Reviewed by: Zachary Stango, SPT; Bridget Collier, PT, DPT
With the majority of low back pain stemming from idiopathic origin, the condition commonly engulfs a large percentage of rehab cases. In individuals with low back pain, proprioception (aka, the awareness of one’s body position in space) plays a key role in posture and balance control, with decreased control likely contributing to these episodes of pain. Core stabilization exercises that include activation of deeper muscles like the transversus abdominis and lumbar multifidus are utilized as a form of therapeutic exercise to supply the spine with adequate stability. Strengthening exercises for the superficial trunk musculature also aid in the stability of the spine. The randomized control trial conducted by Hlaing et al. (2021) aimed to measure these two parameters, core stabilization and strengthening exercises, on the effects of the factors that are often lacking in individuals with subacute non-specific low back pain, namely: proprioception, balance, and muscle thickness.
The inclusion criteria for this trial consisted of individuals ages 20-50, with subacute nonspecific low back pain of 6-12 weeks, and pain of 3-7/10 on the Visual Analog Scale with a score of 19% or greater on the Modified Oswestry Disability Index. 36 individuals were evenly split into groups performing core stabilization exercises or strengthening exercises and completed these programs for 30 minutes, three times a week, for four weeks. For the participants in the core stabilization group, the muscles were isolated utilizing a drawing in maneuver, with a biofeedback device and manual palpation used to ensure successful contraction. The core stabilization group progressed throughout the weeks to include co-contractions of the transversus abdominis and lumbar multifidus with upper and lower body movements, advancing from sitting to supine to quadruped to ultimately a standing position. For the participants in the strengthening exercise group, the program consisted of progressing exercises centered around spinal flexion and extension to target the abdominal and back musculature respectively, while also working the oblique muscles with side-lying leg raises.
Follow up metrics were examined following the scheduled programs, and proprioception was measured through joint repositioning, with balance analyzed using the Romberg Test and muscle thickness calculated with ultrasound imaging. The results of this study overall demonstrated significant improvements in proprioception, balance, muscle thickness and reductions in pain within both experimental groups. Compared to the strengthening exercise group, the core stabilization group displayed superior improvements in proprioception, balance, and muscle thickness. The participants that underwent core stabilization also exhibited greater reductions in their fear of movement and functional disability scores compared to the strengthening group.
Clinical Bottom Line:
The results of this trial serve as evidence that the inclusion of exercises targeting deep abdominal and spinal muscles, like the transversus abdominis and lumbar multifidus, should not be neglected when treating individuals with subacute nonspecific low back pain. The addition of core stabilization exercises, compared to a sole focus on strength, can contribute to a more holistic rehab approach. Low back pain is often a debilitating condition contributing to fear avoidance and altered compensatory movements, and the transversus abdominis and lumbar multifidus can serve as potent protectors of allowing patients to return to their prior level of function with confidence in their body’s ability to thrive.
Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):998. Published 2021 Nov 30. doi:10.1186/s12891-021-04858-6