“It is usually performed as a supervised exercise. An example would be to lie down and draw your lower abdomen in toward your spine to learn how to activate these muscles. Some studies in our review reported “core exercises” or “stabilisation exercises”, which we included although these exercises are not entirely included in the definition of MCE.”
What the reviews DO NOT say is that therapists and trainers should discard MCE or similar exercise modalities. Almost any type of movement or exercise can benefit those with acute or chronic low back pain.
“The non-MCE exercises included a wide variety of exercises (i.e., general exercises, aerobic exercises, stretching, general strengthening). It is already known that exercise is effective for low back pain irrespectively for the type of exercise,” Saragiotto explained. “If you have a previous training or experience on MCE, you should use because it seems to be effective just like other exercises, the same if you are trained in another type of exercise (i.e., Pilates), they seem to be equally effective.
“The open question here is whether there is a subgroup of patients that would respond better to MCE than other type of exercises, but we can’t answer this question yet.”
When asked about the reliability of the acute low back pain review due to the low number of trials reviewed, Saragiotto stated that there are no firm conclusions can be drawn about MCE and acute low back pain. “Our evidence was mostly of very low/low quality. On the other hand, we had more robust findings for chronic LBP.”
“For patients, they should consider costs and their preferences to choose the right exercise for them.” ~ Bruno Saragiotto, PT
These reviews seem to go along with the idea that manual therapists (and trainers and coaches) should adopt a more “interactor” approach to working with patients, clients, and athletes rather than leaning toward an “operator” approach. In the Journal of Manual and Manipulative Therapy, authors Diane Jacobs and Dr. Jason Silvernail described the operator approach as “the patient is a passive recipient of the manual act.” The patient or client passively receives the work while the therapist and the modality get most of the credit.
An interactor approach, however, involves “the context of the treatment including the technique, the provider, the participant, the environment, and the interaction between these factors may contribute to patient outcomes.” Thus, it is not just about the technique or modality; therapists and trainers need to take a broader view and approach to working with those in pain.
1. Saragiotto BT, Maher C, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Motor control exercise for chronic non-specific low-back pain. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD012004. DOI: 10.1002/14651858.CD012004.
2. Macedo LG, Saragiotto BT, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Maher C. Motor control exercise for acute non-specific low back pain. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012085. DOI: 10.1002/14651858.CD012085.
3. Jacobs D, Silvernail J. Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther. 2011 May; 19(2): 120–121. DOI: 10.1179/106698111X12998437860794