Dynamic Versus Traditional Core Strengthening Exercises in Patients With Chronic Non-specific Low Back Pain

Chronic non-specific low back pain can limit mobility and function in daily life. Core strengthening is often a component included in rehabilitation practices. Dynamic and traditional core strengthening methodologies can differ, however, their effectiveness when used in rehabilitation is comparably untested. The effects of dynamic and traditional core strengthening on pain, disability and lumbar stability were the primary focuses of this study.

In this module, we describe results from an open-label, randomised, two-arm, parallel-group, superiority trial on 70 adults from the general population. An equal number of participants in the two arms of the study (dynamic versus traditional core strengthening) was also offered routine physiotherapy. Each intervention was delivered three times a week for eight weeks. All participants were assessed for pain, disability and lumbar stability at baseline and at week 8. The assessments used were the Visual Analogue Scale, the Roland-Morris Disability Questionnaire and the Prone Instability Test. Analyses were conducted to determine differences between the study arms and assess clinically meaningful changes.

• Routine Physiotherapy (Behavioral): Routine physiotherapy included 10 minutes of lumbar heat application, static calf stretching, unilateral knee-to-chest exercise, pain-free straight-leg raises, and cross-leg stretching. This was provided prior to the scheduled core strengthening exercises.
• Dynamic Core Strengthening Exercises (Behavioral): Participants were required to maintain trunk stability while executing progressive alternate and opposite upper and lower limb movements. These exercises, done in a four-point kneeling position, were repeated in three sets of one-minute duration with one-minute interval rests. This treatment was applied three times a week for two months.
• Traditional Core Strengthening Exercises (Behavioral): The participants performed progressive bridging and straight leg raising exercises. They performed each exercise in sets of three and rested for one minute between sets. This treatment was delivered three times a week for a duration of eight weeks.

Primary outcomes

• Visual Analog Scale [Baseline and week 8]: Pain intensity was scaled using a 10-centimeter Visual Analog Scale ranging from 0 (no pain) to 10 (extreme pain). Pain is linearly proportional to pain score, and so, change from baseline was assessed for week 8, and a pain score move in the direction of decreasing pain was considered a clinically significant score change in the direction of decreasing pain if the score decreased by at least 2 centimeters to the left on the scale.
• Roland-Morris disability questionnaire [Baseline and week 8]: The 24-item Roland-Morris Disability Questionnaire was used for the evaluation of back-related disability with a score ranging from 0 to 24 with 24 indicating the highest disability. Roland-Morris scores from baseline to week 8 were analyzed for this study. It was determined a decrease of 3.5 or more points was clinically significant.
• Prone instability test [Baseline and week 8]: Results were positive for lumbar instability or negative for lumbar stability based on the Prone Instability Test. Progressive changes in lumbar stability by way of test results taken at baseline and again at 8 weeks were examined.

Sex: All, ages: 20 Years to 50 Years

Inclusion Criteria:

* Age between 20-50
* Chronic non-specific low back pain for more than 12 weeks
* Male or female
* Voluntary participation with a signed informed consent
* Ability to follow instructions of the prescribed exercises

Exclusion Criteria:

* Low back pain with a specific cause (i.e. fracture, tumor, infection, or back pain due to other inflammatory diseases)
* History of any spinal surgery
* Presence of severe neurological deficits
* Pregnancy
* Presence of severe cardiovascular or systemic diseases
* Cognitive impairment or inability to perform the prescribed exercises and follow instructions safely

• Abdelhamid, A. S., Ali, F., Asal, M. S., & Salem, S. (2025). Effect of lumbar Stabilization Exercises Combined with Ball and Balloon Exercise in Treatment of Chronic Non-specific Low Back Pain: Randomized Clinical Trial. Bulletin of Physical Therapy Research and Studies, 3(1), 1-19. Amila Amila, Henny Siyapitri, Evarina Sembiring. (2021). The Effect of William Flexion Exercise on Reducing Pain Intensity For Elderly with Low Back Pain. International Journal of Nursing and Health Services (IJNHS), Volume 4 NO.1, pp 28-36e-ISSN: 2654-6310 DOI: https://doi.org/10.35654/ijnhs.v4i1.374 Bhattarai, D., & Khanna, A. (2025). Effect of Core Stabilization Exercises in Combination with Conventional Physiotherapy in Chronic Low Back Pain. Integrative and Complementary Therapies, 31(1), 12-16. Burton, A. K., Balagué, F., Cardon, G., Eriksen, H. R., Henrotin, Y., Lahad, A., Leclerc, A., Müller, G., van der Beek, A. J., & COST B13 Working Group on Guidelines for Prevention in Low Back Pain (2006). Chapter 2. European guidelines for prevention in low back pain : November 2004. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 15 Suppl 2(Suppl 2), S136-S168. https://doi.org/10.1007/s00586-006-1070-3 Custers, P., Van de Kelft, E., Eeckhaut, B., Sabbe, W., Hofman, A., Debuysscher, A., Van Acker, G., & Maes, G. (2024). Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review. Life, 14(9), 1090. https://doi.org/10.3390/life14091090 Dar SM, Muhardzi NM, Kamsan SS. The effectiveness of lumbar stabilisation exercises on pain and functional disability among patients with non-specific low back pain: a systematic review. IIUM Journal of Orofacial and Health Sciences. 2025 Feb 28;6(1):94-114. Das, Shazal & Khan, Abid & Islam, Muhammad & Alam, Nadira & Nesaruddin, & Alam, Md & Rahman, Tanvir & Shawon, Afroza & Hi

• Waqar ul Hassan, MS MSK, Principal investigator, University of Lahore