Is core stability exercise more effective than general exercise in improving pain and function in patients with chronic LBP?
Low back pain is one of the leading causes of disability in the United States. A considerable amount of low back pain cases are classified as non-specific low back pain, indicating that a specific anatomical source of pain cannot be established. Despite the prevalence of patients seeking physical therapy for low back pain, there is a lack of consensus on which physical therapy interventions are most effective in reducing pain and improving function. Many research studies in the recent years have focused on core stability and motor control exercises, specifically emphasizing contraction of deep core muscles such as transverse abdominis. Although there are several systematic reviews that support the benefits of core stability exercise on decreasing pain and disability, it is unclear whether it is more effective than other forms of exercise commonly prescribed for low back pain.
Motor control exercise has become a popular intervention when managing patients with chronic non-specific low back pain. This intervention was initially developed due to research citing impaired control of deep trunk muscles, such as multifidus and transverse abdominis, as a potential mechanism for chronic non-specific low back pain (Hodges 2003). Motor control exercise initially focuses on contraction and coordination of deep trunk muscles, then progresses to stabilization during functional exercises with more global trunk muscle involvement. A large systematic review by Saragiotto et al. (2016) included 29 trials comparing motor control exercise to no treatment, manual therapy, or conventional therapeutic exercise programs. The researchers discovered that motor control exercise was superior to no treatment, but they found no clinically meaningful difference between motor control exercise and conventional exercise or manual therapy in reducing pain or disability. These results were consistent at both short and long term follow ups.
Shamsi et al. (2014) aimed to compare core stability exercise with general trunk exercises for chronic low back pain. 39 participants with chronic low back pain were divided into two groups for a 16-session program, with the experimental group receiving instruction on performing core stability exercise with emphasis on co-contraction of deep trunk muscles during functional tasks. The control group performed general trunk exercises with activation of both abdominal and paraspinal muscles. Outcome measures included the Oswetry Disability Index, VAS pain ratings, and three lumbopelvic stability tests – single leg squat, dip test, and runner pose test (maintaining hip flexion in standing). Both core stability exercise and general trunk strengthening exercises demonstrated significant improvements in trunk stability tests, Oswetry Disability Index scores, and VAS pain ratings. However, there was no significant difference between groups, indicating that core stability is not more effective when compared to other more general forms of resistance exercise.
A meta-analysis by Wang et al. (2012) including five randomized controlled trials comparing the effects of core stability and general exercise programs on patients with chronic low back pain found that core stability decreased pain and improved function more than general exercise after three months. However, the interventions were equally effective at reducing pain at six- and twelve-month follow-ups. Therefore, it may be more important to consider patient preference, safety, and cost of interventions as positive outcomes are present with a variety of therapeutic exercise interventions. Physical therapists should communicate with patients to find activities and forms of exercise they enjoy to improve adherence to HEP and self-efficacy during recovery.
References
Hodges P. W. (2003). Core stability exercise in chronic low back pain. The Orthopedic clinics of North America, 34(2), 245–254. https://doi-org.proxy.kumc.edu/10.1016/s0030-5898(03)00003-8
Shamsi, M. B., Rezaei, M., Zamanlou, M., Sadeghi, M., & Pourahmadi, M. R. (2016). Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiotherapy theory and practice, 32(3), 171–178. https://doi-org.proxy.kumc.edu/10.3109/09593985.2015.1117550
Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Motor control exercise for chronic non‐specific low‐back pain. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD012004. DOI: 10.1002/14651858.CD012004.
Wang, X. Q., Zheng, J. J., Yu, Z. W., Bi, X., Lou, S. J., Liu, J., Cai, B., Hua, Y. H., Wu, M., Wei, M. L., Shen, H. M., Chen, Y., Pan, Y. J., Xu, G. H., & Chen, P. J. (2012). A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PloS one, 7(12), e52082. https://doi-org.proxy.kumc.edu/10.1371/journal.pone.0052082