Efficacy of Specific Skilled Motor Versus General Exercise Training on Muscle and Neural Alterations in Recurrent Low Back Pain: Protocol of a Randomized Clinical Trial

BackgroundStructural and functional alterations of the brain and paravertebral muscles have been suggested as underlying mechanisms for the recurrence of non-specific low back pain (LBP). Although exercise therapy is recommended as the treatment of choice, the most effective type and mechanisms underlying its observed effects remain unclear. This study will examine the effects of skilled motor training versus general exercise training on muscle and neural alterations.MethodsIn this double-blind randomized controlled clinical trial, 42 people in remission from recurrent LBP and with a flexion motor control impairment pattern will be randomly allocated to a 13-week exercise program with 18 sessions of skilled motor training or general exercise training. Outcomes related to brain structure (gray and white matter micro- and macro-structure), brain function (resting state functional connectivity), paravertebral muscle structure (cross-sectional area, muscle fat index), paravertebral muscle function (metabolic muscle function), lumbopelvic sensorimotor control, pain sensitivity, pain modulation, psychosocial factors, self-reported pain, LBP-related disability and LBP recurrence will be assessed at baseline, mid-way (after 9 sessions), at completion (after 18 sessions) and at 3-month follow-up. Selected outcomes will be reassessed at 1, 2, 6, and 9-month follow-up.DiscussionFindings may provide novel insights to guide treatment for recurrent LBP. Registered at ClinicalTrials.gov (https://clinicaltrials.gov): NCT05706103.