Chronic low back pain (CLBP) is a debilitating musculoskeletal condition primarily
involving the lumbar spine, sacrum, and the surrounding soft tissue structures often
resulting in the potential for pain radiating to the lower extremities (1) (2). It is
characterized by prolonged pain lasting more than 12 weeks, impacting around 20% of the
worldwide population (3, 4) (5). CLBP significantly impacts the quality of life affecting
activities fundamental to daily living (6). Low back pain (LBP) seems to influence
approximately 60% to 80% of adults in their lifespan, and almost 10% of these individuals
eventually progress towards CLBP (7). The precise underlying cause of CLBP remains
unknown in nearly 85% of cases. However, sedentary living habits, reduced muscle
strength, poor neuromuscular control of deep trunk muscles, and proprioception are
considered some of the risk factors for CLBP, contributing to strain of the lumbar spine,
and leading to functional limitations. (7) (8) (9).
The patient's motivation and active participation are of utmost importance for the
exercise rehabilitation program, decreasing pain and improving functional activities (2)
(10). Commonly adopted exercises like extension and flexion-focused routines as well as
other conservative management including spinal manipulative therapy, pain neuroscience
education (PNE) and acupuncture alleviate pain and disability related to LBP (10) (4).
However, the outcomes are limited and may not target the central issue of impaired lumbar
joint sense, a significant factor in LBP (10) (4).
Core stabilizing exercises are a standard treatment method for CLBP (10) (8). The
exercises involve combined activation and conditioning of the pelvic floor and deep core
muscles, attaching to the thoracolumbar fascia (8) (10) (11). This connection results in
reinforcing the lumbar spine, increasing stability and neuromuscular control through
elevated abdominal pressure, and reducing stress on the lumbar vertebrae (10) (8) (11).
These core stabilizing exercises also help in decreasing pain and stability, further
optimizing proprioception, postural alignment, and stability in patients with LBP (9)
(12). The outcome of one of the studies conducted by O'Sullivan on patients with CLBP
showed that the pain intensity decreased and functional disability improved in patients
in receipt of Transverse Abdominis and Multifidus muscle training for 10 weeks (3).
Proprioception refers to the body's remarkable ability to perceive and sense joint and
body movements, commonly known as kinesthetic, while also perceiving the position of the
body or its segments within space (13) (14). This ability contributes significantly to
muscle awareness and posture, as it involves accumulating information from the
surrounding environment and relaying it to the central nervous system (15) (14) (16).
Reduction in proprioception can cause neuromuscular dysfunction, leading to tense,
imbalanced muscular activation and compromised postural alignment (17). Consequently,
prioritizing the maintenance of proprioception and improving neuromuscular function
becomes crucial for engaging in daily activities without experiencing LBP (16) (14).
Exercises targeting proprioception would comprise balance training, incorporating other
components of balance such as the vestibular system, base of support, and center of
gravity, which stimulates sensory receptors, increasing the perception of joint position
and movement (16) (14). Kinesthetic exercises are essential in motor control and
prediction of proprioceptive responses (18) (19). Calisthenic exercises are a series of
repetitive movements that create numerous muscle contractions that can be isotonic or
isometric. These type of exercises utilizes the body's weight to enhance muscular
strength, endurance, flexibility, proprioception, balance, and coordination, deemed
superior when compared to other exercise programs.
Chronic low back pain stands as a prevalent musculoskeletal condition worldwide, leading
to significant functional limitations and disability. This presents a complex issue
within both healthcare infrastructures and socioeconomic frameworks, necessitating
focused attention and effective solutions. While alternative treatment methods exist,
ongoing research in this area would facilitate the development of additional solutions
for managing low back pain, enhancing the patient's plan of care. A diverse range of
interventions prove beneficial, ultimately offering long-term advantages for patients'
well-being.