Motor control exercise for acute non-specific low back pain

Luciana G Macedo, Bruno T Saragiotto, Tiê P Yamato, Leonardo O P Costa, Luciola C Menezes Costa, Raymond W J G Ostelo, Christopher G Maher, Luciana G Macedo, Bruno T Saragiotto, Tiê P Yamato, Leonardo O P Costa, Luciola C Menezes Costa, Raymond W J G Ostelo, Christopher G Maher

Abstract

Background: Motor control exercise (MCE) is used by healthcare professionals worldwide as a common treatment for low back pain (LBP). However, the effectiveness of this intervention for acute LBP remains unclear.

Objectives: To evaluate the effectiveness of MCE for patients with acute non-specific LBP.

Search methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), four other databases and two trial registers from their inception to April 2015, tracked citations and searched reference lists. We placed no limitations on language nor on publication status.

Selection criteria: We included only randomised controlled trials (RCTs) examining the effectiveness of MCE for patients with acute non-specific LBP. We considered trials comparing MCE versus no treatment, versus another type of treatment or added as a supplement to other interventions. Primary outcomes were pain intensity and disability. Secondary outcomes were function, quality of life and recurrence.

Data collection and analysis: Two review authors screened for potentially eligible studies, assessed risk of bias and extracted data. A third independent review author resolved disagreements. We examined MCE in the following comparisons: (1) MCE versus spinal manipulative therapy; (2) MCE versus other exercises; and (3) MCE as a supplement to medical management. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the quality of evidence. For missing or unclear information, we contacted study authors. We considered the following follow-up intervals: short term (less than three months after randomisation); intermediate term (at least three months but within 12 months after randomisation); and long term (12 months or longer after randomisation).

Main results: We included three trials in this review (n = 197 participants). Study sample sizes ranged from 33 to 123 participants. Low-quality evidence indicates no clinically important differences between MCE and spinal manipulative therapy for pain at short term and for disability at short term and long term. Low-quality evidence also suggests no clinically important differences between MCE and other forms of exercise for pain at short or intermediate term and for disability at intermediate term or long term follow-up. Moderate-quality evidence shows no clinically important differences between MCE and other forms of exercise for disability at short term follow-up. Finally, very low-quality evidence indicates that addition of MCE to medical management does not provide clinically important improvement for pain or disability at short term follow-up. For recurrence at one year, very low-quality evidence suggests that MCE and medical management decrease the risk of recurrence by 64% compared with medical management alone.

Authors' conclusions: We identified only three small trials that also evaluated different comparisons; therefore, no firm conclusions can be drawn on the effectiveness of MCE for acute LBP. Evidence of very low to moderate quality indicates that MCE showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment in decreasing pain and disability among patients with acute and subacute low back pain. Whether MCE can prevent recurrences of LBP remains uncertain.

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.1 Pain.
4
4
Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.2 Disability.
1.1. Analysis
1.1. Analysis
Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 1 Pain.
1.2. Analysis
1.2. Analysis
Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 2 Disability.
2.1. Analysis
2.1. Analysis
Comparison 2 Motor control exercise vs other exercises, Outcome 1 Pain.
2.2. Analysis
2.2. Analysis
Comparison 2 Motor control exercise vs other exercises, Outcome 2 Disability.
3.1. Analysis
3.1. Analysis
Comparison 3 Motor control exercise as a supplement to medical management, Outcome 1 Pain.
3.2. Analysis
3.2. Analysis
Comparison 3 Motor control exercise as a supplement to medical management, Outcome 2 Disability.
3.3. Analysis
3.3. Analysis
Comparison 3 Motor control exercise as a supplement to medical management, Outcome 3 Recurrence.

References

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    1. Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: a randomized placebo controlled crossover study. North American Journal of Medical Sciences 2011;3:461.
Kumar 2012 {published data only}
    1. Kumar S, Sharma VP, Aggarwal A, Shukla R, Dev R. Effect of dynamic muscular stabilization technique on low back pain of different durations. Journal of Back & Musculoskeletal Rehabilitation 2012;25:73‐9.
Kuukkanen 1996 {published data only}
    1. Kuukkanen T, Malkia E. Muscular performance after a 3 month progressive physical exercise program and 9 month follow‐up in subjects with low back pain. A controlled study. Spine 1996;6:112‐21.
Lee 2015 {published data only}
    1. Lee JS, Kim TH, Kim DY, Shim JH, Lim JY. Effects of selective exercise for the deep abdominal muscles and lumbar stabilization exercise on the thickness of the transversus abdominis and postural maintenance. Journal of Physical Therapy Science 2015;27:367‐70.
Lewis 2005 {published data only}
    1. Lewis JS, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S. A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain. Scandinavian Journal of Medicine & Science in Sports 2005;30:711‐21.
Lie 1999 {published data only}
    1. Lie H, Frey S. [Mobilizing or stabilizing exercise in degenerative disk disease in the lumbar region?]. [Norwegian]. Tidsskrift for Den Norske Laegeforening 1999;119:2051‐3.
Lomond 2015 {published data only}
    1. Lomond KV, Jacobs JV, Hitt JR, DeSarno MJ, Bunn JY, Henry SM. Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial. Spine Journal 2015;15:596‐606.
Long 2004 {published data only}
    1. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 2004;29:2593‐602.
Macedo 2008 {published data only}
    1. Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, et al. Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskeletal Disorders 2008;5:65.
Macedo 2012 {published data only}
    1. Macedo LG, Latimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy 2012;93:1‐15.
Magalhaes 2013 {published data only}
    1. Magalhaes MO, França FJR, Burke TN, Ramos LAV, Carvalho e Silva APMC, Almeida GPL, et al. Efficacy of graded activity versus supervised exercises in patients with chronic non‐specific low back pain: protocol of a randomised controlled trial. BMC Musculoskeletal Disorders 2013;14:36. [DOI: 10.1186/1471-2474-14-36]
Magnusson 2008 {published data only}
    1. Magnusson ML, Chow DH, Diamandopoulos Z, Pope MH. Motor control learning in chronic low back pain. Spine 2008;33:E532‐8.
Maher 2005 {published data only}
    1. Maher CG, Latimer J, Hodges PW, Refshauge KM, Moseley L, Herbert RD, et al. The effect of motor control exercise versus placebo in patients with chronic low back pain. BMC Musculoskeletal Disorders 2005;6:54.
Mannion 1999 {published data only}
    1. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24:2435‐48.
Mannion 2009 {published data only}
    1. Mannion AF, Helbling D, Pulkovski N, Sprott H. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. European Spine Journal 2009;18:1881‐91.
Mannion 2012 {published data only}
    1. Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. European Spine Journal 2012;21:1301‐10.
Marshall 2008 {published data only}
    1. Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain. Archives of Physical Medicine & Rehabilitation 2008;89:1305‐13.
Meira 2013 {published data only}
    1. Meira DM. Functional reeducation program associated with back school improves functional disability and pain in workers with chronic low back pain: a pilot study. Annals of the Rheumatic Diseases 2013;72:A1095.
Miller 2005 {published data only}
    1. Miller ER, Schenk RJ, Karnes JL, Rousselle JG. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. The Journal of Manual & Manipulative Therapy 2005;13:103‐12.
Mohseni‐Bandpei 2011 {published data only}
    1. Mohseni‐Bandpei MA, Rahmani N, Behtash H, Karimloo M. The effect of pelvic floor muscle exercise on women with chronic non‐specific low back pain. Journal of Bodywork & Movement Therapies 2011;15:75‐81.
Monteiro 2009 {published data only}
    1. Monteiro FC, Kirkwood RN, Magalhaes CMB. Lumbar stabilization exercises and manual therapy for treatment of non‐specific and chronic low back pain [Exercícios de estabilizaçao lombar e terapia manual no tratamento da dor lombar crônica inespecífica]. Revista Fisioterapia Brasil 2009;10:442‐7.
Monticone 2004 {published data only}
    1. Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub‐acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow‐up. Europa Medicophysica 2004;40:263‐8.
Moon 2013 {published data only}
    1. Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Annals of Rehabilitation Medicine 2013;37:110‐7.
Moseley 2002 {published data only}
    1. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy 2002;48:297‐302.
Moseley 2003 {published data only}
    1. Moseley GL. Joining forces ‐ combining cognition ‐ targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain. Journal of Manual & Manipulative Therapy 2003;11:88‐94.
Moussouli 2014 {published data only}
    1. Moussouli M, Vlachopoulos SP, Kofotolis ND, Theodorakis Y, Malliou P, Kellis E. Effects of stabilization exercises on health‐related quality of life in women with chronic low back pain. Journal of Physical Activity & Health 2014;11:1295‐303.
Navalgund 2009 {published data only}
    1. Navalgund A. Evaluating the effect of a 10‐week stabilization exercise program on the postural stability and the neuromuscular control of the spine in subjects with subacute recurrent low back pain. Dissertation.. Ohio State University, Columbus, Ohio: Ohio State University; 2009.
NCT00201513 {published data only}
    1. NCT00201513. Anticipatory muscle control and effect of stabilizing exercises in patients with subacute and chronic low back pain. (accessed 25 June 2015).
NCT00555802 {published data only}
    1. NCT00555802. The effect of motor control exercise versus general exercise on lumbar local stabilizing muscles thickness. (accessed 25 June 2015).
NCT00624533 {published data only}
    1. NCT00624533. Efficiency of GDS method for lumbar stabilization for non‐specific low back pain in primary care. (accessed 25 June 2015).
NCT01061632 {published data only}
    1. NCT01061632. High (deadlift) versus low intensity motor control exercises on low back pain. (accessed 25 June 2015).
NCT01124201 {published data only}
    1. NCT01124201. Lumbar stabilization, strengthening and stretching in chronic low back pain. (accessed 25 June 2015).
NCT01362049 {published data only}
    1. NCT01362049. Mechanisms of specific trunk exercises in low back pain. (accessed 25 June 2015).
NCT02112760 {published data only}
    1. NCT02112760. Specific stabilization exercise with ultrasound feedback for patients with recurrent low back pain. (accessed 25 June 2015).
NCT02170753 {published data only}
    1. NCT02170753. Regional manual therapy and motor control exercise for chronic low back pain. (accessed 25 June 2015).
NCT02200913 {published data only}
    1. NCT02200913. Effects of core stabilization exercise on balance. (accessed 25 June 2015).
NCT02221609 {published data only}
    1. NCT02221609. Movement system impairment based classification versus general exercise for chronic non‐specific low back pain: a randomised controlled trial. (accessed 25 June 2015).
NCT02374970 {published data only}
    1. NCT02374970. Transversus abdominis muscular training and chronic low back pain. (accessed 25 June 2015).
NCT02398760 {published data only}
    1. NCT02398760. Relationship between clinical tests and clinical outcomes after motor control exercises intervention. (accessed 25 June 2015).
Nelson 1995 {published data only}
    1. Nelson BW, O'Reilly E, Miller M, Hogan M, Wegner JA, Kelly C. The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1‐year follow up. Orthopedics 1995;18:971‐81.
Nelson‐Wong 2009 {published data only}
    1. Nelson‐Wong E. Biomechanical predictors of functionally induced low back pain, acute response to prolonged standing exposure, and impact of a stabilization‐based clinical exercise intervention. Dissertation.. University of Waterloo (Canada), Waterloo, Ontario, Canada: University of Waterloo; 2009.
Niemisto 2003 {published data only}
    1. Niemisto L, Lahtinen‐Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 2003;28:2185‐91.
Niemisto 2004 {published data only}
    1. Niemisto L, Sarna S, Lahtinen‐Suopanki T, Lindgren KA, Hurri H. Predictive factors for 1‐year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone. Journal of Rehabilitation Medicine 2004;36:104‐9.
Niemisto 2005 {published data only}
    1. Niemisto L, Rissanen P, Sarna S, Lahtinen‐Suopanki T, Lindgren KA, Hurri H. Cost‐effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2‐year follow‐up. Spine 2005;30:1109‐15.
Norris 2008 {published data only}
    1. Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complementary Therapies in Clinical Practice 2008;14:255‐63.
O'Sullivan 1997 {published data only}
    1. O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 1997;22:2959‐67.
Oguzhan 2011 {published data only}
    1. Oguzhan H, Ozyurek S, Kaya E. Effectiveness of back school program to quality of life and disability in patients with chronic low back pain. European Journal of Pain Supplements. Conference: 7 Congress of the European Federation of Pain Chapters: Pain in Europe VII, EFIC. Hamburg, Germany, 2011.
Ota 2011 {published data only}
    1. Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality of life. Journal of Physical Therapy Science 2011;23:679‐81.
Pereira 2010 {published data only}
    1. Pereira NT, Ferreira LAB, Pereira WM. Effectiveness of segmental stabilization exercises on mechanical‐postural chronic low back pain [Efetividade de exercícios de estabilização segmental sobre a dor lombar crônica mecânico‐postural]. Fisioterapia em Movimento 2010;23:605‐14.
Puntumetakul 2013 {published data only}
    1. Puntumetakul R, Areeudomwong P, Emasithi A, Yamauchi J. Effect of 10‐week core stabilization exercise training and detraining on pain‐related outcomes in patients with clinical lumbar instability. Patient Preference and Adherence 2013;7:1189‐99.
Rabin 2014 {published data only}
    1. Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A clinical prediction rule to identify patients with low back pain who are likely to experience short‐term success following lumbar stabilization exercises: a randomized controlled validation study. Journal of Orthopaedic & Sports Physical Therapy 2014;44:6‐B13.
Rasmussen‐Barr 2003 {published data only}
    1. Rasmussen‐Barr E, Nilsson‐Wikmarn L, Arvidsson I. Stabilizing training compared with manual treatment in sub‐acute and chronic low‐back pain. Manual Therapy 2003;8:233‐41.
Rasmussen‐Barr 2009 {published data only}
    1. Rasmussen‐Barr E, Ang B, Arvidsson I, Nilsson‐Wikmar L. Graded exercise for recurrent low‐back pain: a randomized, controlled trial with 6‐, 12‐, and 36‐month follow‐ups. Spine 2009;34:221‐8.
Rhee 2012 {published data only}
    1. Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Medical Science Monitor 2012;18:CR174‐81.
Riipinen 2005 {published data only}
    1. Riipinen M, Niemisto L, Lindgren KA, Hurri H. Psychosocial differences as predictors for recovery from chronic low back pain following manipulation, stabilizing exercises and physician consultation or physician consultation alone. Journal of Rehabilitation Medicine 2005;37:152‐8.
Rydeard 2006 {published data only}
    1. Rydeard R, Leger A, Smith D. Pilates‐based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy 2006;36:472‐84.
Saner 2011 {published data only}
    1. Saner J, Kool J, Bie RA, Sieben JM, Luomajoki H. Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial. BMC Musculoskeletal Disorders 2011;12:207. [DOI: 10.1186/1471-2474-12-207]
Saner 2015 {published data only}
    1. Saner J, Kool J, Sieben JM, Luomajoki H, Bastiaenen CH, Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: a randomised controlled trial with one‐year follow‐up. Manual Therapy 2015 Feb 26 [Epub ahead of print].
Shakeri 2013 {published data only}
    1. Shakeri H, Fathollahi Z, Karimi N, Arab AM. Effect of functional lumbar stabilization exercises on pain, disability, and kinesiophobia in women with menstrual low back pain: a preliminary trial. Journal of Chiropractic Medicine 2013;12:160‐7.
Shaughnessy 2004 {published data only}
    1. Shaughnessy M, Caulfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. International Journal of Rehabilitation Research 2004;27:297‐301.
Shnayderman 2013 {published data only}
    1. Shnayderman I, Katz‐Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation 2013;27:207‐14.
Smeets 2009 {published data only}
    1. Smeets RJEM. Do lumbar stabilising exercises reduce pain and disability in patients with recurrent low back pain?. Australian Journal of Physiotherapy 2009;55:138.
Smith 2011 {published data only}
    1. Smith D, Bissell G, Bruce‐Low S, Wakefield C. The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain. Journal of Back and Musculoskeletal Rehabilitation 2011;24:241‐9.
Sokunbi 2008 {published data only}
    1. Sokunbi O, Watt P, Moore A. A randomised controlled trial (RCT) on the effects of frequency of application of spinal stabilisation exercises on multifidus cross sectional area (MFCSA) in participants with chronic low back pain. Physiotherapy Singapore 2008;11:9‐16.
Stankovic 2012 {published data only}
    1. Stankovic A, Lazovic M, Kocic M, Dimitrijevic L, Stankovic I, Zlatanovic D, et al. Lumbar stabilization exercises in addition to strengthening and stretching exercises reduce pain and increase function In patients with chronic low back pain: randomized clinical open‐label study. Turkish Journal of Physical Medicine and Rehabilitation 2012;58:177‐83.
Streicher 2014 {published data only}
    1. Streicher H, Matzold F, Hamilton C, Wagner P. Comparison of group motor control training versus individual training for people suffering from back pain. Journal of Bodywork and Movement Therapies 2014;18:489‐96.
Stuge 2004 {published data only}
    1. Stuge B, Laerum E, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 2004;29:359.
Suni 2006 {published data only}
    1. Suni J, Rinne M, Natri A, Statistisian MP, Parkkari J, Alaranta H. Control of the lumbar neutral zone decreases low back pain and improves self‐evaluated work ability: a 12‐month randomized controlled study. Spine 2006;31:E611‐20.
Teyhen 2010 {published data only}
    1. Teyhen DS, Usalis J, Szymanek EB, Paschall JC, Meagher MS, Harvey AD, et al. Rehabilitative ultrasound imaging assessment of the lumbar multifidus during stabilization exercises in healthy adults. Journal of Orthopaedic & Sports Physical Therapy 2010;40:A39.
Torstensen 1998 {published data only}
    1. Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self‐exercise in patients with chronic low back pain. A pragmatic, randomized, single‐blinded, controlled trial with 1‐year follow‐up. Spine 1998;23:2616‐24.
Trampas 2014 {published data only}
    1. Trampas A, Mpeneka A, Malliou V, Godolias G, Vlachakis P. Immediate effects of core stability exercises and clinical massage on dynamic balance performance of patients with chronic specific low back pain. Journal of Sport Rehabilitation 2014 Dec 4 [Epub ahead of print].
Tsauo 2009 {published data only}
    1. Tsauo JY, Chen WH, Liang HW, Jang Y. The effectiveness of a functional training programme for patients with chronic low back pain – a pilot study. Disability and Rehabilitation 2009;31:1100‐6.
Unsgaard‐Tondel 2010 {published data only}
    1. Unsgaard‐Tondel M, Fladmark AM, Salvesen O, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1‐year follow‐up. Physical Therapy 2010;90:1426‐40.
Vasseljen 2010 {published data only}
    1. Vasseljen O, Fladmark AM. Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients. Manual Therapy 2010;15:482‐9.
Vasseljen 2012 {published data only}
    1. Vasseljen O, Unsgaard‐Tondel M, Westad C, Mork PJ. Effect of core stability exercises on feed‐forward activation of deep abdominal muscles in chronic low back pain. Spine 2012;37:1101‐8.
Wang 2012 {published data only}
    1. Wang X, Zheng J, Bi X, Liu J. Effect of core stability training on patients with chronic low back pain. HealthMED 2012;6:754‐9.
Willemink 2012 {published data only}
    1. Willemink MJ, Es HW, Helmhout PH, Diederik AL, Kelder JC, Heesewijk JP. The effects of dynamic isolated lumbar extensor training on lumbar multifidus functional cross‐sectional area and functional status of patients with chronic nonspecific low back pain. Spine 2012;37:E1651‐8.
Williamson 2008 {published data only}
    1. Williamson W. Effect of supervised and directed exercise on low back pain and functional activity. Dissertation.. Oklahoma State University, Stillwater, Oklahoma: Oklahoma State University; 2008:118.
Xueqiang 2012 {published data only}
    1. Xueqiang W, Jiejiao Z, Xia B, Jing L. Effect of core stability training on patients with chronic low back pain. HealthMED 2012;6:759.
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    1. Yang EJ, Park WB, Shin HI, Lim JY. The effect of back school integrated with core strengthening in patients with chronic low‐back pain. American Journal of Physical Medicine & Rehabilitation 2010;89:744‐54.
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    1. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low‐back pain: a randomized trial. Spine 2004;29:9‐16.
Yoo 2012 {published data only}
    1. Yoo YD, Lee YS. The effect of core stabilization exercises using a sling on pain and muscle strength of patients with chronic low back pain. Journal of Physical Therapy Science 2012;24:671‐4.
You 2014 {published data only}
    1. You JH, Kim SY, Oh DW, Chon SC. The effect of a novel core stabilization technique on managing patients with chronic low back pain: a randomized, controlled, experimenter‐blinded study. Clinical Rehabilitation 2014;28:460‐9.
Zhang 2015 {published data only}
    1. Zhang Y, Tang S, Chen G, Liu Y. Chinese massage combined with core stability exercises for nonspecific low back pain: a randomized controlled trial. Complementary Therapies in Medicine 2015;23:1‐6.
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Menezes Costa 2009
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Source: PubMed

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