Core stability versus conventional exercise for treating non-specific low back pain.
Date First Published:
December 9, 2015
Last Updated:
February 17, 2016
Report by:
John Davin and Michael Callaghan., 1st Team Rehabilitation Physiotherapist. Head of Therapies (Manchester United Football Club)
Three-Part Question:
In [patients presenting with low back pain] is [a core stability programme more effective than conventional exercise based therapy] at [decreasing pain, increasing mobility and returning to play].
Clinical Scenario:
A 24 year old male presents with chronic low back pain. Investigations have ruled out any serious disc, joint or bony pathology. Current opinion advocates core stability as the ‘go to’ treatment for this non-specific pain scenario. You wonder if it would be more effective than a conventional exercise programme?
Search Strategy:
MEDLINE (1966-05/2015), CINAHL (1982-05/2015), AMED (1985 – 05/2015) and SPORTDiscus (1830 – 05/2015) and EMBASE (1996 – 05/2015) databases were searched using the OVID interface using the following strategy:
1. Low Back Pain
2. Discogenic
3. Low Back Strain
4. 1 or 2 or 3
5. Core stability
6. Core stabilisation
7. 5 or 6
8. Lumbopelvic control
9. Lumbar pelvic dysfunction
10. Lumbopelvic stabilisation
11. 8 or 9 or 10
12. 4 AND 7 AND 11
The Cochrane Library was also searched using the strategy: low back pain AND exercise
1. Low Back Pain
2. Discogenic
3. Low Back Strain
4. 1 or 2 or 3
5. Core stability
6. Core stabilisation
7. 5 or 6
8. Lumbopelvic control
9. Lumbar pelvic dysfunction
10. Lumbopelvic stabilisation
11. 8 or 9 or 10
12. 4 AND 7 AND 11
The Cochrane Library was also searched using the strategy: low back pain AND exercise
Search Details:
All searches were limited to human AND English language.
Outcome:
Six papers were found which were relevant to the three part question. One of which (Inani and Selkar 2013) was found to be included in one of the systematic reviews and the other was a meta analysis in 2012 (Wand et al) which was superceded by a subsequent meta analysis in 2014 (Smith et al). The four remaining papers were subsequently analysed. There were also 2 Cochrane systematic reviews on LBP and exercise but these were not relevant to the 3 part Q.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The effect of core stability exercise on variations in acceleration of trunk movement, pain, and disability during an episode of acute non-specific low back pain: a pilo Aluko A, DeSouza L, Peacock J. 2012 UK | 33 participants with acute NSLBP Group 1 = Regular exercise & core stability 2 males 15 female 35.8 (SD 9.1) Group 2 = group 1 + specific stabilising exercise 3 males 13 females age 36.2 SD 9.8) |
Level 1b RCT | 1. Pain VAS | 1. NSS | Both groups did core stability type exercises Small sample size and risk of type II statistical error |
| 2. Roland Morriss Disability Questionnaire (RMDQ) | 2.NSS | ||||
| 3. Lumbar Motion Monitor | 3.NSS | ||||
| Core stability exercises for low back pain in athletes: a systematic review of the literature. Stuber KJ, brunoi P, Sajko S, Hayden JA. 2014 Canada | 5 studies 2 RCTs 84 participants |
Systematic review Level 1a |
1. Back pain and disability | 1. No meta analysis | Search criteria only in English language Large Heterogeneity Quality of literature overall was deemed low by authors |
| 2. Function and global health | 2.No meta analysis | ||||
| An update of stabilisation exercises for low back pain: a systematic review with meta-analysis Smith BE, Littlewood,C, May S. 2014 UK | 29 studies included 2,359 participants A discrepancy in the number of participants is because the number is taken from articles found with the paper. - it doesn't include any taken from May & Johnson (2008). To save time the reader was referred to this original review. |
Systematic review Level 1a | 1.Pain VAS | 1.meta analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain | Search criteria only in English language. |
| 2.RMDQ | 2.Difference between groups was clinically insignificant | ||||
| 3.Patient specific functional scale | 3.when compared with alternative forms of exercise no statistical or clinical significance was found between that or core stability exercises | ||||
| 4.Oswestry disability index (ODI) | 4. 1 study showed Group 1 had significantly greater re-injury with 7 athletes (70%) P=0.005. 1 athlete in Group 2 (7.7%). The other no data available. | ||||
| 5.Quality of life health survey | The other no data available. | ||||
| 6.Numerical rating scale for pain | The other no data available. | ||||
| The effects of a novel core stabilisation technique on managing patients with chronic low back pain: a randomised controlled, experimenter blinded study You JH, Kim SY, Oh DW, Chon SC. 2014 South Korea | 40 participants with low back pain 20 experimental mean 50.3 years (SD 9.3) and 20 control 51.3 years (SD 7). men n=19 women n=21 |
Level 1b RCT |
1. ODI | 1 P<0.001 | No intention to treat analysis. |
| 2. RMDQ | 2. P<0.001 | ||||
| 3. VAS | 3. NSS | ||||
| 4. PDI | 4. P<0.001 | ||||
| 5.Pain rating scale | 5. P<0.011 | ||||
| 6.‘Core stability test’ | 6. P<0.001 |
Author Commentary:
There is no conclusive evidence that stabilisation exercises are more effective for low back pain than any other form of active exercise in the short and long term. Core stabilisation exercises need not be the ‘go to’ treatment for low back pain.
Bottom Line:
The perception that a core stability rehab programme will improve low back pain has not yet been proven.
References:
- Aluko A, DeSouza L, Peacock J. . The effect of core stability exercise on variations in acceleration of trunk movement, pain, and disability during an episode of acute non-specific low back pain: a pilo
- Stuber KJ, brunoi P, Sajko S, Hayden JA. . Core stability exercises for low back pain in athletes: a systematic review of the literature.
- Smith BE, Littlewood,C, May S. . An update of stabilisation exercises for low back pain: a systematic review with meta-analysis
- You JH, Kim SY, Oh DW, Chon SC.. The effects of a novel core stabilisation technique on managing patients with chronic low back pain: a randomised controlled, experimenter blinded study
- May S, Johnson R .. Stabilisation exercises for low back pain: a systematic review.
- Inani SB, Selkar SP .. Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial.
- Wang XQ, Zheng JJ, Yu ZW, et al .. A meta-analysis of core stability exercise versus general exercise for chronic low back pain.