Non-specific Low Back Pain Research Articles

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain.

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness. A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA. Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio. This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

Clinical Evaluation of the McGill Stabilization Exercise Program for Chronic Nonspecific Low Back Pain: Insights from Case Studies

Clinical Evaluation of the McGill Stabilization Exercise Program for Chronic Nonspecific Low Back Pain: Insights from Case Studies

The effect of stabilization-based exercises on kinesiophobia in patients with non-specific chronic low back pain: a systematic review and meta-analysis

The effect of stabilization-based exercises on kinesiophobia in patients with non-specific chronic low back pain: a systematic review and meta-analysis

Association between MRI measurements of lumbar spine alterations and self-reported outcomes of pain and disability in subjects with non-specific low back pain.

This study aims to elucidate the association between MRI measurements of spine alterations and self-reported outcomes of pain and disability in individuals with non-specific low back pain, using a comprehensive perspective based on machine learning algorithm. 246 consecutive subjects were assessed. Pain severity in cervical, lumbar, and leg regions was determined using visual analogue scale, and functional disability was acquired by Oswestry Disability Index. Sagittal and axial MRI scans of the thoracolumbar spine were evaluated. Severity of disc degeneration, spinal canal stenosis, and presence of vertebral endplate lesions based on two different classification schemes involving the extent and the shape of defects were quantified at the levels from T12L1 to L5S1. The following parameters describing the lumbar region as a whole were calculated: maximum value along spinal levels, sum of values along levels, number of levels characterized by severe condition. The association with pain and disability was assessed by generalized multiple linear regression modelling. Disc degeneration was identified as a predictor of disability and partially of pain, whereas canal stenosis was found associated with changes in pain in the leg region. Partial correlation values ranged from 0.11 to 0.32. Endplate lesions did not show significant associations. A partial association between MRI measurements and self-reported outcomes of pain and disability was confirmed. Disc degeneration was the most correlated with the reported indexes, while canal stenosis mainly affected the pain levels in the leg region. The presence of endplate lesions did not demonstrate any significant relationships.

Effects of attentional focus on quiet standing balance control in individuals with non-specific chronic low back pain

Despite the widespread research about the effects of attentional focus on balance control in different populations, to the best of our knowledge, no study has yet investigated the effects of attentional focus instructions on balance control in individuals with chronic low back pain (CLBP). Therefore, this study was aimed to compare the effects of internal focus (IF) and external focus (EF) of attention on quiet standing balance control between individuals with CLBP and healthy controls. Twenty individuals with CLBP and 20 healthy controls were enrolled in this quasi-experimental study. The participants were asked to stand still with eyes open and eyes closed while performing three tasks: baseline standing with no focus instructions, internally focusing on their feet, and externally focusing on two markers were placed on the force platform. Statistical analyses showed a significant main effect of group for mean total velocity (p = 0.02), area (p = 0.01), and displacement in mediolateral (ML) direction (p = 0.003). Moreover, a significant main effect of vision was observed for mean total velocity (p < 0.001), area (p < 0.001), and displacement in anteroposterior (AP) (p < 0.001) and ML directions (p < 0.001). Also, the results revealed a significant main effect of attentional focus for mean total velocity (p < 0.001), area (p < 0.001), and displacement in AP (p < 0.001) and ML directions (p = 0.01). Our results showed that in both healthy controls and individuals with CLBP, EF led to improve quiet standing balance control compared to IF and control conditions. From a clinical perspective, it may be useful for physical therapists to consider the use of instruction cues that direct performer's attention away from the body for improving quiet standing balance control in individuals with CLBP.

A Comparison of Combined Pilates-Kinesio Tape and Mulligan-Kinesio Tape Exercises on Pain, Lumbar Range of Motion, Hamstring Strength, and Pelvic Rotation in Women with Non-specific Chronic Low Back Pain

Background: Low back pain is one of the most significant musculoskeletal problems, causing various functional limitations that adversely affect individuals' quality of life. Objectives: The effect of combined Pilates-Kinsey and Mulligan-Kinsey exercises in women with non-specific chronic back pain has not been investigated. Methods: In the present quasi-experimental study, thirty women with non-specific chronic back pain with a range age of 35 - 65 years old were included in the study and were randomly divided into two Pilates-Kinesiotype (n = 15) and Mulligan-Kinesiotype (n = 15) groups. Exercise interventions were conducted for 6 weeks and 3 sessions per week. Pain, lumbar range of motion, hamstring stiffness and hip rotation were measured before and after the training intervention. Also, analysis of covariance (ANCOVA) test was used to analyze the data. Results: The results showed that there is a significant difference between the effect of Pilates-Kinesiotype training and Mulligan Kinesiotype training in the variables of pain, hamstring stiffness and hip rotation (P &lt; 0.05) and the reduction of pain and hip rotation in the Pilates-Kinesiotype training group compared to The Mulligan-Kinesiotype group was better. But the hamstring range of motion was better in the Mulligan-Kinesiotype group than in the Pilates-Kinesiotype group. In addition, the results showed that there is no significant difference between the waist range of motion of the research groups (P &lt; 0.05). Conclusions: Due to the fact that mulligan and Pilate's exercises together with Kinesiotype have an effect on pain variables, hamstring stiffness and hip rotation, and each of mulligan and Pilate's exercises have different effectiveness. These exercises can be used in combination with Kinesiotype to help women with non-specific chronic back pain.

The Importance of Mind-Body in Pilates Method in Patients with Chronic Non-Specific Low Back Pain-A Randomized Controlled Trial.

Background/Objectives: Chronic non-specific low back pain (CNSLBP) is a prevalent condition causing significant distress and healthcare costs globally. Despite various treatments, effective management remains challenging. Pilates, recognized for its focus on core strength and postural alignment, has emerged as a promising intervention. This study investigates the impact of mind-body in Pilates for directing participants on CNSLBP outcomes. Methods: A randomized controlled trial was conducted with 67 participants, aged 18 to 65 years, suffering from CNSLBP. They were allocated into two groups: Pilates with mind-body cueing (n = 34) and Pilates without cueing (n = 33). Both groups underwent 60 min sessions twice weekly for 8 weeks. Outcome measures included pain intensity (Visual Analogue Scale), functional disability (Roland Morris Disability Questionnaire), fear of movement (Tampa Scale of Kinesiophobia), and adherence (percentage of sessions attended). Statistical significance was determined through repeated measures ANOVA. Results: Both groups showed significant improvement in pain reduction, functional ability, and kinesiophobia. However, the mind-body group demonstrated a statistically significant reduction in kinesiophobia compared to the non-cueing group (p = 0.048), indicating the potential additional benefit of mind-body cueing in managing movement-related fear in CNSLBP. Conclusions: This study underscores the effectiveness of an 8-week Pilates intervention in managing CNSLBP, highlighting the added value of mind-body cueing in reducing fear of movement. These findings suggest incorporating mind-body cueing in Pilates could enhance the therapeutic benefits, particularly for patients with high levels of movement-related fear, potentially improving long-term adherence to physical activity and rehabilitation outcomes.

STANDARD AND BIOPSYCHOSOCIAL OSTEOPATHIC MANAGEMENT FOR PATIENTS WITH NON-SPECIFIC LOW BACK PAIN (THE OSCAR STUDY): A SINGLE-CASE EXPERIMENTAL DESIGN

Purpose and BackgroundGuidelines recommend biopsychosocial care for chronic, complex musculoskeletal conditions, including non-specific low back pain. The aims were: 1/ to assess how patients with low back pain respond to osteopathic treatment, both before and after an osteopath has completed a Biopsychosocial Pain Management (BPM) course; and 2/ to assess if it is feasible and acceptable for osteopath participants to receive weekly SCED data and use it to guide patient management.Methods and ResultsA multiple baseline single case experimental design trial (clinicaltrials.gov, on 18/10/2021, ID number NCT05120921) with 11 UK osteopaths was conducted. Patients were randomised to early, middle or late treatment start dates. Statistical analysis assessed the change between baseline, intervention and follow-up periods. Primary outcomes were the Numeric Pain Rating (NPR) and Patient Specific Function Scales (PSFS), measured during the baseline, the 6-week intervention, and during a 12-week follow-up period.At baseline, the osteopaths reported stronger biopsychosocial attitudes to pain, compared to biomedical beliefs (PABS: 34 behavioural scale; 29 biomedical scale). Overall, patient participants showed daily increases in symptoms during the pre-treatment phase (+0.24/day, p&lt;0.001), and daily decreases during treatment (−2.94 over the treatment phase, p&lt;0.001), which continued post-treatment (−3.36 over 12 weeks, p=0.04). Similar improvements were observed for function.ConclusionOsteopathic care was shown to help patients with persistent low back pain. Patient recruitment was challenging because of the randomisation. With further development, the method shows feasibility as a means of enhancing research activity among practising clinicians.Previous presentations or publications of the workThe protocol was published (https://doi.org/10.1016/j.ijosm.2023.100660) and presented at SBPR in 2022. The results were presented to an osteopathic conference in October 2023.Ethics approval was received from the University College of Osteopathy Research Ethics Committee.Conflicts of interestsJerry Draper-Rodi receives fees from the sales of the e-learning course on the biopsychosocial management on the UCO CPD platform.Sources of fundingThe research was funded by the Osteopathic Foundation.

Hypopressive Exercise for the Treatment of Adults with Chronic Nonspecific Low Back Pain

Chronic non-specific low back (NSCLBP) pain significantly affects the population, being the main cause of disability, work absenteeism, early retirement, and a serious public health problem that affects the quality of life of the adult population and its economy. Physiotherapy presents itself as an alternative for the management of chronic low back pain (CLBP), through different modalities and specific exercises aimed at proper functioning of the trunk muscles. Within this area are hypopressive exercises (HE). The aim of this article is to determine the effectiveness of HE in the treatment of NSCLBP adults, conducting an exploratory and descriptive bibliographic study that compiled evidence from bibliographic sources PubMed, Scielo, Ebsco, Dialnet, Elsevier, Science Direct, PEDro, and SAGE Journals, with quartile between Q1 and Q4, in an observation window between 2018 and 2024, with no age, gender, and language restriction. The results yielded 5 articles which met the eligibility criteria. It was possible to recognize that 4 of these articles affirm a significant decrease in the Numerical Rating Scale that was used to measure low back pain after an intervention of HE. In conclusion, according to these studies, HE represents a non-invasive alternative to address NSCLB and have significant effects to reduce pain and improve functionality in people who suffer from these symptoms that are currently affecting the adult population.

Effect Of Pain Neuroscience Education Followed By Cognition-Targeted Motor Control Training On Pain, Disability, Central Sensitization And Kinesiophobia In Patient With Nonspecific Chronic Low Back Pain

Effect Of Pain Neuroscience Education Followed By Cognition-Targeted Motor Control Training On Pain, Disability, Central Sensitization And Kinesiophobia In Patient With Nonspecific Chronic Low Back Pain

Exploring the association between adherence to home-based exercise recommendations and recovery of nonspecific low back pain: a prospective cohort study

BackgroundAdherence to home-based exercise (HBE) recommendations is critical in physiotherapy for patients with low back pain (LBP). However, limited research has explored its connection with clinical outcomes. This study examined how adherence to HBE relates to changes in physical function, pain intensity, and recovery from LBP in patients undergoing physiotherapy treatment.MethodsData from a multicenter cluster randomized controlled trial in the Netherlands involving patients with LBP from 58 primary care physiotherapy practices were used. Adherence to HBE was assessed with the Exercise Adherence Scale (EXAS) at each treatment session. Previously identified adherence trajectories served as a longitudinal measure of adherence and included the classes “declining adherence” (12% of participants), “stable adherence” (45%), and “increasing adherence” (43%). The main outcomes included disability (Oswestry Disability Index), pain (Numeric Pain Rating Scale), and recovery (pain-free for > 4 weeks), which were measured at baseline and after three months. Linear and binomial logistic regression analyses adjusted for confounders were used to examine adherence–outcome relationships.ResultsIn the parent trial, 208 participants were included. EXAS scores were available for 173 participants, collected over a median of 4.0 treatment sessions (IQR 3.0 to 6.0). Forty-five (28.5%) patients considered themselves to have recovered after three months. The median changes in the Oswestry Disability Index and Numeric Pain Rating Scale were − 8 (IQR − 1 to -20) and − 2 (IQR − 0.5 to -4), respectively. The mean EXAS scores varied among patient classes: “declining adherence” (46.0, SD 19.4), “stable adherence” (81.0, SD 12.4), and “increasing adherence” (39.9, SD 25.3), with an overall mean of 59.2 (SD 25.3). No associations between adherence and changes in physical functioning or pain were found in the regression analyses.ConclusionsNo association between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP was found. These findings suggest that the relationship between adherence to HBE recommendations and treatment outcomes may be more complex than initially assumed. Further research using detailed longitudinal data combined with qualitative methods to investigate patient motivation and beliefs may lead to a deeper understanding of the relationship between adherence and clinical outcomes in patients with LBP.

Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial

Objective To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Design Randomised placebo-controlled study with three intervention groups. Setting The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Participants Eighty-one patients with chronic non-specific low back pain aged 18–80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. Intervention The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. Main measures The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. Results The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = −3.6, −0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. Conclusion The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Musculoskeletal Dimension and Brightness Reference Values in Lumbar Magnetic Resonance Imaging-A Radio-Anatomic Investigation in 80 Healthy Adult Individuals.

Background/Objectives: Magnetic resonance imaging (MRI) is the preferred diagnostic means to visualize spinal pathologies, and offers the possibility of precise structural tissue analysis. However, knowledge about MRI-based measurements of physiological cross-sectional musculoskeletal dimensions and associated tissue-specific average structural brightness in the lumbar spine of healthy young women and men is scarce. The current study was planned to investigate characteristic intersexual differences and to provide MRI-related musculoskeletal baseline values before the onset of biological aging. Methods: At a single medical center, lumbar MRI scans of 40 women and 40 men aged 20-40 years who presented with moderate nonspecific low back pain were retrospectively evaluated for sex-specific differences in cross-sectional sizes of the fifth lumbar vertebrae, psoas and posterior paravertebral muscles, and respective sex- and age-dependent average brightness alterations on T2-weighted axial sections in the L5-level. Results: In women (mean age 33.5 years ± 5.0 (standard deviation)), the investigated musculoskeletal cross-sectional area sizes were significantly smaller (p < 0.001) compared to those in men (mean age 33.0 years ± 5.7). Respective average musculoskeletal brightness values were higher in women compared to those in men, and most pronounced in posterior paravertebral muscles (p < 0.001). By correlating brightness results to those of subcutaneous fat tissue, all intersexual differences, including those between fifth lumbar vertebrae and psoas muscles, turned out to be statistically significant. This phenomenon was least pronounced in psoas muscles. Conclusions: Lumbar musculoskeletal parameters showed significantly larger dimensions of investigated anatomical structures in men compared to those in women aged 20-40 years, and an earlier onset and faster progress of bone loss and muscle degradation in women.

The Effect Of General Exercise Program Combined With Cognitive Functional Therapy On Pain, Quality Of Life And Muscle Endurance Of Women With Chronic Non-Specific Low Back Pain

The Effect Of General Exercise Program Combined With Cognitive Functional Therapy On Pain, Quality Of Life And Muscle Endurance Of Women With Chronic Non-Specific Low Back Pain

Beliefs regarding the use of imaging among patients with low back pain: A cross-sectional study in the context of a middle-income country.

Patients with low back pain may play an active role in the prescription of excessive spine imaging. To determine the proportion of patients with low back pain who have beliefs not aligned with current evidence regarding the use of imaging and to identify factors associated with these beliefs. Secondary analysis of baseline data of a previously published randomized clinical trial. Outpatient physical therapy clinic in a middle-income country. Individuals with non-specific low back pain. Outcome variables were two statements assessing the extent of patient agreement on the need for imaging in the management of low back pain. The predictor variables were age, educational level, duration of symptoms, disability level, pain intensity in the last 24 hours, beliefs about inevitable consequences of low back pain (assessed using the Back Belief Questionnaire), and having received imaging previously. Multivariable logistic models were used for data analysis. Level of agreement with Statement 1: X-rays or scans are necessary to get the best medical care for low back pain and Statement 2: Everyone with low back pain should have spine imaging. A total of 159 patients were included. Of these, 88.1% believed that imaging was necessary for the best medical care for low back pain and 62.9% believed that everyone with low back pain should obtain imaging. Lower scores on the Back Belief Questionnaire were associated with beliefs that imaging was necessary (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.81, 0.99) and low education level was associated with the belief that everyone with low back pain should obtain imaging (OR = 3.03, 95% CI: 1.38, 6.61), after controlling for potential confounders. Nearly 90% of patients believe that spine imaging is necessary for the management of low back pain. Beliefs about the inevitable consequences of low back pain and low education level may be factors that need to be considered when developing new interventions.

Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries: protocol for a systematic review and meta-analysis

IntroductionChronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a...

Identifying the low back pain-related attitudes, beliefs of Turkish physiotherapists’ and associated factors

Purpose The aim of the research is to determine the biomedical and biopsychosocial approaches of Turkish physiotherapists towards chronic non-specific low back pain (CNLBP) and related factors. Methods This research, planned as a cross-sectional study, was completed with the inclusion of 134 physiotherapists using the online survey method. Attitudes and beliefs of Turkish physiotherapists regarding CNLBP were evaluated using Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and Revised Neurophysiology of Pain Questionnaire (RNPQ). The characteristics of the participants were also evaluated. Spearman’s correlation and simple linear regression analysis were conducted between the characteristics and attitudes and beliefs of Turkish physiotherapists towards CNLBP. Results Simple linear regression analysis showed presence of training on low back pain (LBP) was associated with lower HC-PAIRS scores. Relationship between professional experience and the biomedical (r: −0.205, p: .018) and biopsychosocial orientation (r: −0.180, p: .038) was observed. Additionally, higher level of education was associated with higher RNPQ scores (r: 0.193, p: .025). Conclusions The results of the study show that factors such as education level, years of professional experience and receiving training on LBP affect Turkish physiotherapists’ attitudes and beliefs towards CN.

The effect of core stability training combined with fascial release on patients with nonspecific low back pain.

Non-specific lower back pain (NLBP) is treated with a variety of therapies, including health education, exercise therapy, soft tissue release, psychological interventions, and shockwave therapy. However, some studies have shown that core stability training or fascial release therapy alone is not effective in the treatment of low back pain. The aim of this study was to investigate the effects of core stability training on patients' inflammatory cytokine levels and lumbar muscle temperature when combined with fascial release for the treatment of non-specific low back pain. In this study, a total of 60 patients with non-specific low back pain who were treated in Mindong Hospital of Ningde City between December 2021 and January 2023 were selected and randomly and equally divided into a control group (30 cases) and an experimental group (30 cases). The control group received core stability training, while the experimental group added fascial release surgery to this. We compared and assessed the pain visual analog score (VAS), Oswestry dysfunction index (ODI), lumbar spine mobility (including anterior flexion, posterior extension, left flexion, and right flexion), as well as levels of inflammatory factors IL-6, TNF-a, and muscle tissue temperature in the two groups. This study has been successfully implemented and covered 60 patients throughout the trials. Upon comparison, the two groups did not show statistically significant differences in baseline data such as age, gender and duration of disease (p> 0.05). After four weeks of treatment, the test group showed statistically significant (p< 0.05) differences in VAS scores, ODI scores, and IL-6 and TNF-a levels that were significantly lower than those of the control group. It is worth mentioning that the muscle tissue temperature of the patients in the test group, as well as their performance in lumbar anterior flexion, posterior extension, left flexion, and right flexion mobility, were significantly better than those of the control group, and these differences also showed statistical significance (p< 0.05). The combination of core stability training and fascial release demonstrates significant clinical results in the treatment of nonspecific lower back pain. Through medical thermography and serum inflammatory factor testing, we were able to assess the treatment effect more objectively, providing a strong basis for future clinical practice.

The effects of an 8-week dynamic neuromuscular stabilization exercise on pain, functional disability, and quality of life in individuals with non-specific chronic low back pain: a randomized clinical trial with a two-month follow-up study

BackgroundLow back pain (LBP) is a common disorder and is considered one of the leading causes of disability worldwide, resulting in adverse health, social, and economic outcomes. This study aimed to investigate the effects and durability of 8-week Dynamic Neuromuscular Stabilization (DNS) exercises on pain, functional disability, and quality of life in individuals aged 30 to 50 years with non-specific chronic low back pain (NSCLBP).MethodsThis research employed a pre- and post-test design with a follow-up period, in which 29 participants (16 in the control group and 13 in the exercise group) remained until the end of the study. Pain intensity, functional disability, and quality of life were assessed using the visual analog scale (VAS), the Oswestry Disability Index, and the SF-36 questionnaire, respectively, before intervention, immediately after, and two months post-intervention. The control group continued their routine daily activities, while the exercise group performed DNS exercises three times a week for 8 weeks. The data was analyzed using a mixed-design ANOVA (P ≤ 0.05).ResultsThe results showed improvements in pain (F (2,24) = 5.31, P = 0.01, η2 = 0.31), functional disability (F (2,24) = 4.17, P = 0.03, η2 = 0.26), and quality of life (F (2,24) = 4.70, P = 0.02, η2 = 0.28) in the exercise group at the Post-test compared to the Pre-test. However, the durability of the exercise effects at the follow-up assessment was not sustainable compared to the Post-test and Pre-test (P > 0.05).ConclusionAn 8-week period of DNS exercises can improve pain, functional disability, and quality of life in individuals with NSCLBP. However, a 2-month period of detraining can reduce the positive outcomes of these exercises.Trial registrationThe researchers retrospectively registered this trial on 21/04/2024, with the identifier IRCT20240107060646N1 in the Iranian Registry of Clinical Trials (IRCT) at the following address: https://irct.behdasht.gov.ir.

The effect of cognitive functional therapy on the plantar pressure distribution symmetry in patients with chronic non-specific low back pain: A randomized controlled trial

ObjectiveThis study aimed to evaluate the effect of Cognitive functional therapy (CFT) on plantar pressure distribution symmetry in chronic non-specific low back pain (CNSLBP) patients. Methodforty females with NSCLBP (age range 30–50 years) were recruited for clinical trials. They were randomly divided into experimental and control groups (Each group had 20 patients). The patients in the experimental group received CFT for 8 weeks. The primary outcome was psychological variables inclusive of pain, kinesiophobia and disability. The secondary outcome was plantar pressure distribution symmetry which assessment in standing condition. The Covariance statistical method was used for data analysis. ResultsThe results of covariance analysis for primary outcome showed a significant difference (p < 0.05) with a reduction of 52 % in pain (p = 0.001), 12 % in kinesiophobia (p = 0.001) and 41% in disability (p = 0.001). Also, the results of covariance analysis for secondary outcome showed a significant difference in plantar pressure distribution symmetry of inter-limbs foot (p = 0.007), forward and backward in the right foot (p = 0.002) and forward and backward in the left foot (p = 0.001). ConclusionCFT reduces of pain, kinesiophobia and disability. In addition significant difference in the plantar pressure distribution symmetry was observed, which it is argued the plantar pressure asymmetric can be influenced by psychological factors.