Background Low back pain is a large and frequent disorder, with a lifetime prevalence that ranges from 60 to 80%. It is also the main cause of work absence and permanent disability. Exercise therapies appear to be an effective treatment to reduce pain and improve axial performance in patients with chronic low back pain. Yet, abdominal CORE exercises have been incorporated for several years in different rehabilitation programmes. Core muscles, can be divided into two groups: 1- deep muscles or stabilizing muscles (connected to lumbar vertebral segment) and 2- shallow muscles, (not connected to lumbar spine (LS)) but enables additional spinal control. Physical activity focused on these groups of muscles could contribute to pain alleviation and spinal functional improvement.
Objectives To perform a global review (overview) of systematic reviews (SR) to evaluate the beneficial effect of abdominal core stabilization exercises on: 1- pain, 2- LS performance, 3-evaluate adverse effects.
Methods We conducted a global review of systematic reviews (SR), based on 3 online databases: CENTRAL, MEDLINE/Pubmed y PEDro, in English and Spanish. Critical appraisal of included studies was performed by 3 authors independently. AMSTAR system was used to rate the quality of SR.
Results From 17 potential studies found, 9 were included and analysed. Quality of SR was good (AMSTAR 6–11). Metanalysis was performed in 55, 5% of references, Quality of references included in SR were rated on different scales: PeDro (3), Cochrane collaboration (5) and Jadad (1). Globally there were 59 articles included but two were not RCT. Interventions and comparisons assessed were deeply heterogeneous. In addition the study population was small. In general, pain and LS function experimented improvement with CORE stabilization exercises in the short and medium term follow-up, but not in the long term. The types of exercises performed on CORE muscles were drastically heterogeneous.
The five papers were metanalysis was performed, showed a significant improvement of pain and LS function with Motor Control exercises (MCE) when compared to general exercises or minimal interventions or control. This was observed in the short and medium term, but not in the long term. No studies mentioned adverse effects.
Conclusions 1. The reviews analysed showed methodological limitations 2. CORE stabilization exercises improve pain and LS function in the short and medium term, but not in the long term. 3. MCE appear to be better than general exercises, minimal interventions or control for pain and LS function. 4. There is no information about adverse effects. 5. Due to the different exercises programmes performed on CORE muscles, and different comparisons evaluated, the clinical efficacy remain uncertain.
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Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015;27(3):619–22.
Disclosure of Interest None declared