Chronic Non-specific Low Back Pain Research Articles

Temporal summation does not predict the acupuncture response in patients with chronic non-specific low back pain.

Previously, we had observed that immediate pain reduction after one acupuncture treatment was associated with high temporal summation of pain (TS) at a pain free control site and younger age in a mixed population of chronic pain patients. The aim of the present study was to verify these results in chronic non-specific low back pain (LBP) and to collect pilot data on the association between TS and the response to an acupuncture series. TS at a pain free control site (back of dominant hand) and at the pain site was quantified by the pin-prick induced wind-up ratio (WUR) in 60 LBP patients aged 50 years or younger. Response to one acupuncture treatment was assessed by change in pain intensity and pressure pain threshold (PPT) at the pain site. The primary hypothesis was that a high TS (WUR > 2.5) would be associated with a clinically relevant reduction in pain intensity of at least 30%. In study part two, 26 patients received nine additional treatments. Response to the acupuncture series was assessed by the pain intensity during the last week, the PPT and the Hannover functional ability questionnaire (FFbH-R). An immediate reduction in pain intensity of at least 30% was frequent irrespective of TS at the control site (low vs. high TS 58% vs. 72%, p = 0.266). High TS at the pain site was also not significantly associated with a clinically relevant immediate reduction in pain intensity (low vs. high TS 46% vs. 73%, p = 0.064). The PPT was not changed after one acupuncture treatment. Study part two did not reveal a consistent association between TS at the control site and any of the outcome measures but also a trend toward a higher chance for a clinically relevant response along with low TS at the pain site. Our results do not suggest an important role of TS for predicting a clinically important acupuncture effect or the response to a series of 10 acupuncture treatments in patients with chronic non-specific LBP. Overall high response rates imply that acupuncture is a suitable treatment option for LBP patients irrespective of their TS.

Kinematic Analysis of Pelvic and Lower Limb Joints during Stand-to-sit Movement in Individuals with Chronic Low Back Pain: A cross-sectional study.

It is crucial to investigate the daily functions commonly utilized by individuals with low back pain (LBP) due to their implications for recurrence and chronicity. Stand-to-sit (StTS) task is one of the more repetitive functions in human daily life. This study aims to evaluate pelvic and lower limb joint kinematics during the StTS task in individuals with Non-Specific Chronic Low Back Pain (NSCLBP) compared to a healthy control group. Pelvic and lower limb joint kinematic data in all three planes were recorded from 20 individuals with LBP and 20 healthy individuals using a Qualisys motion capture system during the StTS task. A Functional Data Analysis statistical approach was employed to compare the kinematic data between the two groups. In the initial phase of the movement, we observed a greater anterior pelvic tilt (P=0.028) and an altered pelvic frontal plane motion pattern (P=0.029) in the LBP compared to the healthy group. The only significant differences between the lower limb joint kinematics of the two groups were a less hip external rotation position (P=0.025) and a more knee adduction pattern (P=0.002) on the right side in the LBP subjects compared to the healthy group. Considering a few differences noted between the two groups across various joints and planes evaluated, it appears that the kinematic pattern of the lower limbs does not significantly differ between the NSCLBP and healthy groups during the StTS task in most comparisons. However, distinct kinematic patterns have been observed in the pelvic region, particularly in the sagittal and frontal planes, between the two groups.

Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis

Abstract Babiloni-Lopez, C, Fritz, N, Ramirez-Campillo, R, and Colado, JC. Water-based exercise in patients with nonspecific chronic low-back pain: a systematic review with meta-analysis. J Strength Cond Res 38(1): 206–219, 2024—This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP (≥12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I 2 statistic), with values of <25%, 25–75%, and >75% representing low, moderate, and high levels, respectively. Alpha was set at p < 0.05. In conclusion, 15 studies (n = 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES = −3.61; p < 0.001) and a similar reduction was noted when compared with land-based trained group (ES = −0.14; p = 0.359). Greater decrease in disability (ES = 2.15; p < 0.001) and greater increase in sit-and-reach (i.e., flexibility; ES = −2.44; p < 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at ≤8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment.

Comparative Effects of Dynamic Neuromuscular Stabilization Exercises on Lumbar Proprioception, Movement Control and Functional Activity Limitation in Movement Control Impairment Subgroup of Non-Specific Chronic Low Back Pain: RCT Interim Analysis

Comparative Effects of Dynamic Neuromuscular Stabilization Exercises on Lumbar Proprioception, Movement Control and Functional Activity Limitation in Movement Control Impairment Subgroup of Non-Specific Chronic Low Back Pain: RCT Interim Analysis

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain

Targeted vibratory therapy as a treatment for proprioceptive dysfunction: Clinical trial in older patients with chronic low back pain.

Proprioceptive function declines with age, leading to falls, pain, and difficulties in performing activities of daily living among older adults. Although individuals with low back pain (LBP) exhibit decreased lumbosacral proprioception in various postures, the mechanism by which reduced proprioceptive function causes LBP remains uncertain. Vibratory stimulation may enhance proprioceptive function; however, its efficacy in treating LBP has not been investigated. Thus, we investigated the feasibility of improving proprioceptive function and its effect on alleviating chronic LBP in older patients through targeted vibratory therapy (TVT) administration. This single arm designed trial included older patients aged >65 years with non-specific chronic LBP. TVT involved applying vibratory stimulation, matching the frequency of dysfunctional receptors, for 1 min daily over 14 days to activate proprioceptors; patients performed TVT three times daily at home. In cases of reduced proprioceptive function at multiple sites, TVT was aimed at the lowest frequency band value. LBP and proprioceptive function were evaluated at 2 weeks after TVT and at 2 weeks after the end of TVT in patients with declined proprioception in the trunk or lower extremities. Overall, 56 patients with chronic LBP were enrolled; 32 patients were recruited for treatment based on a proprioceptive dysfunction diagnosis and 24 patients were recruited with a normal diagnosis with no significant differences observed between the two sets of patients in sarcopenia-related factors and clinical proprioception-related characteristics. No patient had any adverse events. Two weeks after TVT, the numerical pain rating scale score improved to <3 points in 78.1% of patients, with 73.1% of patients achieving a score of ≤ 3 points. Proprioceptive function improved in 81.3% of cases, and engagement in activities of daily living improved significantly. TVT demonstrated efficacy in improving proprioception and alleviating LBP in older patients with impaired proprioceptive function without affecting non-targeted proprioceptors.

Ab. No. 16 Exercises and Pain Education Improves Clinical Outcomes in a Subgroup of Patients With Chronic Low Back Pain Positive for Central Sensitization

Introduction: Exercises have been found to decrease pain and the overall sensitivity of the central nervous system through the activation of exercise-induced endogenous analgesia and spinal inhibitory mechanisms. Despite the recommendations of many reviews that exercise programs reduce pain and disability in persons with chronic pain, the overall confidence is considered ‘critically low’. This study aimed to evaluate the effect of different exercises (aerobic, motor control, and superficial strengthening) relative to patient education on pain sensitivity and clinical outcomes in patients with chronic non-specific low back pain (NSCLBP) positive for central sensitization. Methods: The trial is a randomized controlled study with concealed allocation and blinding of assessors with four experimental groups (n=172) and one healthy control group (n=43). Participants were engaged in moderately intense treadmill walking sessions, activities for trunk stabilization, and strengthening exercises for the trunk and abdominal muscles along with patient education as per their group allocation. The control group received only patient education. The primary outcome was the cold pressor test. The secondary outcomes were pain intensity, disability, letter-number sequencing subtest, Stroop neurophysiological test, quality of life, and isometric muscle strength of the spine and hip muscles. Measures were taken at baseline and 12 and 24 weeks. Result: The results showed that patients with CLBP exhibit impaired CPM relative to healthy volunteers even after the intervention period. The overall results of the study showed improvement with time, and there was no difference between the groups in improving outcomes (p &gt; 0.05). There was a small effect size in favor of groups that received exercise and patient education (&lt;0.15) over the control group. Conclusion: Considering the comparable effects on clinical outcomes in patients with NSCLBP, this population may be encouraged to undertake exercises of moderate intensity of their preference.

Disease-modifying therapy and adjuvant support in complex therapy of chronic non-specific low back pain. Resolution of the Multidisciplinary Board of Experts

Disease-modifying therapy and adjuvant support in complex therapy of chronic non-specific low back pain. Resolution of the Multidisciplinary Board of Experts

Impact of Trunk Stabilization Training on Cricketers with Chronic Non-Specific Low Back Pain

Impact of Trunk Stabilization Training on Cricketers with Chronic Non-Specific Low Back Pain

Effect of Soft Tissue Mobilisation on Somatic Symptoms in Chronic Low Back Pain Patients: A Pilot Pretest Post-test Randomised Clinical Trial

Introduction: Numerous studies suggest a significant correlation between Chronic Low Back Pain (CLBP) and somatic symptoms. These symptoms often stem from altered fascial biomechanics. Implementing Soft Tissue Mobilisation (STM) techniques aimed at restoring fascial biomechanics can markedly alleviate somatic symptoms associated with CLBP. Aim: To assess the efficacy of STM in alleviating somatic symptoms in patients with Chronic Low Back Pain (CLBP). Materials and Methods: A pilot pretest post-test randomised clinical trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from July 2023 to December 2023, on participants diagnosed with Non Specific Chronic Low Back Pain (NSCLBP) accompanied by somatic symptoms. The experimental group (Group 1), n=6 (41.00±6.29 years), received myofascial unwinding and myofascial release. In contrast, the clinical group (Group 2), n=6 (43.83±11.20 years), received conventional physiotherapy care, including structured exercises and electrophysical modalities, over 4 weeks. Both groups underwent three sessions per week, amounting to 12 sessions in total. The evaluation of somatic symptoms was conducted using the Hamilton Depression Rating Scale (HDRS) at baseline and after the 4 weeks. Results: The statistical analysis demonstrated significant withingroup differences in HDRS (p-value=0.002) in Group 1, and no statistically significant difference in Group 2 (p-value=0.749). The between-group analysis demonstrated a statistically significant difference in HDRS (p=0.035) with a large effect size (d=1.4). Conclusion: STM effectively improves somatic symptoms in NSCLBP patients. The beneficial effect of STM on somatic symptoms can be translated into clinical practice after strengthening results in the larger population.

Lower limb muscle strength is associated with disability in non-specific chronic low back pain

Low back pain is one of the most common health problems that affects daily living activities of most people at some time in their lifetime. Non-specific chronic low back pain (NS-CLBP) can be seen in 85-95% of the population. Although it is known that disability and lower limb muscle strength are affected in patients with NS-CLBP, no study investigated the relationship between these variables. The aim of this study was to identify association between disability and lower limb muscle strength in these patients. 79 patients with NS-CLBP were enrolled. The strength of knee extensor and ankle dorsiflexor muscles were measured using a hand-held dynamometer. The disability was assessed using Oswestry Disability Index. Spearman correlation analysis revealed that there were negative significant correlations between Oswestry Disability Index score and right knee extensor muscle strength, left knee extensor muscle strength and left ankle dorsiflexor muscle strength (r=-0.290, p=0.009; r=-0.408, p

Effectiveness of Kinesio-Taping and Conventional Therapy for Non-Specific Chronic Low Back Pain

Chronic non-specific low back pain, which is treated in orthopedic rehabilitation settings, is a frequent musculoskeletal issue. Lumbar spondylosis, Psychogenic Low Back Pain, Spinal Stenosis and poor posture are all causing pain for the patient. Kinesio-Taping helps to reduce or eliminate discomfort. Objective: To see how effective kinesio-tapping and traditional therapy are for non-specific chronic low back pain. Methods: This was a quasi-experimental study design in which 30 patients were recruited using a convenient sampling sample, with 15 individuals in each group (Group A, Kinesio-Tapping with Conventional Therapy includes stretching, strengthening and hot pack) Group B which consists solely of standard conventional therapy. An independent T-Test for inter-group comparison and a paired sample T-Test for within-group analysis were used to assess the Oswestry Low Back Pain Disability and Numeric Pain Rating Scale. Results: There was a significant change between the baseline and post-treatment NRPS values. Mean difference of 10.42 and 3.14 were reported between the pretreatment and post treatment values of NPRS in KT taping Group which was significant (p-value &lt; 0.05). Mean difference of 14.18 and 3.68 were reported between the pretreatment and post treatment values of NPRS in Conventional PT Program Group which was significant (p-value &lt; 0.05). Conclusions: Kinesio-Taping in conjunction with Conventional Therapy is more effective than Conventional Therapy alone in treating Chronic Non-specific Low Back Pain.

Investigation of Factors Associated with Pain Level in Individuals with Chronic Non-Specific Low Back Pain

Objectives: The aim of this study was to investigate the factors associated with pain levels in individuals with chronic non-specific low back pain (CSLBP). Material and Methods: A total of 90 patients (44 males and 46 females) diagnosed with CS LBP were included in the study. Pain level was assessed by the Visual Analogue Scale (VAS), body balance was assessed statically and dynamically by the Biodex Stability System, quadriceps femoris muscle strength was assessed by an isometric dynamometer, and disability level was assessed by the Oswestry Disability Index (ODI). A linear regression analysis was performed to determine the factors affecting pain level. Results: According to the results of linear regression analysis, static balance (anteroposterior, mediolateral, and general), dynamic balance (anteroposterior, mediolateral, and general), ODI, and quadriceps femoris muscle strength (left, right) explained 98.1% of the variance. In addition, all sub-parameters of dynamic balance (general p=0.000, anteroposterior p=0.001, mediolateral p=0.008) and ODI (p=0.000) were independent predictors of pain level. Conclusion: It was determined that pain level was associated with balance, muscle strength (quadriceps femoris), and disability level in individuals with CSBP. It was also observed that dynamic balance and ODI were factors affecting the pain level.

Comparison of the efficacy of Transcutaneous Electrical Nerve Stimulation and Short Wave Diathermy on Patients with Chronic Nonspecific Low Back Pain

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain. Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. 120 patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s) Age, Sex, Occupational status, Socioeconomic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, and Oswestry disability Index. Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between group-B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. But, these were not statistically significant (P&gt;0.05) between Group B and Group C. Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn. TAJ 2023; 36: No-2: 135-143

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy.

The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L. The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol

BackgroundLow back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients’ outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.MethodsThis study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.DiscussionThis study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients’ pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.Trial registrationNCT05823857, registered prospectively on April 27th, 2023.

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial

BackgroundMany people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP.Methods70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches.ResultsThere were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, − 3.25 to − 1.15). The standardized mean difference and their 95% confidence intervals (Cohen’s d) revealed a large effect of pain at 22 weeks: (Cohen’s d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes.ConclusionsIn this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks.Trial RegistrationClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

Effects of Lumbar Stabilization and Graded Activity Exercises on Selected Biochemical Mediators and Clinical Outcomes in Patients With Non-specific Chronic Low Back Pain

Effects of Lumbar Stabilization and Graded Activity Exercises on Selected Biochemical Mediators and Clinical Outcomes in Patients With Non-specific Chronic Low Back Pain

Effects of transcranial direct current stimulation combined with Pilates-based exercises in the treatment of chronic low back pain in outpatient rehabilitation service in Brazil: double-blind randomised controlled trial protocol

IntroductionChronic low back pain may be associated with pathoanatomical, neurophysiological, physical, psychological and social factors; thus, treatments to reduce symptoms are important to improve the quality of life of this...

Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)

BackgroundLow back pain (LBP) is the leading cause of years lived with disability worldwide. Public safety workers are highly exposed to physically demanding activities and inappropriate postures, increasing the risk of experiencing LBP. Smartphone app-based self-managed interventions may be an alternative for chronic non-specific LBP (CNSLBP) treatment. This study aims to evaluate the effectiveness of a smartphone app-based self-managed exercise program plus health education, compared to a health education program alone, on neuromuscular and perceptual outcomes in police officers and firefighters with CNSLBP.MethodsThis is a parallel, two-armed, blinded evaluator randomized clinical trial. Police officers and firefighters (from public safety institutions in the Rio Grande do Sul state, Brazil) will be randomly assigned to a m-health self-managed exercise program (twice a week) plus health education or health education alone. Self-management exercise program components are mobility and core resistance exercises, available on the app. Follow-ups will be conducted post-treatment (8 weeks) and 16 weeks after randomization. The co-primary outcomes will be pain intensity and disability post-treatment (8 weeks). Secondary outcomes will be biopsychosocial factors related to CNSLBP.DiscussionWe hypothesize that the effects of a smartphone app-based self-managed exercise program on co-primary and secondary outcomes will be superior, compared to the health education only in public safety workers with CNSLBP.Trial registrationThe study was prospectively registered at ClinicalTrials.gov (NCT05481996. Registered on August 01, 2022).