercises are good for low back pain but, Does it Matter Which Exercise?
This is not the newest research out there, However the methodology of this research is excellent and the sample size includes more than 300 patients worldwide, It is a very simple, elegant and clear research and here is a short description of it:
The clinical question was: “will there be a difference in clinical outcome of patients if we will give them a specific exercise designed for them or it will be just as good as general exercises”. The patients went through a Mechanical Diagnosis and Treatment physiotherapy evaluation (MDT or “McKenzie method”) that tried to establish whether the patients had a directional preference (DP- more on that in the next blog) and If yes what is it (Flexion, extension or Lateral movement).
After this evaluation the patients were divided into 3 different groups:
- Group A : Matched Direction – patients got as an exercise the same movement that seemed to be beneficial on the initial evaluation.
- Group B : Opposite direction- the name makes it clear, i.e patient that seemed to respond to extension positively got the opposite movement.
- Group 3, control : Evidence- based group – these patients got a non-specific exercise program in multiple directions.
I am sure you are all curious about the results – All the groups improved somewhat in all the measurements: Back and/or leg pain intensity, functional questionnaire ( Roland-Morris DQ), Pills per day for Low Back Pain and so on.
However, the improvement in the Matched Direction group was much more significant (P values <0.001) in all measurement (see graphs bellow ).
So, to answer our question, Does it Matter which exercise? Most definitely yes , and you got the proof..