Lumbopelvic neuromuscular training and injury rehabilitation: a systematic 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.