Low back pain is defined as pain, increased muscle tension or stiffness localised between
the costal margin and lower gluteal folds and associated with lower extremity pain (1).
Between 70-85% of people experience low back pain throughout their lives. Almost 20% of
these cases become permanent (2). Chronic low back pain (CLBP) is defined as low back
pain lasting longer than three months. It is a worldwide common disease that imposes a
significant medical and economic burden on individuals and society (3). Mechanical low
back pain is defined as a clinical picture that develops as a result of overuse, strain
or traumatisation or deformation of the structures forming the spine. In order to define
low back pain as mechanical, all organic causes such as inflammatory, infectious,
tumoural, metabolic causes, fractures and pain reflected from internal organs should be
excluded (4).
It is very important that CLBP, which is very common in the society and is one of the
most expensive diseases in terms of both labour loss and treatment cost, is treated with
conventional (non-surgical) treatment methods (7). It has been reported that medical,
psychological, physical approaches and multidisciplinary methods are effective in the
treatment of CLBP(13). In the last thirty years, changes have been made in the basic
recommendations in clinical practice guidelines. Self-management, physical, psychological
therapies and some complementary medicine treatments are now given more importance and
pharmacological and surgical treatments are less preferred. Guidelines recommend active
treatments that address psychosocial factors and focus on functional recovery (14).
Within this approach, waist protection training, which is called waist school, is
accepted as an effective and economical method (5).
The lumbar school method was developed by Mariane Zachrisson Forssel in Sweden in 1969
with the aim of managing the patient's current condition and preventing recurrent low
back pain (6). The programme consists of 4 sessions lasting approximately 45 minutes and
each session is organised with theoretical components and includes exercises to improve
mobility (5). Standard training strategies can be used in patients with chronic low back
pain. However, it is not sufficient as a treatment alone. Standard training strategies
should include exercise-related practices (7). Clinical guidelines state that trunk
coordination, strengthening and endurance exercises should be utilised to reduce the
disability in CLBP (7,8). Various therapeutic exercises are applied in clinical practice
for CBLP patients.
Core stabilisation exercises (CSE) are based on a motor learning approach and provide the
activation of the transversus abdominis and lumbar multifidus muscles together. These
deep stabilisation muscles increase intra-abdominal pressure by adhering to the
thoraco-lumbar fascia. It has a firming effect on the lumbar spine. It increases the
segmental stability of the spine (9). In addition, CSE reduces pain by reversing the
pain-related structuring in the motor cortex. It improves muscle strength and improves
neuromuscular control of spinal stability. CSE increases the sense of proprioception and
successfully corrects postural disorders (10).
Although many different interventions are widely used in physiotherapy clinics, there are
few studies evaluating the effects of lumbar school and CSE, and no studies comparing
their effectiveness with each other have been found. Therefore, the aim of the present
study was to investigate the comparative efficacy of lumbar school training or core
stabilisation exercises on pain, mobilisation and quality of life in patients with CBLP.