A new approach to chronic lower back pain has reduced pain and disability in a research study.
Some of those who took part in the trial of Cognitive Muscular Therapy (CMT) said it was life changing.
The therapy combines psychological strategies for managing pain with biomechanical training to reduce muscle overactivity. It was developed in Salford through a joint research programme at the University of Salford and Northern Care Alliance NHS Foundation Trust. The work is led by Professor Stephen Preece, Director of the Centre for Human Movement and Rehabilitation Research at the university and Nathan Brookes, Lead Physiotherapist and Honorary Research Fellow.
Successful trials
The therapy was originally designed for painful knee osteoarthritis and was adapted for lower back pain after successful trials with knee patients.
CMT has five components: understanding pain, general relaxation, postural deconstruction, contextual triggers and functional integration. The key differences between this approach and other back pain treatment is in the postural deconstruction component which aims to unpick patterns of interconnected muscle tension and in the contextual triggers component, which educates patients on how anticipating pain can trigger unwanted muscular behaviour. In the final component, functional integration, patients work through a range of activities, such as going up and down stairs, lifting a heavy object or putting on socks – applying what they have learned in order to perform the task without pain.
In the pilot study, 15 participants had seven weekly hour-long sessions of CMT with a physiotherapist. They also had access to an online platform with animated videos and instruction sheets.
Positive feedback
Mr Brookes said: “In this pilot study we saw large reductions in disability associated with chronic lower back pain and very positive feedback from patients. The therapy guides patients through an individualised programme in which they learn to improve muscle coordination and to change the way they think about and react to pain.
“Although this was a small-scale study, the idea of using psychological techniques with a biomechanical framework which addresses postural muscle activity is very promising. In future we hope to be able to carry out a larger scale study in low back pain. We are now carrying out an NIHR-funded randomised controlled trial of CMT in knee osteoarthritis with 250 participants.”
The work has been published in the journal Musculoskeletal Science and Practice – Stephen Preece, Jason Smith, Nathan Brookes, Sally Gates, Daniela Ghio: Cognitive Muscular Therapy™ for low back pain: a pilot study.