Efficiency Of Core Stability Exercises For Chronic LBP

Are core stability exercises effective when it comes 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 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 the ineffectiveness of therapy.
  • Koumantakis study 2005. In this study people with LBP were observed for 8 weeks and divided intowards 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


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.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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