Do Core Stability exercises work in the treatment of Non Specific Low Back Pain (NSLBP) ?
A Physiotherapist in Derby and his colleagues set out to review the literature surrounding the use of stabilisation or ‘core stability’ exercises in patients with back pain. They performed a systematic review of the evidence and included 29 studies.
The review concluded that there is strong evidence that core stability exercises are no better at reducing levels of pain and disability than any other form of exercise in the long term. This study agreed strongly with a previous study in 2008 carried out by a different team. It concluded that although core stability exercises were better than no treatment, they did not appear any better than any other exercise.
This study highlights a real problem when trying to make sense of back pain management research and something I find myself discussing with worried therapists and patients alike. On the face of it, the research seems to show that as long as patients engage in some kind of exercise in combination with treatment, they should benefit, regardless of the type of exercise.
Findings like these have patients asking me whether they are wasting their time going to Pilates or Yoga classes, or whether their previous Physiotherapist had been wasting their time making them spend hours practising with a pressure biofeedback unit. Local Pilates instructors then contact me demanding to know how a Physiotherapist could be involved in research like this which must be wrong because their clients all benefit from Pilates!
In fact from a personal point of view, this feeds into my natural bias against the mass use of core stability exercises as a ‘cure all’ approach to treating back pain. I remember having to endure lectures from core stability converts within my profession on the importance of a perfect isolated Transversus abdominus muscle contraction in my patients. God forbid any patient should be able to do anything more interesting than lying on their back with their knees bent up, whilst trying to work out exactly how to ‘zip up’ or ‘draw in’ for hours on end.
‘Do some gentle exercise, preferably something you enjoy and will be motivated to stick with’ is a simple message I have given many times over to patients. However in truth, whilst this study supports this basic message, it does fail to acknowledge one glaring issue. That is the issue of what is Non Specific Low Back Pain and how should our knowledge of it guide our treatment and advice?
As my last blog piece pointed out, NSLBP is back pain that has no specific cause or disease. That is an awful lot of back pain and of course will encompass many different types. In fact the systematic review I am discussing included patients with chronic pain (pain longer than 3 months) and acute pain (pain less than 3 months), leg pain or no leg pain, pain sitting or pain standing, rich or poor, employed or non employed and so many more variables.
There are so many types and presentations of back pain that clumping them into one big group, whilst simple is also probably not helpful in the end. For example, how do we know that some patients would do brilliantly with core stability exercises whilst others would do better with Tai Chi, jogging, swimming gymnastics or anything else for that matter?
Well, we don’t and that is where so much research is now concentrated. How do we find a better way to classify different types of back pain? If we can, could we better select those patients who will respond well to certain treatments or exercise?
I would suggest that as a patient, when you see a good therapist, you are seeing someone who is using best current research, as well as someone using high quality clinical reasoning to work out what approach should work best for you. It doesn’t make sense to me if a therapist does the same thing with everyone they see, whether that be core stability exercises, acupuncture or manipulation.
“If all you have is a hammer, then everything you see is a nail”.
If you or anyone you know is suffering from low back pain and would like to have a physiotherapy assessment for suitability of physiotherapy treatment, contact us here.
Smith B et al, An update of stabilisation exercises for low back pain: a systematic review with meta-analysis, BMC Musculoskeletal Disorders, 2014, 15-416.