Document Type : Research Paper
Authors
1
PhD. Candidate in Corrective Exercises and Sports Injuries at the University of Isfahan and Faculty Member at the Persian Gulf University, Bushehr, Iran
2
Department of Sport Injuries and Corrective Exercises, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
3
Associate Professor of Biostatistics, Department of Epidemiology and Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
4
Assistant Professor of Neurosurgery, School of Medicine, Neurosciences Research Center Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background and Purpose
Chronic low back pain (CLBP) is a leading cause of disability worldwide, affecting over half a billion people globally. It negatively impacts spinal and adjacent joint movements, resulting in functional limitations. Beyond disability, CLBP imposes substantial economic burdens on individuals and societies, even contributing to a global reduction in productivity. Faulty movement patterns have been associated with CLBP. Individuals with back pain often adopt compensatory movement patterns to perform tasks. Recently, non-invasive and non-pharmacological approaches for managing non-specific CLBP have gained prominence. Experts recommend exercise therapy and manual therapy as the primary treatments for these patients. This study aimed to investigate the effects and durability of a course of Dynamic Neuromuscular Stability (DNS) exercises on basic movement patterns in individuals aged 30–50 with non-specific CLBP.
Methods
Thirty-six individuals with non-specific CLBP were randomly assigned to two groups of 18 participants each after purposeful sampling. Pain intensity was assessed using the Visual Analog Scale (VAS), and basic movement patterns were evaluated using the Functional Movement Screen (FMS). After the initial assessment, the control group continued their routine activities, while the exercise group performed exercises based on the DNS approach three times per week (one in-person session and two at-home sessions) for eight weeks.
In the in-person sessions, the trainer demonstrated the correct execution of each position after a five-minute warm-up and provided relevant explanations. Simultaneously, a trainer’s assistance recorded the correct demonstration from multiple angles. Participants then performed the exercises under supervision for 40–50 minutes. After a five-minute cool-down, the trainer scheduled two at-home sessions weekly; participant videos were shared and reviewed. Each in-person session introduced new exercises based on ability and progress, emphasizing joint centration and breathing. Post-tests and follow-ups assessed outcomes.
A mixed-design repeated measures ANOVA (3×2) analyzed interactions, with repeated measures ANOVA evaluating within-group changes and independent t-tests comparing between-group differences at a 0.05 significance level.
Results
Sixteen control and thirteen exercise group participants completed the study. Mauchly’s test confirmed sphericity for pain (X²(2) = 1.85, p = 0.40). A significant time × group interaction occurred (F(2,54) = 3.23, p = 0.05, η² = 0.11). Post-test pain differed significantly between groups (F(1,27) = 11.94, p < 0.01, d = 1.29). Within-group analysis indicated significant pain reduction in the exercise group (F(2,24) = 5.31, p = 0.01, η² = 0.31), but not control (F(2,30) = 0.57, p = 0.57, η² = 0.04). Bonferroni tests showed significant pre-post improvement in the exercise group (p < 0.001), with no significant changes in follow-up comparisons.
For FMS, sphericity was confirmed (X²(2) = 0.35, p = 0.84). Significant time × group interaction was found (F(2,54) = 11.29, p < 0.001, η² = 0.29). Post-test FMS scores differed significantly (F(1,27) = 10.23, p < 0.01, d = -1.19). The exercise group showed significant FMS improvement (F(2,24) = 10.99, p < 0.001, η² = 0.48), unlike control (F(2,30) = 2.75, p = 0.08, η² = 0.15). Bonferroni tests mirrored pain outcomes.
Conclusion
DNS exercises significantly improved pain and movement patterns in individuals with non-specific CLBP. The benefits persisted after a two-month detraining period, with a nonsignificant slight decline. DNS likely enhances core stability via subcortical reflex mechanisms, restoring functional stability and natural movement patterns stored in the central nervous system. As motor control training, DNS shows superior efficacy versus traditional therapy for this condition. Therefore, it is recommended for managing non-specific chronic low back pain.
Article Message
Low back pain is a major disability cause globally with broad health and economic impacts. Therapeutic exercise is a safe, non-invasive management method. This study shows DNS exercises improve pain and movement, emphasizing the importance of ongoing activity to sustain benefits.
Ethical Considerations
Informed consent was obtained, with confidentiality assured and participant rights respected. Ethics approval was granted by University of Isfahan (IR.UI.REC.1400.119), and the trial registered as IRCT20240107060646N1.
Authors’ Contributions
Alireza Rabieezadeh: Study conceptualization, exercise protocol implementation, data collection
Reza Mahdavinejad: Supervisory role, defining aims and review
Morteza Sadehi: Data analysis and interpretation
Meysam Adimi: Participant recruitment and identification
Conflict of Interest
Supported by the Center for Strategic Studies and Research, Ministry of Sport and Youth.
Acknowledgments
Gratitude is extended to all study participants.
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