The Effectiveness of Home-Based Exercises Versus Supervised Core Stability Exercises on Pain and Functional Disability in Controlled Hypertensive Patients with Chronic Mechanical Non-specific Low Back Pain: A Randomized Controlled Trial

Background: Low back pain (LBP) is one of the main causes that affect mechanical function in human bodies worldwide, 90% of the cases with non-specific LBP. Different options are available for the management of non-specific LBP. While Maitland mobilization and core stability exercises are usually utilized in clinical practice for managing Chronic Nonspecific Low Back Pain, there is now a lack of research examining their comparative effectiveness. Objective: The objective of this study is to assess and compare the efficiency of Maitland mobilization and core stability exercise as treatment modalities for adults suffering from chronic non-specific low back pain. Methods: A total of 36 Non-specific low back pain (NSLBP) patients with ages 18 to 45 years were inducted and given their Informed consent. Subjects were allocated into two groups through simple random sampling. Group A (N=18) received central posterior-anterior vertebral mobilization while group B (N=18) received core stability exercises. Pain and functional disability were assessed using the Visual Analogue scale (VAS) and Oswestry Disability Index (ODI) respectively. Pre & post-treatment scores were documented and compared to achieve the aim of this study. Results: T-test indicated that the results pre- and post-treatment were showed a statistically positive significant difference by applying Maitland mobilization technique with non-specific LBP to improve functional disability (ODI) and reduce pain intensity (VAS) with (p = 0.001), respectively. On the other hand, results for the application of core stability exercises in management NSLBP also showed positive signs in reducing VAS and improving ODI with (p= 0.001) respectively. The findings suggest that there was no statistically significant difference between the Maitland mobilization technique and core stability exercises in treating NSLBP for pain reduction with (p = 0.312) and improvement in ODI with (p = 0.055). For applying Maitland mobilization in NSLBP, Pearson correlation results indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.034) and pain severity (VAS) with (p = 0.808). For core stability exercises, the results of Pearson's correlation indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.959) and pain intensity (VAS) with (p = 0.987). By gender, the results showed there were no statistically significant role for Maitland mobilization and core stability exercises in improving function and reducing pain among patients with chronic non-specific low back pain. Conclusion: Both core stability exercises and Maitland method have demonstrated effectiveness in reducing pain and improving functional disability in patients with chronic nonspecific low back pain.

Background & objective: Chronic non-specific low back pain (CNSLBP) is a common, disabling condition that affects millions worldwide, often causing functional limitations and a reduced quality of life. This study examines the combined effects of 8 weeks of core stabilization exercises (CSE) and vitamin D supplementation on pain reduction and functional improvement in adults with CNSLBP, and whether combining CSE with vitamin D supplementation results in greater improvements in pain reduction and functional limitations than CSE alone. Methodology: A randomized controlled trial was conducted on 62 adults aged 25-45 years, diagnosed with CNSLBP. Participants were randomly assigned to two groups: the experimental group received 8 weeks of CSE and vitamin D supplementation, while the control group received only CSE. Pain intensity was measured using the Visual Analog Scale (VAS), and functional limitations were assessed with the Oswestry Disability Index (ODI). Blood tests for 25-Hydroxyvitamin D levels were conducted before and after the intervention. Results: Significant improvements were observed in the experimental group. VAS pain scores decreased (P = 0.000), ODI scores showed functional improvement (P = 0.002), and vitamin D levels increased significantly (P = 0.000). The combined intervention was more effective than exercises alone. Conclusion: The combination of core stabilization exercises and vitamin D supplementation significantly reduced pain and improved functionality in chronic non-specific low back pain patients. Abbreviations: CNSLBP: Chronic non-specific low back pain, CSE: core stabilization exercises, NCID: Normalizing, Comparison, Interpretation, and Discussion technique, ODI: Oswestry Disability Index, VAS: Visual Analog Scale Keywords: chronic low back pain; core stabilization exercises; vitamin D supplementation; pain reduction; functional improvement; Oswestry Disability Index; visual analog scale Citation: Mukhtar T, Hafeez M, Subhani FUR, Rehman H, Ishfaq MU. Effects of 8-week core stabilization exercise with vitamin D supplement on pain and functional limitation in adults with chronic non-specific low back pain. Anaesth. pain intensive care 2025;29(7):679-684. DOI: 10.35975/apic.v29i7.2946 Received: May 09, 2025; Revised: October 26, 2024; Accepted: January 01, 2025

BackgroundDue to delayed activation of the deep trunk muscles, patients with chronic non-specific low back pain use different adjustment strategies to maintain postural control. Patients with chronic non-specific low back pain maintain a quite standing posture during pain episode and challenging activities by using signals from other joints, mainly the ankle joint. Since proprioceptive signals from the ankle joint reduce postural control variability in patients with chronic non-specific low back pain, this study explored whether ankle stability exercises added to traditional physical therapy exercises would improve the intensity of pain, functional disabilities and lumbar flexion range of motion in patients with chronic non-specific low back pain.MethodsSixty patients with chronic non-specific low back pain participated in the current study. Patients were randomly assigned into two groups: group A and group B. Patients in group A received traditional physical therapy exercises for low back pain. Patients in group B received the same traditional physical therapy exercises as patients in group A, plus ankle stability exercises. The intensity of pain, functional disability, and lumbar flexion range of motion were assessed twice before and after a 6-week period during which each group received their interventions.ResultsMixed design MANOVA revealed a significant decrease in visual analog scale and Oswestry Disability Index in group B compared to group A post treatment (p < 0.05). Moreover, there was a significant increase in the lumbar flexion range of motion in group B compared with group A post treatment (p < 0.05).ConclusionThe findings of this study revealed that adding ankle stability exercises to the traditional physical therapy exercises significantly improved pain, Oswestry Disability Index, and lumbar flexion range of motion in patients with chronic non-specific low back pain. Thus, ankle strengthening and proprioceptive exercises may be beneficial in the management of chronic non-specific low back pain.

Study Design: Randomized controlled single blinded clinical trial. Objective: To identify prevalence of thoraco-lumbar dysfunction (TLD) and analyze the role of latissimus dorsi and Lower Trapezius in it. Summary of background data: 30% of chronic mechanical back pains are due to TLD. The thoracolumbar and Lower Trapezius muscles control the dynamic and postural stability of the lower spine. Though core stabilization exercises are widely recommended for low back pain, but no reports are available for exercises specific to thoraco-lumbar dysfunction. Methods: 30 subjects in age group of 25 to 40 years with non traumatic, chronic mechanical low back pain were identified for study and randomly divided into two groups. Group-A (n=15): core stabilization exercises with Latissimus dorsi and Group-B (n=15): latissimus dorsi strengthening, core stabilization and Lower trapezius exercises. Primary outcome measure was pain intensity (VAS score). Secondary outcome measures were general health (SF-36) and back pain disability (Aberdeen back pain disability score). Outcome measurement scores were compared using paired t-test. Results: Core muscles, latissimus dorsi along with lower trapezius strengthening alone is more effective in relieving pain and improving life than strengthening of core muscles and latissimus dorsi alone. Conclusion: Identification of TLD as a cause of low back pain is recommended in all non-traumatic, chronic, mechanical low back pains. Strengthening of Latissimus dorsi along with Lower Trapezius relieves thoraco-lumbar related back pain.

BackgroundThe Feldenkrais Method and Dynamic Neuromuscular Stabilization (DNS) exercises have each demonstrated benefits for managing chronic low back pain (CLBP). However, limited research has explored their combined efficacy, particularly in older women with nonspecific CLBP. This study aimed to assess the clinical effects of combining these interventions.MethodsThis randomized controlled trial (RCT) was conducted over eight weeks (July 17 to September 11, 2024) at the Sports Sciences Laboratory of Bu-Ali Sina University, Hamedan, Iran. Thirty elderly women, aged 60–80 years, with nonspecific CLBP were randomly assigned using a computer-generated sequence to either a DNS group (n=15) or a combined DNS exercises and Feldenkrais Method (DNSFME) group (n=15). The DNS protocol consist of stabilization exercises targeting core control, while the Feldenkrais Method involved awareness and movement re-education sessions. Outcome measures were pain intensity, measured by the Visual Analog Scale (VAS), lumbar flexion and extension range of motion (ROM), assessed via Schober’s test, and kinesiophobia evaluated using the Tampa Scale for Kinesiophobia (TSK). Assessments were conducted at baseline and post-intervention. Between-group differences were analyzed using analysis of covariance (ANCOVA) adjusted for baseline values, and paired t-tests were used to assess within-group changes (P≤0.05).ResultsParticipants were older women (mean age 65.44 ± 3.99 years) with no significant baseline differences in demographic or clinical characteristics between groups. The DNSFME group showed significantly greater improvements compared to the DNS group in pain intensity (p = 0.010, partial η² = 0.255), kinesiophobia (p < 0.001, partial η² = 0.493), lumbar flexion ROM (p = 0.007, partial η² = 0.273), and lumbar extension ROM (p < 0.001, partial η² = 0.429). Within-group improvements were significant for both groups. For the DNS group: pain (p < 0.001, 95% CI: 3.15 to 4.57), kinesiophobia (p < 0.001, 95% CI: 10.25 to17.18), lumbar flexion ROM (p < 0.001, 95% CI: –1.57 to –1.09), and lumbar extension ROM (p < 0.001, 95% CI: –0.81 to–0.50). For the DNSFME group: pain (p < 0.001, 95% CI: 4.27 to 5.72), kinesiophobia (p < 0.001, 95% CI: 17.57 to 24.16), lumbar flexion ROM (p < 0.001, 95% CI: -2.16 to -1.59), and lumbar extension ROM (p < 0.001, 95% CI:-1.12 to -0.84).ConclusionBoth interventions effectively alleviated pain and fear of movement while enhancing lumbar range of motion in older women with chronic low back pain. The combined intervention, integrating the Feldenkrais Method with Dynamic Neuromuscular Stabilization exercises, yielded superior clinical outcomes, supporting its incorporation into rehabilitation programs to improve functional independence and quality of life

Effects of Adding Respiratory Exercises to Core Stability Training in Office Workers With Chronic Low Back Pain: A Randomized Controlled Trial.

Introduction: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders and it is documented that &gt;90% of the cases have no defined cause for pain, called nonspecific low back pain (NSLBP). Alteration in the joint position, abnormal posture, and impaired muscle recruitment may result in recurrent CLBP. Lumbar lordosis (LL) provides strength against the compressive forces of gravity and it also protects the posterior spinal ligament and acts as a shock absorber for vertical forces. Increased LL is considered as a reason for radiculopathy, facet pain, and postural pain. Spinal posture and pelvic position were analyzed and documented as altered in CLBP patients. Anatomically, the anterior and posterior tilt of the back and pelvis by the force of different muscles can alter the spinal curvature. Posterior pelvic tilt in a standing position can decrease the LL. The pelvic inclination is related to the lumbar curve, and both are related to the performance and length of the back and abdominal muscles. Therefore, in this study, we aimed to evaluate the effect of core stabilization exercise on pain intensity, functional disability, LL, and pelvic inclination in NSLBP. Methodology: A total of 63 patients aged between 20 and 60 years who met the selection criteria were included. All participants gave their written consent to participate in this study. Demographic data such as age, weight, height, and duration of the back pain were documented. Patients were asked to report their pain using the Visual Analogue Scale (VAS) and Disability in Roland Morris Disability Questionnaire (RMDQ). Exclusion criteria were participants with musculoskeletal disorders (osteoarthritis and rheumatoid arthritis) and a history of previous fractures and systemic diseases. DIERS Formetric 4D spine and posture analyzer were used to assess spinal alignment using the light-optical scanning method on the back of patient in standing position. Angle of LL: the angle formed by the apex of LL and the T12 and L5 spinous processes. Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. Core stabilization exercises were given for 30 min, five days a week, for 12 sessions. Pre- and posttest values were documented and analyzed. Result: In this experimental study, we used Pearson’s correlation coefficient to find the correlation between LL and pelvic inclination angle and found a strong positive correlation (r = 0.76; P = 0.001). The study showed that core stabilization exercise for 12 weeks’ duration had statistically significant reduction in the pain intensity (p &lt; 0.01), functional disability (p &lt; 0.002), LL (p &lt; 0.05), and pelvic inclination angle (p &lt; 0.05) among patients with chronic NSLBP. Conclusion: From this research, we conclude that core stabilization exercises decrease the pain intensity, functional disability, LL, and pelvic inclination angle in patients with chronic NSLBP. Thus, evaluation of the lumbar curvature and pelvic inclination, and designing the appropriate exercise is recommended in the management of NSLBP.

Background of the study: Chronic non-specific low back pain causes significant disability worldwide. This study compared the effectiveness of core stabilization exercises versus routine exercise therapy in managing pain and functional disability. Methodology: A randomized controlled trial included 34 patients with chronic non-specific low back pain at Mayo Hospital, Lahore. Participants were randomly allocated to Group A (core stabilization exercises, n=17) or Group B (routine exercise therapy, n=17). Both groups received conventional hot pack therapy. Treatment was administered three times weekly for four weeks. Outcomes were measured using Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) for functional disability. Results: Both groups showed significant improvements (p&lt;0.001). Group A demonstrated superior outcomes with post-treatment VAS scores of 1.24±0.66 versus Group B's 4.18±0.81 (mean difference 2.94, p&lt;0.001). ODI scores were 11.65±2.85 in Group A versus 21.65±2.96 in Group B (mean difference 10.00, p&lt;0.001). Conclusion: Core stabilization exercises were significantly more effective than routine exercise therapy in reducing pain and improving functional disability in chronic non-specific low back pain patients. Keywords: Pain, Low back, Chronic, Stabilization, Nonspecific, Exercise, Core

Purpose. The study aimed to compare the effects of combining thoracic lymphatic pump technique (TLPT) and exercises versus exercises alone on pain intensity, lumbar spine mobility, and functional disability in patients with chronic mechanical low back pain (CMLBP), the second most common orthopedic condition. Methods. Fifty-two CMLBP patients, whose mean age was 25 years, were classified into 2 equal groups randomly. Group (A) received exercises (hamstring stretching, lower back stretching, abdominal strengthening, and trunk extensor strengthening). Group (B) received the same exercises plus the thoracic lymphatic pump technique. Both groups received 12 sessions on nonconsecutive days. All patients were evaluated using the Visual Analogue Scale (VAS) for pain intensity, the Modified-Modified Schober test (MMST) for lumbar mobility (flexion-extension), and the Oswestry Disability Index (ODI) for functional disability. Assessments were performed prior to and after the end of treatment. For data analysis, the unpaired t-test, chi-squared test, and mixed MANOVA test were used. Results. The study found significant improvements in pain intensity, lumbar mobility (flexion, extension), and functional disability in both groups (P &lt; 0.05), with no significant difference in pain intensity or lumbar spine mobility. However, group (B) had a statistically significant advantage in functional disability (P &lt; 0.05). Conclusion. The addition of the thoracic lymphatic pump technique to therapeutic exercises significantly enhances pain, lumbar spine mobility, and functional abilities in CMLBP patients than therapeutic exercises alone.

Background: Low back pain (LBP) affects nearly 80% of adults worldwide and is a major cause of disability, reduced job satisfaction, and economic burden. Mechanical low back pain, often associated with degenerative changes or disc prolapse, requires effective therapeutic strategies. Conventional physiotherapy and McKenzie exercises are widely used, while yoga therapy has recently emerged as a promising complementary approach focusing on both physical and psychological outcomes. Objective: To compare the effectiveness of yoga therapy practices, McKenzie exercises, and core stability exercises on disability and job satisfaction levels in subjects with mechanical low back pain. Methods: Ninety male participants with chronic mechanical low back pain were randomized into three groups: Group A (yoga therapy), Group B (McKenzie and core stability exercises), and Group C (control). The intervention lasted several weeks with structured sessions. Disability was assessed using the Oswestry Disability Index (ODI), while job satisfaction was measured using the Job Satisfaction Scale (Bubey, Uppal &amp; Verma, 1989). Data were analyzed using ANOVA and Scheffé’s post hoc tests. Results: At baseline, no significant differences were observed among groups (F = 1.47, p &gt; 0.05). Post-intervention, significant differences emerged in both disability (F = 196.69, p &lt; 0.05) and job satisfaction (F = 9.44, p &lt; 0.05). Adjusted post-test means indicated that yoga therapy (Group A: 41.02) showed greater improvement in reducing disability compared to McKenzie/core stability exercises (Group B: 46.23) and control (Group C: 76.22). Similarly, job satisfaction improved significantly in the yoga group (43.83) and McKenzie group (52.39) compared to the control group (68.05), with yoga therapy demonstrating superior effectiveness. Conclusion: Both yoga therapy and McKenzie exercises are effective in improving disability and job satisfaction among individuals with mechanical low back pain. However, yoga therapy produced greater overall benefits, suggesting its potential as a safe, holistic, and cost-effective intervention. Further large-scale studies are recommended to confirm these findings and to explore associated physiological and psychosocial mechanisms.

Background: Mechanical low back pain refers to back pain that starts intrinsically from the spine, intervertebral discs, or surrounding soft tissues. This includes lumbosacral muscle strain, disc herniation, lumbar spondylosis, spondylolisthesis, spondylolysis, etc. and this accounts for 97% of cases. It is characterized by increased pain with motion and decreased pain with rest. Repetitive trauma and overuse are common causative factors of chronic mechanical low back pain. The suboccipital muscle inhibition technique (SMIT) has been reported to be beneficial in reducing pain, increasing hamstring extensibility and reducing functional disability in chronic low back pain patients. So, the aim was to compare the effectiveness of suboccipital muscle inhibition technique along with conventional approach and conventional approach alone on pain, physical function and range of motion in patients with chronic mechanical low back pain. Method: Total 46 patients were included and divided into two groups (23 in each group). Experimental group was treated with suboccipital muscle inhibition along with conventional approach and Control group was treated with conventional approach alone for 5 days a week for 4 weeks. Inter-group analysis by Mann Whitney U-test and Unpaired t-test showed statistically significant difference in pain, physical function and lumbar flexion range of motion (P value ≤ 0.001). Conclusion: Suboccipital muscle inhibition along with conventional approach was found to be more predominant in improving pain, physical functional and lumbar range of motion (flexion) in chronic mechanical low back pain than conventional approach. Also, suboccipital muscle inhibition and conventional approach were equally effective in improving lumbar range of motion (extension).

Chronic low-back pain (CLBP) affects most people at some point in their lives. The aim of this study was to evaluate the efficiency of 3 methods which are popular and known as non-invasive way in rehabilitation of CLBP. 60 men in age of group 25-45 with CLBP were randomly divided into four groups (Core Stabilization, massage, reflexology and control) and instructed to perform Core Stabilization exercise for 8 week, massage and foot reflexology for 10 days. Patient were assessed by McGill pain questioner (MPQ) and Oswestry Disability Index (ODI), based on pain feeling and the ability to do routine activity of life before starting the study (Pre-test Data) and at the end of study procedure (post-test Data). Results were analyzed by Paired T test, one way ANOVA and Tukey post hock. There was no significantly difference in Pre-treatment session between the 4 groups. MPQ and ODI were significantly lower in post-treatment sessions as compared to pre-treatment values in experimental groups (Core Stabilization, massage and foot reflexology). Significant decrease in MPQ and ODI values were found in all experimental groups, but no difference in efficacy were found between these groups. However the result that reach from comparison between each of experimental group and control group, showed that the experimental groups were significantly effective. Core Stabilization exercise, massage and foot reflexology in men with mechanical chronic low-back pain reduce pain and improved disability. Researchers were not found any differences between these 3 methods as compare with each other. Due to the results, Authors suggest that may be using massage therapy or foot reflexology, for patients with CLBP, is better and more effective if therapists are looking for treating in shortest possible duration.

Background and Aim: Balance disorders are among common complications of chronic low back pain (LBP). Since the tissue and echo­genicity of thoracolumbar fascia changes in chro­nic LBP, the independent motion of fascia layers would negatively alter, and it may affect the con­trol of spine movements. It has been shown that myofascial release (MFR) improves the function of transversus abdominis as a core muscle in LBP. So, MFR may affect the balance and pos­tural control in these patients. The aim of this study was to evaluate the immediate effects of MFR and core stability (CS) exercises on dyna­mic balance and pain in women with chronic non-specific LBP. Methods: In this pilot study, with a pretest-posttest design, 10 females aged 30 ± 9.04 parti­cipated. The participants received one session of MFR on thoracolumbar fascia and CS exercises. The outcome measures were dynamic balance by Y balance test (YBT) and pain with visual ana­logue scale (VAS), which were assessed before and immediately after the intervention. Results: Dynamic balance improved signifi­cantly (p &lt; 0.02) after intervention. The VAS as an indicator of pain intensity showed significant improvement (p = 0.005). Conclusion: The application of MFR plus CS exercises for a single session is effective in improving dynamic balance and pain in women with chronic non-specific LBP. Keywords: Dynamic balance; core stability; low back pain; myofascial release

BackgroundMechanical low back pain (MLBP) is a major cause of illness and disability, especially in people of working age. People with chronic low back pain often experience anger, fear, anxiety, decrease in physical ability, and inadequacy of role fulfillment.ObjectiveThis study aimed to compare the efficacy of extension exercise program versus muscle energy technique in treating patients with chronic mechanical low back pain.Subjects and methodsForty patients complaining of chronic mechanical low back pain participated in the study. Patients were randomly allocated into two equal groups: group A which received spinal extension exercise program and group B which received muscle energy technique. Treatment sessions were given three times per week for four successive weeks. Patients were assessed before and after treatment using visual analogue scale (VAS), Oswestry Disability Index (ODI), and digital goniometer to assess pain intensity, functional disability, and range of motion (ROM) of lumbar spine respectively.ResultsThere was significant decrease in the scores of pain and functional disability in both groups post-treatment especially in group B. There was significant increase in lumbar range of motion in both groups post-treatment, especially in group A.ConclusionExtension exercise program had better effect on improving lumbar range of motion, whereas muscle energy technique was better in decreasing pain and functional disability in patients with chronic mechanical low back pain.

A randomized controlled trial. To investigate feed-forward activation or timing of abdominal muscle activation in response to rapid shoulder flexion after 8 weeks with core stability exercises, sling exercises, or general exercises in chronic nonspecific low back pain (LBP) patients. Delayed onset in abdominal muscles has been associated with LBP. Low load exercises to volitionally activate the transversus abdominis were introduced to restore trunk muscle activation deficits. More forceful co-contraction exercises have been advocated by others. This study explored whether abdominal muscle onset changed after low-load core stability exercises, high-load sling exercises, or general exercises. Subjects (N = 109) with chronic nonspecific LBP of at least 3 months' duration were randomly assigned to 8 weekly treatments with low-load core stability exercises, high-load stabilizing exercises in slings, or general exercises in groups. Primary outcome was onset recorded bilaterally by m-mode ultrasound imaging in the deep abdominal muscles in response to rapid shoulder flexion. No or small changes were found in onset after treatment. Baseline adjusted between group differences showed a 15 ms (95% confidence interval [CI], 1-28; P = 0.03) and a 19 ms (95% CI, 5-33; P < 0.01) improvement with sling relative to core stability and general exercises, respectively, but on 1 side only. There was no association between changes in pain and onset over the intervention period (R ≤ 0.02). Abdominal muscle onset was largely unaffected by 8 weeks of exercises in chronic LBP patients. There was no association between change in onset and LBP. Large individual variations in activation pattern of the deep abdominal muscles may justify exploration of differential effects in subgroups of LBP.