For all included studies, outcomes were assessed during and/or after intervention only, between 3 and 12 weeks after baseline.42,43,46 None of the studies performed long-term follow-up assessments after their postintervention assessments. Four studies used the visual analog scale (VAS) to measure pain intensity;42,44–46 the remaining study used the Borg Category Ratio Scale.43 One study46 used the Oswestry Disability Index (ODI) and short-form 36 questionnaire (SF-36) in addition to the VAS. Three studies used some form of physical function outcome measure.42,45,46
Control/comparison group interventions also varied widely between the studies—for example, therapeutic ultrasound, short-wave diathermy, and floor-based lumbar strengthening exercises (which could also be considered a form of core stability exercise);45 Souchard postural exercises with stretching and unweighted abdominal and back muscle strengthening exercises (potentially another form of core stability exercise);42 and regular training and recreational activities.43,46 One observational study did not include a control or comparison intervention.44
Two RCTs (75 participants) and 2 nonrandomized trials (69 participants) provided information on the effect of core stability exercises compared with other treatments. One study45 noted statistically significant and clinically important improvements in pain intensity, favoring the core stability intervention group over their conventional treatment group (which included lumbar strengthening). Jackson et al46 noted statistically significant but not clinically important improvements in pain intensity in both of their core stability intervention groups compared with the control group, with no statistically or clinically significant differences noted between the 2 intervention groups. The remaining studies42,43 did not find statistically significant or clinically important differences in pain intensity between their intervention and comparison groups.
Issues with muscular weakness, imbalance, and recruitment specific to the hip and/or core musculature have been implicated among many potential sources of LBP in athletes.49–53 Athletes with a history of LBP are also at increased risk for future LBP.54 Therefore, it seems plausible that core stability exercises would be a potentially suitable intervention to consider for athletes with LBP. Although core stability exercises may be useful in treating athletes with chronic LBP, it cannot be conclusively stated which form(s) of core stability exercise are most effective because the included studies varied.
Among the strengths of this review were the searching of multiple databases and using reference searching, along with authors independently evaluating database search results and assessing the literature for quality and risk of bias, with a third author resolving differences. However, the relatively small number of studies that met the inclusion criteria and the overall low quality of included studies could lead to bias in the conclusions. In addition, the inclusion of nonrandomized comparative studies and uncontrolled studies in this review could potentially be a source of bias. Another limitation was that only articles in English were retrieved. However, as the search strategy was conducted in all languages, such cases should have been identified. It is also possible that there is publication bias with respect to the use of core stability exercises in athletes with LBP, particularly given the popularity of core stability exercises in the lay media and their use among the general population.
The heterogeneity of the included studies (eg, athlete characteristics, nature of the “core stability exercise” interventions) limits the interpretation of the findings of this review and their applicability in clinical practice. It is also acknowledged that some participants in studies evaluating core stability exercises for LBP in the general population may be athletes from different sports and at different levels of competition. However, such studies also include nonathletes and do not specifically analyze the results of athletes versus nonathletes.
Further research is clearly needed on this topic. Researchers and clinicians need to determine whether core stability exercises should be used to treat low back injuries, prevent low back injuries and possible recurrences, or if they should be used for performance enhancement. Perhaps, the role of core stability exercises is a combination of the above. A consistent definition of what comprises a core stability exercise must be used in future research. This could be determined through a consensus study.
Higher-quality adequately powered RCTs are needed to determine which interventions have the greatest effect on athletes with LBP and should compare different forms of core stability exercise, both alone and in combination with other treatments (eg, manual therapies, biopsychosocial interventions, different forms of exercise therapy). The effects of core stability exercises in athletes with LBP of different durations (ie, acute, subacute, or chronic) across different age groups (youths, adults, seniors), from different sports, and at different levels of competition (recreational, amateur, professional), each need to be further evaluated. Continued use of the VAS as an outcome measure is advocated for future research, as well as some form of functional outcome, and a measure of disability due to back pain (eg, ODI). The use of standardized exercise protocols and outcome measurement in future research would be beneficial in allowing for meta-analyses to be performed.
The authors thank and acknowledge Anne Taylor-Vaisey of the Canadian Memorial Chiropractic College and Mary Chipanshi of the University of Regina for their assistance with formulating the search strategy and conducting the literature search.
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Medline Search Strategy
- Athletic performance.
- Athletic injuries.
- Sports injuries.
- 1 or 2 or 3 or 4 or 5.
- Low back pain.
- Lumbar vertebrae.
- Low back pain.
- Lower back pain.
- Lumbar pain.
- 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14.
- Exercise therapy.
- Resistance training.
- Physical therapy modalities.
- Isometric contraction.
- Abdominal muscles.
- Dynamic muscular stabilization techniques.
- Periodized resistance training.
- Periodized musculoskeletal rehabilitation.
- Trunk muscle strength.
- Resistance exercise.
- Segmental muscle control exercise.
- Lumbar extensor strengthening.
- Back strengthening.
- Lumbar strengthening.
- Spine rehabilitation.
- Core exercise.
- Core strength.
- Core stabilization.
- Isometric core exercise.
- 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34.
- 6 and 15 and 35.