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Lumbopelvic Neuromuscular Training and Injury Rehabilitation: A Systematic Review

Briggs, Matthew S. DPT*,†,‡; Givens, Deborah L. PhD, DPT§; Best, Thomas M. MD, PhD‡,¶; Chaudhari, Ajit M. PhD*,‡,‖,**

Clinical Journal of Sport Medicine: May 2013 - Volume 23 - Issue 3 - p 160–171
doi: 10.1097/JSM.0b013e318280aabb
Critical Review

Objective: The aim of this systematic review was to assess the evidence for lumbopelvic neuromuscular training (LNMT) in individuals after musculoskeletal (MSK) injury.

Data Sources: A literature search of PubMed and EMBASE databases was performed for English studies from January 1990 to March 2012. Search terms including and related to trunk, core, stability, injury, and LNMT were used.

Study Selection: All studies directly involving LNMT for MSK injuries were reviewed by 2 authors. These articles were assessed based on the inclusion criteria and if appropriate selected for further analysis. Expert opinion, review articles, and articles involving non-MSK injuries were excluded. Four authors then scored the selected articles for methodological quality. A total of 2312 articles were initially identified. Twenty-nine articles met the inclusion criteria for review and were divided into categories of lower extremity (LE), lumbar, and upper extremity (UE). No trials involving the UE met the inclusion criteria.

Data Extraction: Data including subject demographics (age, height, weight, gender, etc), injury type, intervention type, and outcome measurements were extracted from the relevant articles. A variety of baseline and follow-up scores were extracted including pain levels, patient satisfaction, disability questionnaires, and other functional outcomes.

Data Synthesis: Two out of 3 LE randomized controlled trials (RCTs) and 9/26 lumbar RCTs were rated with high methodological quality based on the scoring system described by van Tulder et al. The average quality score for the LE RCTs was 6.3 (range = 4–9) and for the lumbar RCTs was 5.1 (range = 2–9). The evidence for the effectiveness of the 3 LE studies was rated as conflicting, whereas 24 lumbar studies demonstrated moderate-to-strong evidence. Unfortunately, heterogeneity of populations, interventions, and outcomes precluded a quantitative meta-analysis and specific clinical recommendations.

Conclusions: High-quality evidence is lacking to make specific clinical recommendations for or against the use of LNMT in the rehabilitation of individuals after MSK injury. Based on this review, future research should focus on well-defined, homogeneous populations, interventions specifically addressing neuromuscular activation of the lumbopelvic musculature, patient-specific clinical outcomes, measures of motor control, biomechanics, and return to specific activities.

*Health and Rehabilitation Sciences PhD Program, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio

Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio

Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio

§Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska

Department of Family Medicine and

Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio

**Perfect Practice, Inc, Canal Winchester, Ohio.

Corresponding Author: Matthew S. Briggs, DPT, School of Health and Rehabilitation Sciences, OSU Sports Medicine, 2050 Kenny Rd, Columbus, OH 43221 (matt.briggs@osumc.edu).

The authors have no financial support to disclose.

M.S. Briggs is employed by OSU Sports Medicine; D.L. Givens has none to declare; T.M. Best is employed by The OSU College of Medicine and has an unrelated NIH grant; A.M. Chaudhari is a volunteer member of the Scientific Advisory Board of TRX Training, LLC.

Received November 09, 2011

Accepted November 29, 2012

© 2013 by Lippincott Williams & Wilkins