Effect of supervised exercise therapy program on the pain, disability, lumbar spine mobility and back muscle endurance in chronic non specific low-back pain patients: a quasi-experimental design

Authors

  • Himanshu M. Pathak Department of Musculoskeletal Physiotherapy, DVVPF’s College of Physiotherapy, Ahmednagar, Maharashtra, India
  • Deepak B. Anap Department of Musculoskeletal Physiotherapy, DVVPF’s College of Physiotherapy, Ahmednagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20260311

Keywords:

Non-specific chronic low back pain, Supervised exercise therapy, Oswestry disability index

Abstract

Background: Chronic non-specific low back pain (CNSLBP) is a prevalent musculoskeletal disorder that leads to pain, functional limitation, and reduced spinal mobility. Exercise therapy is widely recommended; however, the effectiveness of supervised exercise interventions requires further evaluation. This study aimed to determine the effect of supervised exercise therapy on pain, disability, lumbar spine mobility, and back extensor muscle endurance in patients with CNSLBP.

Methods: A quasi-experimental study was conducted on participants diagnosed with chronic non-specific low back pain. All participants underwent a 12-week supervised exercise therapy program that consisted of motor control exercises, strengthening, and stretching exercises. Outcome measures included pain intensity using the visual analogue scale (VAS), disability using the Oswestry disability index (ODI), spinal mobility using Schober’s flexion and extension tests, and back extensor endurance using the Sorenson test. Pre- and post-intervention values were statistically analyzed, with significance set at p<0.05.

Results: Significant reductions were found in mean pain scores (VAS: 56.73 to 31.22, p<0.001) and disability levels (ODI: 24.33 to 12.72, p<0.001). There were notable improvements in back extensor endurance (Sorenson test: 28.68 to 51.27 seconds, p<0.001) and lumbar spine mobility in both flexion (Schober’s flexion: 4.79 to 6.0 cm, p<0.001) and extension (2.8 to 3.8 cm, p<0.001).

Conclusion: Twelve weeks of supervised exercise therapy produced significant improvements in pain reduction, functional ability, lumbar spine mobility, and back extensor endurance among individuals with chronic non-specific low back pain. These findings support the incorporation of supervised exercise programs as an effective therapeutic approach for managing CNSLBP.

Metrics

Metrics Loading ...

References

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-91. DOI: https://doi.org/10.1016/S0140-6736(11)60610-7

Meleger AL, Krivickas LS. Neck and back pain: musculoskeletal disorders. Neurol Clin. 2007;25(2):419-38. DOI: https://doi.org/10.1016/j.ncl.2007.01.006

Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197-223. DOI: https://doi.org/10.1016/S0140-6736(12)61690-0

Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004;4(1):106-15. DOI: https://doi.org/10.1016/S1529-9430(03)00174-8

Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, et al. Core stability exercise versus general exercise for chronic low back pain: a meta-analysis. PLoS One. 2012;7(12):e52082. DOI: https://doi.org/10.1371/journal.pone.0052082

Searle A, Spink M, Ho A, Chuter V. Exercise interventions for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2015;29:1155-67. DOI: https://doi.org/10.1177/0269215515570379

van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):193-204.

Jeong UC, Sim JH, Kim CY, Hwang-Bo G, Nam CW. Effects of gluteus muscle strengthening and lumbar stabilization exercises on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci. 2015;27(12):3813-6. DOI: https://doi.org/10.1589/jpts.27.3813

Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, et al. Comparison of general exercise, motor control exercise, and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain. 2007;131(1-2):31-7. DOI: https://doi.org/10.1016/j.pain.2006.12.008

Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. DOI: https://doi.org/10.1002/14651858.CD009790.pub2

van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):193-204. DOI: https://doi.org/10.1016/j.berh.2010.01.002

Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: a biopsychosocial approach. Musculoskelet Care. 2017;15(4):413-21. DOI: https://doi.org/10.1002/msc.1191

Owen PJ, Miller CT, Mundell NL, Verswijveren S, Tagliaferri SD, Brisby H, et al. Which specific modes of exercise training are most effective for treating low back pain? A network meta-analysis. Br J Sports Med. 2020;54(21):1279-87. DOI: https://doi.org/10.1136/bjsports-2019-100886

Bodes Pardo G, Lluch Girbés E, Roussel NA, Gallego Izquierdo T, Jiménez Penick V, Pecos Martín D. Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: a single-blind randomized controlled trial. Arch Phys Med Rehabil. 2018;99(2):338-47. DOI: https://doi.org/10.1016/j.apmr.2017.10.016

Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009;89:1275-86. DOI: https://doi.org/10.2522/ptj.20090218

Norris CM. La guía completa de los estiramientos. Barcelona: Editorial Paidotribo. 2007.

Kisner C, Colby LA. Therapeutic exercises: foundations and techniques. 5th edition. Philadelphia (PA): F.A. Davis Company. 2007.

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. J Back Musculoskelet Rehabil. 2013;26:37-43. DOI: https://doi.org/10.3233/BMR-2012-0348

Hawker GA, Mian S, Kendzerska T. Measures of adult pain: Visual Analog Scale, Numeric Rating Scale, McGill Pain Questionnaire, Short-Form McGill Pain Questionnaire, Chronic Pain Grade Scale, SF-36 Bodily Pain Scale, and ICOAP. Arthritis Care Res. 2011;63(Suppl 11):S240-52. DOI: https://doi.org/10.1002/acr.20543

Joshi VD, Pai Raiturker PP, Kulkarni AA. Validity and reliability of English and Marathi Oswestry Disability Index (version 2.1a) in Indian population. Spine. 2013;38(11):E662-8. DOI: https://doi.org/10.1097/BRS.0b013e31828a34c3

Biering-Sørensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. 1984;9:106-19. DOI: https://doi.org/10.1097/00007632-198403000-00002

Biering-Sørensen F. Problems in measuring isometric endurance of the back muscles. In: Bendix T, Biering-Sørensen F, Donde R, editors. Back and muscle research. Copenhagen: Dansk Fysiurgisk Selskab; 1983;41-52.

Hansen JW. Postoperative management in lumbar disc protrusions. Acta Orthop Scand Suppl. 1964;71:1-47.

Troup JDG, Chapman AE. Changes in the waveform of the electromyogram during fatiguing activity in the muscles of the spine and hips. Electromyography. 1972;12:347-65.

Tousignant M, Poulin L, Marchand S, Viau A, Place C. The modified–modified Schober test for lumbar flexion in low back pain patients. Disabil Rehabil. 2005;27(10):553-9. DOI: https://doi.org/10.1080/09638280400018411

Yang EJ, Park WB, Shin HI, Lim JY. Effect of back school integrated with core strengthening in chronic low back pain. Am J Phys Med Rehabil. 2010;89(9):744-54. DOI: https://doi.org/10.1097/PHM.0b013e3181e72239

Blanco-Giménez P, Vicente-Mampel J, Gargallo P, Baraja-Vegas L, Bautista IJ, Ros-Bernal F, Barrios C. Clinical relevance of combined exercise treatment in chronic low back pain: a randomized controlled trial. Sci Rep. 2024;14(1):17042. DOI: https://doi.org/10.1038/s41598-024-68192-2

R GV, Mathias L, Ghori MM. Effectiveness of core stabilization and motor control exercises in patients with low back ache. Int J Physiother. 2015;2(3):544-51. DOI: https://doi.org/10.15621/ijphy/2015/v2i3/67029

Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in chronic nonspecific low back pain. Pak J Med Sci. 2017;33(4):1002-6. DOI: https://doi.org/10.12669/pjms.334.12664

Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic strengthening exercises in chronic low back pain. Ann Rehabil Med. 2013;37(1):110-7. DOI: https://doi.org/10.5535/arm.2013.37.1.110

Berry DB, Padwal J, Johnson S, Englund EK, Ward SR, Shahidi B. Effect of high-intensity resistance exercise on lumbar musculature in low back pain patients. BMC Musculoskelet Disord. 2019;20(1):290. DOI: https://doi.org/10.1186/s12891-019-2658-1

Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain. J Orthop Sports Phys Ther. 2019;49(6):464-76. DOI: https://doi.org/10.2519/jospt.2019.8827

Ansari S, Sharma S. Isometric back extensor endurance and chronic low back pain in university athletes. J Sport Rehabil. 2025;34(6):638-43. DOI: https://doi.org/10.1123/jsr.2024-0168

Shaw J, Jacobs JV, Van Dillen LR, Beneck GJ, Smith JA. Understanding the Biering-Sørensen test. J Electromyogr Kinesiol. 2024;74:102854. DOI: https://doi.org/10.1016/j.jelekin.2023.102854

Gou Y, Lei H, Chen X, Wang X. Effects of hamstring stretching on pain and function in low back pain: a systematic review and meta-analysis. SAGE Open Med. 2024;12:20503121241252251. DOI: https://doi.org/10.1177/20503121241252251

Dobija L, Pereira B, Cohen-Aknine G, Roren A, Dupeyron A, Coudeyre E. Immediate effect of passive hamstring stretching in chronic low back pain. Heliyon. 2023;9(9):e19547. DOI: https://doi.org/10.1016/j.heliyon.2023.e19753

Sany SA, Mitsi M, Tanjim T, Rahman M. Effectiveness of aerobic exercise in chronic low back pain: a systematic review. F1000Res. 2023;11:136. DOI: https://doi.org/10.12688/f1000research.75440.2

Costa LOP, Maher CG, McAuley JH, et al. Lumbar stabilization exercises compared with electrotherapeutic modalities for chronic low back pain. Phys Ther. 2009;89(7):817-25.

Javadipour Z, Sedaghati P, Ahmadabadi S. Effects of combining core stability with stretching exercises in chronic nonspecific low back pain. Ann Appl Sport Sci. 2021;9(2):e964. DOI: https://doi.org/10.52547/aassjournal.908

Kim JH, Park HY. Effects of combined hip exercise and passive stretching on pain and disability in older adults with low back pain. Phys Act Nutr. 2022;26(3):16-24. DOI: https://doi.org/10.20463/pan.2022.0014

Downloads

Published

2026-01-31

How to Cite

Pathak, H. M., & Anap, D. B. (2026). Effect of supervised exercise therapy program on the pain, disability, lumbar spine mobility and back muscle endurance in chronic non specific low-back pain patients: a quasi-experimental design. International Journal Of Community Medicine And Public Health, 13(2), 812–819. https://doi.org/10.18203/2394-6040.ijcmph20260311

Issue

Section

Original Research Articles