Cognitive Muscular Therapy™ for low back pain: a pilot study

Cognitive Muscular Therapy™ for Chronic Low Back Pain. BACKGROUND: Chronic low back pain (cLBP) is a major cause of disability. Research shows that people with cLBP over activate the abdominal and superficial paraspinal muscles and this may indicate an underlying pattern of antagonistic flexor-extensor tone. This study was designed test a new intervention for cLBP, Cognitive Muscular Therapy™ (CMT). CMT integrates biomechanical training to improve postural tone with psychological techniques for pain management. METHODS: The CMT intervention included five components: Understanding back pain, General relaxation, Postural deconstruction, Contextual triggers, and Functional integration and incorporated Electromyography (EMG) biofeedback to visualise erector spinae activity. An observational case series was carried out on fifteen participants with cLBP, who each received seven weekly sessions of CMT. Alongside disability and psychological factors, the activation profile of the erector spinae was measured during walking, using EMG. Five participants provided qualitative feedback through interviews. RESULTS: Significant clinical improvements were observed. The Roland-Morris Disability Questionnaire score reduced by 7 points, the Pain catastrophizing scale reduced by 13.2 points and the Tampa scale of kinesiophobia reduced by 7.8 points. EMG data suggested improved phasic activation of the erector spinae during walking, while interviews showed increased self-efficacy and improved pain management. CONCLUSION: This is the first study of CMT for cLBP, showing promising results in reducing pain and disability. By integrating psychological strategies within a biomechanical framework, CMT offers a novel approach to retraining muscle activity. Future work is now required to explore the proposed mechanism of action and fully quantify the clinical effectiveness of this new intervention. TRIAL REGISTRATION: NCT05611476.