Cited by 165Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

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Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain

Rasmussen-Barr, E, Nilsson-Wikmar, L, Arvidsson, I·2003·Manual Therapy

DOI 10.1016/s1356-689x(03)00053-5

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Abstract

The present aim was to compare the effects of stabilizing training with those of manual treatment in patients with sub-acute or chronic low-back pain (LBP). Forty-seven patients were randomized to a stabilizing training group (ST group) or a manual treatment group (MT group). The patients underwent a 6-week treatment programme on a weekly basis. Pain, health and functional disability level at the start of treatment, after treatment, and at 3- and 12-month follow-ups were assessed. In the ST group all assessed variables improved significantly (P<0.05) after the treatment period and were maintained long term. After the treatment period there was a significant difference between the groups in assessed function (P<0.05). More individuals in the ST group had improved than in the MT group. At the 3-month follow-up significantly more improved individuals were evident in the ST group regarding pain, general health and functional disability levels. In the long term, significantly more (P<0.05) patients in the MT group reported recurrent treatment periods. The study did not indicate any clear short-term differences between the groups in the accessed outcome measures. In the long term, however, stabilizing training seemed to be more effective than manual treatment in terms of improvement of individuals and the reduced need for recurrent treatment periods.

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Background
Spinal cord modularity: evolution, development, and optimization and the possible relevance to low back pain in man
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“Motor adaptations initiated during the acute pain period of a low back injury (Brumagne et al. 2004, 2008) may remain in place after injury resolution or elimination of pain and may play a key role in recurrence of symptoms (Hides et al. 1996 2001; Rasmussen-Barr et al. 2003).”
Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF)
Apeldoorn, A. T., Swart, N. M., Conijn, D., Meerhoff, G. A., & Ostelo, R. (2024) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.24.08352-7 · Cited by 36
“…of mobilization and/or manipulation was compared with another intervention aligned with the guideline in the short term (≤4 months) in 21 RCTs, 158, 160, 162, 163, 169, 171, 172, 176, 178, 180, 181, 185, 187, 188, 195, 198, 200, 201, 206, 208, 209 and in the long term (>4 months) in 12 rcts. 158,”
Background
Effectiveness of motor control exercise on non-specific chronic low back pain, disability and core muscle morphological characteristics: a meta-analysis of randomized controlled trials
Zhang, C., Li, Y., Zhong, Y., Feng, C., Zhang, Z., & Wang, C. (2021) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.21.06555-2 · Cited by 30
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A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks' duration
Hettinga, D. M., Jackson, A. E., Moffett, J. K., May, S., Mercer, C., & Woby, S. R. (2007) · Physical Therapy Reviews · doi:10.1179/108331907x222958 · Cited by 26
Moderators of the Effect of Spinal Manipulative Therapy on Pain Relief and Function in Patients with Chronic Low Back Pain
de Zoete, A., de Boer, M. R., Rubinstein, S. M., van Tulder, M. W., Underwood, M. R., Hayden, J. A., Buffart, L. M., & Ostelo, R. (2020) · Spine · doi:10.1097/brs.0000000000003814 · Cited by 27
Over Half of Clinical Trials of Mobilization and Manipulation for Patients With Low Back Pain May Have Limited Real-World Applicability: A Systematic Review of 132 Clinical Trials
Maddox, D., Subialka, J. A., Young, J. L., & Rhon, D. I. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.10962 · Cited by 25
Effectiveness of the Physical Therapy Godelive Denys-Struyf Method for Nonspecific Low Back Pain
Díaz‐Arribas, M. J., Sánchez, M. R., Hervás, P. P., Chicharro, J. L., Carrere, M. T. A., Molina, P. O., & Arbiza, P. A. (2009) · Spine · doi:10.1097/brs.0b013e3181aa2771 · Cited by 25
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Blanco-Gímenez, P., Mampel, J. V., Gargallo, P., Baraja-Vegas, L., Bautista, I. J., Ros‐Bernal, F., & Barrios, C. (2024) · Scientific Reports · doi:10.1038/s41598-024-68192-2 · Cited by 27
“Core stabilization exercises have been shown to be as effective as MT in decreasing disability and improving quality of life 44 .”
Background
Treatment of low back pain: monitoring clinical practice through audit
Sparkes, V. (2005) · Physiotherapy · doi:10.1016/j.physio.2004.10.007 · Cited by 22
Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis
Jenks, A. D., de Zoete, A., van Tulder, M. W., Rubinstein, S. M., International IPD-SMT group, Brønfort, G., Cecchi, F., Ferreira, M., Gudavalli, M. R., Hidalgo, B., et al. (2022) · European Spine Journal · doi:10.1007/s00586-022-07210-1 · Cited by 19
Self-citation
A classification and treatment protocol for low back disorders
Ford, J. J., Richards, M. C., & Hahne, A. J. (2012) · Physical Therapy Reviews · doi:10.1179/1743288x12y.0000000034 · Cited by 18
Audiovisual Biofeedback-Based Trunk Stabilization Training Using a Pressure Biofeedback System in Stroke Patients: A Randomized, Single-Blinded Study
Jung, S., Lee, K., Kim, M.-J., & Song, C. (2017) · Stroke Research and Treatment · doi:10.1155/2017/6190593 · Cited by 17
Efficacy of Manual Therapy versus Conventional Physical Therapy in Chronic Low Back Pain Due to Lumbar Spondylosis. A Pilot Study
Sharma, A., Alahmari, K. A., & Ahmad, I. (2015) · Medical Sciences · doi:10.3390/medsci3030055 · Cited by 17
“Very few studies have looked into the efficacy of manual therapy on chronic low back pain [10–12], and some have found that lumbar mobilization, using the Maitland technique, relieves pain and normalizes function [10,11].”
Background
Sommerfeld Assessment System
Niemier, K., Seidel, W., Ritz, W., Pioch, E., & Werin, A. (2005) · Journal of Orthopaedic Medicine · doi:10.1080/1355297x.2005.11736261 · Cited by 17
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Lanier, V. M., Lang, C. E., & Dillen, L. R. V. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1460627 · Cited by 16
Effects of mechanical horseback riding on the balance ability of the elderly
Kang, K.-Y. (2015) · Journal of Physical Therapy Science · doi:10.1589/jpts.27.2499 · Cited by 15
Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review.
Merepeza, A. (2014) · Europe PMC (PubMed Central) · Cited by 15
Effect of Therapeutic Exercise Versus Manual Therapy on Athletes With Chronic Low Back Pain
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The effects of Gyrotonic expansion system exercise and trunk stability exercise on muscle activity and lumbar stability for the subjects with chronic low back pain
Seo, H.-R., & Kim, T.-H. (2019) · Journal of Exercise Rehabilitation · doi:10.12965/jer.1836512.256 · Cited by 13
“Rasmussen-Barr et al. (2003) reported that the intensity of low back pain in patients who performed a stabilization exercise was lesser than that in patients who only performed spinal manipulation.”
Background
Impact of Pain Neuroscience Education Program in Community Physiotherapy Context on Pain Perception and Psychosocial Variables Associated with It in Elderly Persons: A Ranzomized Controlled Trial
Mampel, J. V., Gargallo, P., Bautista, I. J., Blanco-Gímenez, P., de Bernardo, N., Alonso-Martín, M., Martínez-Soler, M., & Baraja-Vegas, L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191911855 · Cited by 14
“However, this statement should be considered with caution because the minimum clinically important change for pain should be at least 25% [58].”
Background
The Effects of Stabilization Exercise with Abdominal Breath on Balance and Oswestry Disability Index for Low Back Pain Patients
Son, H.-H. (2015) · Journal of the Korean Society of Physical Medicine · doi:10.13066/kspm.2015.10.1.107 · Cited by 13
Effects of Clinic-based and Telerehabilitation-based Motor Control Exercises in Individuals with Chronic Low-back Pain
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“39,40 A study comparing CB, TR-B and home exercise approaches found that pain intensity decreased with all methods, especially CB and TR-B, where reductions exceeded the MCID.”
Terapia com exercício físico na dor lombar
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Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: A systematic review
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ESSOMM European core curriculum and principles of manual medicine
Locher, H. A., Bernardotto, M., Beyer, L., ESSOMM Rome Consensus Group, Acarkan, T., Barth, F., Borgstrøm, H., Bultman, H., Buzhov, B., Okur, S. Ç., et al. (2022) · Manuelle Medizin · doi:10.1007/s00337-022-00886-y · Cited by 11
Movement control impairment as a sub-group of non-specific low back pain : evaluation of movement control test battery as a practical tool in the diagnosis of movement control impairment and treatment of this dysfunction
Luomajoki, H. A. (2010) · UEF eRepo (University of Eastern Finland) · Cited by 11
Spinal manipulative therapy for adults with chronic low back pain
de Zoete, A., Innocenti, T., Petrozzi, M. J., van Middelkoop, M., Assendelft, W. J., de Boer, M. R., van Tulder, M. W., & Rubinstein, S. M. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008112.pub3 · Cited by 11
Exercise Therapy Versus Manual Therapy for the Management of Pain Intensity, Disability, and Physical Function in People With Chronic Low Back Pain: A Systematic Review With Meta‐Analysis and Meta‐Regression
González‐Gómez, L., Moral-Muñoz, J. A., Rosales‐Tristancho, A., Cuevas‐Moreno, A., Cardellat‐González, M., & Rodríguez‐Domínguez, Á. (2025) · European Journal of Pain · doi:10.1002/ejp.70090 · Cited by 12
“However, it introduced two studies in which patients with sub-acute LBP were randomised (Rasmussen-Barr et al. 2003) and a Back School programme was prescribed within the MT protocol (Goldby et al. 2006).”

Authors: Rasmussen-Barr, E., Nilsson-Wikmar, L., & Arvidsson, I.
Affiliations: Karolinska Institutet (SE)
ORCID: Rasmussen-Barr, E
Nilsson-Wikmar, L
Venue: Manual Therapy
Publisher: Elsevier BV
Published: 2003-11
Volume: 8
Issue: 4
Pages: 233-241
ISSN: 1356-689X (ISSN-L)
DOI: 10.1016/s1356-689x(03)00053-5
OpenAlex: W2082024962
Cited by: 165
References: 45
Citations by year: 2026: 1 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 6 · 2016: 6 · 2015: 12 · 2014: 9 · 2013: 13 · 2012: 9
FWCI: 4.39
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Manual Therapy (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Keywords: low back pain, subacute low back pain, chronic low back pain, functional disability, pain, health-related quality of life, long-term outcomes
MeSH terms: Acute Disease, Adult, Chronic Disease, Disability Evaluation, Female, Humans, Male, Middle Aged, Pain Measurement, Time Factors, Treatment Outcome, Patient Satisfaction, Low Back Pain, Manipulation, Spinal, Exercise Movement Techniques

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Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain

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