How specific do we need to be in prescribing our exercises for musculoskeletal disorders?
Motor control exercises lead to greater reductions in pain and disability when compared to strengthening exercises among adults with musculoskeletal injuries in the short-term, but these effects might only be clinically important in non-osteoarthritis conditions.
The Running Clinic and its speakers actively participate in scientific research. Research that changes clinical practices and sometimes changes our beliefs for the benefit of runners! Simon Lafrance, a physiotherapist and doctoral student at Université de Montréal, conducted a large-scale study with a team of international researchers, including Blaise Dubois from The Running Clinic. The original article “Motor control exercises compared to strengthening exercises for upper and lower extremity musculoskeletal disorders: a systematic review with meta-analyses of randomized controlled trials” has been published in the journal of the American Physical Therapy Association.
Simon Lafrance, guest blogger
What are the best rehab exercises: Motor control or strengthening?
Even though 2020 was a difficult year with the COVID-19 situation, it seems that more people have been practicing sports like cycling, cross-country skiing and running, which is great. However, a rapid increase in physical activity volume could lead to pain and injury if the human body is not given enough time to adapt. Physiotherapists often prescribe exercises to people with musculoskeletal injuries. For years, there has been an ongoing debate in the physiotherapy community about which types of exercises are best to treat various injuries such as patellofemoral pain or knee osteoarthritis. This blog article discusses the potential benefits of motor control and strengthening exercises based on the latest research.
What are motor control exercises and how are they different from strengthening exercises?
Motor control exercises focus on the activation of specific muscle and/or specific movement control. They could include stability and proprioception training. On the other hand, strengthening exercises focus on strength deficits and on gradual reloading of the tissues (e.g., tendons). Let’s take the example of a step-down exercise. The motor control approach would target specific activation of the glutes, and movement control while the strengthening approach would add weights, without the specific muscle activation. It is important to mention that motor control exercises often include strengthening components and gradual tissue loading, despite their focus on muscle activation and movement control.
Which ones are better?
Recently, our research group conducted a systematic review with meta-analyses comparing motor control and strengthening exercises for upper and lower extremity injuries. We included 1,244 participants from 21 randomized clinical trials.
Based on moderate quality evidence, we concluded that motor control exercises are superior to strengthening exercises to reduce pain and disability. However, the difference between the two types of exercises was small, likely not clinically important, and only observed in the short term (3 months). Interestingly, the effects of motor control exercises might be different depending on the conditions. We found that non-osteoarthritis conditions such as patellofemoral pain or shoulder pain (rotator cuff tendinopathy or instability) seem to benefit more from motor control than osteoarthritis conditions such as knee osteoarthritis. Again, it is unclear whether the difference is clinically important, even for non-osteoarthritis conditions, in the short term. Comparable results have also been reported in adults with chronic low back pain (Saragiotto et al., 2016).
Regarding running injuries, we already know from previous research that education related to training loads, often called “mechanical stress quantification” or “load management” is a very important component of rehabilitation and might be sufficient on its own (de Olivera Silva et al., 2020; Esculier et al., 2018). However, if additional exercises are used during rehabilitation, our results suggest that motor control exercises might be prioritized over strengthening exercises for adults with patellofemoral pain. On the other hand, it is still unclear which types of exercises should be prioritized for adults with knee osteoarthritis.
de Oliveira Silva, D., Pazzinatto, M. F., Rathleff, M. S., Holden, S., Bell, E., Azevedo, F., & Barton, C. (2020). Patient Education for Patellofemoral Pain: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy, (0), 1-36.
Esculier, J. F., Bouyer, L. J., Dubois, B., Fremont, P., Moore, L., McFadyen, B., & Roy, J. S. (2018). Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial. Br J Sports Med, 52(10), 659-666.
Lafrance S., Ouellet P., Alaoui R., Roy J.S., Lewis J.S, Christiansen D.H., Dubois B., Langevin P., Desmeules F., 22020) Motor control exercises compared to strengthening exercises for upper and lower extremity musculoskeletal disorders: a systematic review with meta-analyses of randomized controlled trials. Physical Therapy. Accepted for publication
Saragiotto, B. T., Maher, C. G., Yamato, T. P., Costa, L. O., Costa, L. C. M., Ostelo, R. W., & Macedo, L. G. (2016). Motor control exercise for chronic non‐specific low‐back pain. Cochrane Database of Systematic Reviews, (1).