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Background People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs). Objective To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs. Design Prospectively registered randomized controlled trial with a blinded assessor. Setting Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics. Patients Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP. Intervention Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment–based treatment, for more than 6 weekly 1-hour sessions plus home exercises. Measurements Pre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. Results Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task. Limitations Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure. Conclusions Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment–based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).

Objective: To determine whether low back pain (LBP) associates with altered postural stabilization and concomitant changes in cerebrocortical motor physiology. Methods: Ten participants with LBP and 10 participants without LBP performed self-initiated, voluntary arm raises. Electromyographic onset latencies of the bilateral internal oblique and erector spinae muscles were analyzed relative to that of the deltoid muscle as measures of anticipatory postural adjustments (APAs). Amplitudes of alpha event-related desynchronization (ERD) and of Bereitschaftspotentials (BP) were calculated from scalp electroencephalography as measures of cerebrocortical motor physiology. Results: The APA was first evident in the trunk muscles contralateral to the arm raise for both groups. Significant alpha ERD was evident bilaterally at the central and parietal electrodes for participants with LBP but only at the electrodes contralateral and midline to the arm raise for those without LBP. The BP amplitudes negatively correlated with APA onset latencies for participants with (but not for those without) LBP. Conclusions: Cerebrocortical activity becomes altered prior to arm movements requiring APAs for individuals with chronic LBP. Significance: These results support a theoretical model that altered central motor neurophysiology associates with LBP, thereby implying that rehabilitation strategies should address these neuromotor impairments.