Core Stability and Hip Exercise to Improve Nonspecific Low Back Pain

Introduction

• Prevalence of Low Back Pain (LBP): 80% of the population experiences LBP at least once in their lifetime. Approximately 90% of LBP cases are classified as non-specific (NSLBP), meaning the cause cannot be identified clinically.

Core Stability and Hip Exercises

• Core Stability Exercises (CSE): Essential for balancing load in pelvis, spine, and kinetic chain. It helps strengthen core muscles reducing LBP.
• Role of Hip Muscles: Weak hip abductors, extensors, and core muscles cause overactivity in hamstrings, iliopsoas, piriformis, and tensor fasciae latae in NSLBP patients.

Study Design

• Participants: 66 patients diagnosed with NSLBP, aged 30-65, with pain intensity ≥3 on a VAS scale. Randomly divided into three groups:
  • Stretch Group (n=24): Engaged in hip muscle stretching.
  • Strengthen Group (n=22): Focused on hip strengthening involving maximal isometric contraction.
  • Sham Group (n=20): Received gentle skin palpation without a real exercise regimen.
• Duration: All groups participated thrice weekly for 6 weeks, assessing outcomes before and after the intervention.

Outcome Measures

• Physical Function: Pain intensity, lower back instability, hip muscle flexibility.
• Physical Activity: Disability level, balance ability, and quality of life (QOL).

Measurement Techniques

• Pain Intensity: Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst pain).
• Lower Back Instability: Passive Straight Leg Raising Test (PSLRT).
• Hip Muscle Flexibility: Several tests including the Toe-Touch Test (TTT) and modified Thomas test (MTT).
• Disability Level: Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ).
• Balance Ability: One-leg standing test (OLST).
• Quality of Life: SF-36 assessment.

Results

• Significant Improvements:
  • Stretch and Strengthening groups showed greater reductions in pain intensity, disability level, balance ability, and improved QOL compared to Sham group (P < 0.05).
  • Stretch group showed the most significant improvements in lower back instability and hip muscle flexibility.

Specific Findings

• Improvements noted across groups for all outcome measures evaluated.
• Pain intensity dropped significantly across all groups, with the Stretch group reporting a mean reduction of 3.58 points, while Strengthen and Sham groups experienced reductions of 3.75 and 2.93 points respectively.

Discussion

• Core Stability Importance: Core exercises appear to enhance muscle coordination and spinal stability, which directly relates to reduced LBP.
• Muscle Activation: CSE and hip interventions likely improved muscle activation in the core and hip areas, rendering better stability and mobility.
• Stretching vs Strengthening effects: Results indicate that while both stretching and strengthening improve outcomes, stretching had a notably stronger impact on lower back instability and flexibility.

Conclusion

• Effective Interventions: Both CSE and hip muscle exercises (stretching and strengthening) are crucial for managing NSLBP, but stretching increases effectiveness in improving physical function and physical activity.
• Future Research: Recommendations include longer-term follow-ups to assess lasting impacts and additional methods such as ultrasound or EMG for deeper insight into muscle changes post-exercise regimen.

Acknowledgments

• Supported by National Research Foundation of Korea. No conflicting interests.