Dynamic Lumbar Strengthening Exercises Versus Pilates, Combined With Myofascial Release in Non Specific Chronic Low Back Pain

Overview

This randomized controlled trial aims to compare the effectiveness of dynamic lumbar strengthening exercises combined with myofascial release versus Pilates combined with myofascial release in individuals with non-specific chronic low back pain. Non-specific chronic low back pain is one of the most common musculoskeletal disorders affecting adults and is associated with pain, reduced spinal mobility, and functional disability. Exercise-based rehabilitation programs and manual therapy techniques are commonly used to improve functional outcomes in these patients. Dynamic lumbar strengthening exercises focus on improving spinal stability and strengthening trunk musculature, whereas Pilates exercises emphasize core muscle activation, postural control, and controlled movement patterns. Myofascial release is a manual therapy technique used to reduce fascial restrictions, improve soft tissue mobility, and decrease pain. In this randomized controlled trial, a total of 60 participants aged between 25 and 35 years with non-specific chronic low back pain lasting more than three months will be recruited from the Physiotherapy Department of the University of Lahore Teaching Hospital. Participants will be randomly allocated into two groups. Group A will receive dynamic lumbar strengthening exercises combined with myofascial release, while Group B will receive Pilates exercises combined with myofascial release. Both groups will also receive baseline therapy consisting of therapeutic massage, interferential therapy, and therapeutic ultrasound applied to the lumbosacral region. The exercise programs will be conducted for eight weeks on alternate days, with each session lasting approximately 20-25 minutes. Outcome measures will include pain intensity assessed using the Visual Analog Scale (VAS), functional disability measured using the Oswestry Disability Index (ODI), and lumbar range of motion measured using an inclinometer. Assessments will be conducted at baseline before the intervention and after completion of the 8-week intervention period. The findings of this study will help determine which exercise approach combined with myofascial release is more effective in reducing pain, improving functional disability, and enhancing spinal mobility in individuals with non-specific chronic low back pain. The results may contribute to evidence-based physiotherapy management and improve rehabilitation strategies for patients with chronic low back pain.

Non-specific chronic low back pain (NSCLBP) is a prevalent musculoskeletal condition that significantly affects quality of life, physical function, and work productivity. It is characterized by persistent pain in the lumbar region lasting longer than three months without a specific identifiable pathology. Conservative physiotherapy interventions including therapeutic exercises and manual therapy techniques are commonly used to manage symptoms and improve functional outcomes. Dynamic lumbar strengthening exercises are designed to enhance spinal stability by strengthening key trunk muscles such as the erector spinae, rectus abdominis, and other core stabilizers. These exercises improve neuromuscular control, spinal support, and functional movement patterns. Pilates-based exercises, on the other hand, focus on controlled movements, core stabilization, breathing control, and activation of deep stabilizing muscles including the transversus abdominis and multifidus. Myofascial release (MFR) is a manual therapy technique that applies gentle sustained pressure and stretching to fascial tissues to reduce fascial restrictions, improve tissue mobility, and relieve musculoskeletal pain. Combining exercise therapy with myofascial release may enhance therapeutic outcomes in individuals with chronic low back pain. This randomized controlled trial will be conducted at the Physiotherapy Department of the University of Lahore Teaching Hospital. A total of 60 participants aged 25-35 years diagnosed with non-specific chronic low back pain for more than three months will be recruited using convenient sampling. Participants meeting the inclusion criteria will provide written informed consent prior to enrollment. Participants will be randomly allocated into two groups using a computer-generated randomization method: Group A: Dynamic lumbar strengthening exercises combined with myofascial release. Group B: Pilates exercises combined with myofascial release. Both groups will receive baseline treatment consisting of therapeutic massage techniques (effleurage, petrissage, stripping, friction, and tapotement), interferential therapy, and therapeutic ultrasound applied to the lumbosacral region. The exercise intervention will be conducted for eight weeks on alternate days, with each session lasting approximately 20-25 minutes. Dynamic lumbar strengthening exercises will include movements such as bird dog, glute bridge, dead bug, side-lying leg lifts, and modified superman. The Pilates program will include exercises such as pelvic tilts, pelvic curl, modified hundred, single-leg stretch, swimming, and knee folds, performed with emphasis on core activation and controlled breathing. Myofascial release techniques will be applied to the thoracolumbar fascia in the prone position using standardized manual techniques including sustained pressure, longitudinal gliding, and bilateral or unilateral fascial stretching. Outcome measures will include pain intensity measured using the Visual Analog Scale (VAS), functional disability assessed using the Oswestry Disability Index (ODI), and lumbar range of motion measured using an inclinometer. Assessments will be conducted at baseline and after completion of the 8-week intervention. The results of this study are expected to provide evidence regarding the comparative effectiveness of dynamic lumbar strengthening exercises versus Pilates exercises when combined with myofascial release for the management of non-specific chronic low back pain.