Efficiency Of Core Stability Exercises For Chronic LBP

Are core stability exercises effective when it comes to spinal problems and LBP? Although recommended by many physiatrists in order to facilitate these complications, there exists some doubt, whether these exercises are helpful at all. The treatments of LBP are usually spinal manipulation, mobilization and various types of exercises, and one of the unavoidable advices is also the performance of core stability exercises.

Therefore, it is necessary from the beginning to explain what core stability in the world of physical therapy is. These are exercises that imply, when making certain movements, we brace and pull in abdominal muscles.

Core Stability Exercises

The Connection of Core Stability and LBP

It is believed that, in people who have a problem with LBP, occurs late transversus abdominis muscle action. This muscle is activated just before the movement of the limbs. Our body is a complex mechanism of interrelated parts—if activation of this muscle is delayed, there are pains in the lower back. This is why the core stability exercises are recommended for LBP. Strengthening of the transversus abdominis muscle (TRAM) and its development, could affect that it be activated at the time, which would prevent or reduce already incurred back pains. — (Hodges et al., 1996, 1999; Richardson et al., 1999=)

The Connection of Core Stability and LBP

Although this exercise is often on the list of advice physiatrists, there is little evidence that speaks in favor of its effectiveness—actually, assumptions on which it is based on very wobbly legs.

There are studies that have shown that the delay of activation TRA muscle is normal, even among people who do not have back pain. ((Mannion et al., 2008; O Vasseljen et al., 2009). Furthermore, the delay of this reaction is not quite confirmed even among people with LBP. The whole theory based on the causal assumptions that there is a normal condition in which the body is, and that any abnormalities and change of the normal state lead to illness. This is a quite simple theory which several times fell into the water when biomedical researches are in question.

There are also studies that have shown that strengthening of the TRA has no special effects in people who suffer from LBP. Ottar Vasseljen was, in one of his works 2012, observed the influence of general and sling exercise in reducing back pain, as well as the impact of core stability exercises. After 8 weeks of observation, he came to a conclusion that there is no difference in pain, disability or in onset timing TRA between individuals who had worked core stability exercises and those who did not.

There are also studies that have pointed to the usefulness of core stability exercises for LBP, but many of them are superficial and without sufficient evidence.

  • Some studies have pointed to the effectiveness of core stability exercises in patients with LBP, but without comparisons with the results of other exercises. (Petrofsky (2008) Pensri & Janwantanakul (2012).
  • Ferreira et al. study (2007) included 240 patients who had problems with LBP for at least three months. They were divided into three groups, and each group was treated differently during eight weeks. One doing general exercises, another core stability exercises, and the last doing spinal manipulation. Measured with a Patient-Specific Functional Scale after 8 weeks, patients who are doing core stability exercises had better function, while the pain and disability in all three groups were the same. The results of this study are not valid because the dropout rate in the group that did general exercises was 9%, while in the group of core stability exercises was 19%. Therefore, any conclusions reached must be taken with reserve because a larger number of cancellations points to the ineffectiveness of therapy.
  • Koumantakis study 2005. In this study people with LBP were observed for 8 weeks and divided into two groups. One group had treatments with general exercises, while the second group had, in addition to general exercises, core stability exercises. According to Roland Morris Disability Questionnaire (RMDQ) participants showed greater resistance to core stability exercises than towards general exercises. The percentage of dropouts was high, but it is included in the sensitivity analysis, so these results are more relevant.
  • Cairns et al. (2006) was observed for 12 weeks, persons which have received standard physiotherapy and those who have working core stability exercises, where the participants in both groups could receive a manual therapy or electrotherapy. The percentage of dropouts was very high, and the results showed no significant differences between groups.
  • Similar studies by Muthukrishnan et al. (2010), Rasmussen-Barr et al. (2009) Norris & Matthews (2008) and Gladwell et al. (2006), showed that a significant improvement in the groups which have worked core stability exercises compared to control groups

Conclusion

Based on the above facts and conducted studies, we can reach a conclusion that the core stability exercises do not have an important role in improving health in patients with LBP. Although often recommended by physiatrists, there is no evidence that they are more efficient than general exercise. The treatment of LBP should not be given preference to core stability exercises, but the general exercises and regime exercises.

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