An update of stabilisation exercises for low back pain: a systematic review with meta-analysis
Open accessAbstract
BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n = 2,258) provided post treatment effect on pain and 24 studies (n = 2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.
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No particular type of exercise has been shown to be superior to another for chronic pain.
“No particular type of exercise has been shown to be superior to another [5, 18]”
From Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. (2018) · cites this paper as [18]
The Results > Pain section reports no clinically significant difference between stabilisation and other exercises, and the Discussion > Summary of main findings says stabilisation offers no long-term benefit over other exercise forms (page numbers unavailable). But the review concerns low back pain, not chronic pain generally, and it found a statistically significant short- and medium-term pain benefit for stabilisation exercises, albeit one it judged clinically insignificant. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStabilisation and core stability exercise were found to be no more effective than other forms of active exercise in the long term.
“Compared to other forms of active exercise, stabilisation and core stability exercise was found to be no more effective than in the long term [7,10].”
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de Bruin, L. J. E., Hoegh, M., Greve, C., & Reneman, M. F. (2024) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2024.11314 · Cited by 5 · see citing works
- Authors
- Smith, B. E., Littlewood, C., & May, S.
- Affiliations
- London Road Community Hospital (GB)
- University of Sheffield (GB)
- Sheffield Hallam University (GB)
- Corresponding author
- Smith, Benjamin E
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2014-12
- Volume
- 15
- Issue
- 1
- Pages
- 416-416
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC4295260
- OpenAlex
- W2069264694
- Cited by
- 207
- References
- 112
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 10 · 2023: 19 · 2022: 24 · 2021: 26 · 2020: 26 · 2019: 21 · 2018: 11 · 2017: 21 · 2016: 19 · 2015: 4
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
- Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- non-specific low back pain, core stability, physiotherapy, exercise therapy, pain, disability, long-term outcomes, treatment effectiveness
- MeSH terms
- Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain
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