Effects of conventional core stability and core stability suspension exercises on multifidus muscle endurance, pain and quality of life in people with nonspecific chronic low back pain

Document Type : Original Article


1 University of Isfahan

2 neyshabour

3 Neishaboor


Background and Aim: Low back pain is one of the most common and costly medical problems and the main cause of absenteeism. The aim of this study was to investigate the effect of conventional core stability and special suspension exercises on multifidus muscle endurance, pain and quality of life in non-specific chronic low back pain patients.
Materials and Methods: This is a quasi-experimental study. The statistical population of the study in patients with chronic low back pain referring to neurological and orthopedic clinics as well as the health center of Sama in Neyshabur city, the samples were selected purposefully. The severity of low back pain, multifidus muscle endurance and quality of life was measured using the test and Quebec questionnaire, Electromyography machine during McGill trunk endurance tests and SF-36 questionnaire. These measurements were repeated after 12 weeks of both exercise in both groups.
Results: The results showed that both types of stability training reduced the amount of pain and increase the trunk muscle endurance and have improved the quality of life in terms of physical and mental aspects and physical function in patients with non-specific chronic low back pain. This decline was significant in special suspension exercises.
Conclusion: Core stability exercises can be used more effectively than core stability exercises on fixed surfaces for these patients, given their more favorable effects on patients.


1-Van Tulder MW, Waddell G. Evidence-based medicine for nonspecific low back pain. Best Practice & Research Clinical Rheumatology 2005; 19(4): vii–ix.
2-Stankovic A, Lazovic M, Kocic M, Zlatanovic d. Spinal segmental stabilization exercises combined with traditional strengthening exercise program in patients with chronic low back pain. Acta Fac Med Naiss 2008; 25(3):165-170.
3-Nezhadromezi S, Rahnama N, Habibi A, Negahban H. The effect of core stability training on pain and performance in women patients with non-specific chronic low back pain. JRRS 2012; 8(1): 57-64. (In Persian(.
4-Ferreira M.L, Ferreira P.H, Latimer J, Herbert R, Maher C. Does spinal manipulative therapy help people with chronic low back pain? Aust J Physiol 2002; (48): 277-284.
5-Naderi, A, et al. Effect of kyphosis exercises on physical function, postural control and quality of life in elderly men with hyperkyphosis. Iranian Journal of Ageing 2019; 13 (4): 464-479.
6-Byrne K, Doody C , Hurly DA. Exercise therapy for low back pain: Asmall-scale exploratory survey of current physiotherapy practice in the Republic of Irland acute hospital setting. Man Ther. 2006 Nov;11(4):272-8.
7-Ferreira PH, Ferreira ML, Hodges PW. Change in recruitment of the abdominal muscles in people with low back pain. Spine, 2004; 22: 2560-66.
8-Nouwen A, Bush C. The relationship between paraspinal EMG and chronic low back pain. Pain,1984;20:109-123.
9-Nicolaisen, T. and Jorgensen, K. Trunk strength, back muscle endurance and low back trouble. Scandinavian journal of rehabilitation medicine,1985;17:12-17.
10-Roy SH, De Luca CJ, Casavant DA. Lumbar muscle fatigue and chronic low back pain. Spine 1989;14:992-1001.
11-Mannion A.F, Dolan P. Electromyographic median frequency changes during isometric contraction of the back extension to fatigue.Spine,1994;19:1223-1229.
12-O.R Abdelraouf, A.A Abdel-aziem. The relationship between core endurance and back dysfunction in collegiate male athletes with and without nonspecific low back pain. Int J Sports Phys Ther. 2016 Jun; 11(3): 337–344.
13-Biering- Sorensen F. Physical measurements as risk indicators for low back trouble over a one year period. Spine,1984;9:106-119.
14-Naderi, E. Does obesity affect the efficacy of therapeutic exercise on pain intensity and disability in patients with chronic non-specific low back pain? 2017: 7(4); 71-83.
15-Kinkade S. Evaluation and treatment of acute low back pain. Am FAM Physician 2007; 75(8), 1181-1188.
16-Naderi, Aynollah, and Wendy B. Katzman. "Effects of a 12-Week Global Corrective Exercise Intervention on Sway Back Posture in Young Adults: A Randomized Controlled Trial. International Journal of Health Studies 20195; 5(3):11-16.
17-Javadeian Y, Behtash H, Akbari Mohammad, Taghipour M, Zekavat H. The effects of stabilization exercise on pain, functuional disability and muscle endurance in patients suspected to lumbar segmental instability. Journal of Mazandaran university of medical sciences 2008; 18 (65): 63-73. (In Persian(.
18-Naderi A. The comparison of effects 3 corrective exercise methods on the spinal alignment of the individuals with sway back posture. Journal of applied exercise physiology 2018; 14 (27): 29-48.
19-Behm DG, Drinkwater EJ, Willardson JM and Cowley PM. Canadian Society for Exercise Phytsiology Position Stand: The use of instability to train the core in athletic and non-athletic conditioning. Applied Physiology, Nutrition, and Metabolism 2010; 35: 11-14.
20-Calatayud J, Borreani S, Colado JC, Martín F, Michael E. Rogers ME, Behm DG and Andersen LL. Muscle Activation during Push-Ups with Different Suspension Training Systems. Journal of Sports Science and Medicine 2014; 13: 502-10.
21-Mok NW, Yeung EW, Cho JC and Hui SC. Core muscle activity during suspension exercises. J Sci Med Sport 2014, 986; 6 Pages
22-Anderson K and Behm DG. Trunk muscle activity increases with unstable squat movements. Canadian Society for Exercise Physiology 2005; 30 (1): 33-45.
23-Behm DG. Neuromuscular implications and applications of resistance training. J Strength Cond Res 1995; 9: 264-274.
24-Rutherford OM and Jones DA. The role of learning and co-ordination in strength training. Eur J Appl Physiol 1986; 55: 100-105
25-Dudgeon WD, Herron JM, Aartun JA, Thomas DD, Kelley EP, Scheett TP. Physiologic and metabolic effects of a suspension training workout. International Journal of Sports Science 2015; 5 (2): 65-72.
26-Kim J,Kim Y,  Bae S, Kim K. The Effect of the Neurac Sling Exercise on Postural Balance Adjustment and Muscular Response Patterns in Chronic Low Back Pain Patients. J Phys Ther Sci 2013; 25: 1015–1019.
27-Hodges P, Kaigle Holm A, Holm S, Ekström L, Cresswell A, Hansson T,Thorstensson A.Intervertebral stiffness of the spine is increased by evoked contraction of transverses abdominis and the diaphragm: in vivo porcine studies. Spine 2003; 28:2594-2601.
28-Bressel E, Dolny, DG, Vandenberg C, Cronin J B. Trunk muscle activity during spine stabilization exercises performed in a pool. Phys Ther Sport 2012; 13:67-72.
29-Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B(2005). The Short Form Health Survey (SF- ٣٦): translation and validation study of the Iranian version. Qual Life Res;14: 875-882.
30-Farajzadeh F, Ghaderi F, Asghari Jafarabadi M, Azghani MR, Eteraf Oskoui MA, Rezaie M, Ghorbanpour A. Effects of Mcgill Stabilization Exercise on Pain and Disability, Range of Motion and Dynamic Balance Indices in Patients with Chronic Nonspecific Low Back Pain. J Babol Univ Med Sci 2017; 19(10): 21-27. (In Persian].
31-Kim J,Kim Y,  Bae S, Kim K. The Effect of the Neurac Sling Exercise on Postural Balance Adjustment and Muscular Response Patterns in Chronic Low Back Pain Patients. J Phys Ther Sci 2013; 25: 1015–1019.
32-Karimzadeh F, Letafatkar A, . Effect of Core Stabilization Exercises on Trunk Flexor and Extensor Musculature Endurance and Quality of Life in Mothers with Low Back Pain Who Have Children with Cerebral Palsy. J Rehab Med. 2017; 5(4): 23-35.
33-Distefano LJ, Distefano MJ, Frank BS, Clark MA and Padua DA. Comparison of integrated and isolated training on performance measures and neuromuscular control. J Strength Cond Res 2013; 27 (4): 1083-1090.
34-Byrne JM, Bishop NS, Caines AM, Crane KA, Feaver AM and Pearcey GE. Effect of using a suspension training system on muscle activation during the performance of a front plank exercise. J Strength Cond Res 2014; 28 (11): 3049-3055.
35-Esha A. Bhadauria, Peeyoosha Gurudut. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial Journal of Exercise Rehabilitation 2017;13(4):477-485.
36-Ghorbanpour A, Taghipour M, Ghaderi F. Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain. J. Phys. Ther. Sci. 30: 481–485, 2018.
37-Kornecki S and Zschorlich V. The nature of stabilizing functions of skeletal muscles. J Biomech 1994; 27: 215-225.
38-Eom MY, Chung SH and KO TS. Effects of Bridging Exercise on Different Support Surfaces on the Transverse Abdominis. J Phys Ther Sci 2013; 25: 1343-1346.
39-Saliba SA, Croy T, Guthrie R, Grooms D, Weltman A and Grindstaff TL. Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. North American Journal of Sports Physical Theraphy 2010; 5(2): 63.
40-Hides Ja, Jull GA, Richardson CA. Longterm effects of specific stabilizing exercises for first-episode low back pain. Spine 2001; 26: 243-248.
41-Barr KP, Griggs M. Cadby T. Lumbar stabilization: core concepts and current literature, Part 1.Am J Phys Med Rehabi 2005; 84(6): 473-480.
42-Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med 2005; 142(9): 75-765.
43-Sadek MT. Effect of TRX suspension training as a prevention program to avoid the shoulder pain for swimmers Science, Movement and Health 2016; 16 (2): 222-227.
44-You YL, Su TK, Liaw LJ, Wu WL, Chu IH and Guo LY. The effect of six weeks of sling exercise training on trunk muscular strength and endurance for clients with low back pain. J Phys Ther Sci 2015; 27: 2591-2596.