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

Su Su Hlaing, Rungthip Puntumetakul, Ei Ei Khine, Rose Boucaut, Su Su Hlaing, Rungthip Puntumetakul, Ei Ei Khine, Rose Boucaut

Abstract

Background: Therapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP).

Methods: Thirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m2; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention.

Results: The CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): - 0.295 (- 0.37 to - 0.2), effect size: 1.38, (p < 0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p < 0.05), and percentage change of muscle thickness of TrA and LM (p < 0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p < 0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program.

Conclusion: Despite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP.

Trial registration: Thai Clinical Trial Registry ( TCTR20180822001 ; August 21, 2018).

Keywords: Joint repositioning error; Stabilization exercise; Subacute low back pain; Ultrasound.

Conflict of interest statement

The authors declare that there is no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Measurement position for joint repositioning error. A laser pointer was put 50 cm behind the participants and pointed on the center of the 10 cm tape measure that positioned on first sacral segment (S1)
Fig. 2
Fig. 2
RUSI measurement of the transversus abdominis (TrA) at rest and during abdominal draw in maneuver (ADIM)
Fig. 3
Fig. 3
Measurement of the lumbar multifidus (LM) muscle at rest and during a contralateral arm raise
Fig. 4
Fig. 4
Flow diagram of the participants throughout the study

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