Akhtar et al. (2017) Bhaduria et al. (2017) Areeudomwong et al. (2019) Inani et al. (2017) Hlaing et al. (2021)
Method RCT
Single blinded		 RCT
Single blinded		 RCT
Single blinded		 RCT RCT
Subjects
  • N=120
  • Average age:
    • CSE=46.5
    • CG=45.5
  • N=44
  • Average age:
    • LS= 33
    • DS=37
    • Pilates=35
  • N=45
  • Average age:
    • CSE=24
    • PNF=24
    • CG=24
  • N=30
  • Average age:
    • CSE=28
    • CG=33
  • 36
  • Average age:
  • CSE=35
  • STE=35
Intervention
  • CSE: CSE exercises targeting deep abdominals
  • CG: exercise for flexibility or strength not specific to core muscles
  • Duration: six weeks
  • One session per week with the PT
  • HEP was =2x/week
  • LS: 16 exercises
  • DS: 14 exercises to active erector spinae and RA muscles
  • Pilates: Isometric contractions, breathing, engaging pelvic floor
  • Duration =2x/week for 6 weeks
  • Treatment study program was given for 10 sessions with PT
  • CSE: exercises to recruit multifidus, diaphragm, and pelvic floor
  • PNF: Rhythmic stabilization isometrics, isotonic for trunk muscles and alternating chop and lifts
  • CG: General trunk strengthening exercise program
  • Duration was =3x/week for four weeks; follow up at three months
  • CSE: CSE exercises given in 4 phases of activation, skill precision, superficial/deep muscle co-activation and functional re-education targeting deep core muscles
  • CG: Conventional exercises for LBP to stretch, isometrics, active spine flexion and extension
  • Duration: 3x/week for three months
  • CSE: CSE exercises given in two phases of low load activation of lumbar multifidus and abdominis. Second stage increased accuracy and duration of exercise.
  • STE: Activation of back and abdominals for extension and flexion.
  • Duration: 30-minute sessions, 3x/week for four weeks
Modalities and Tools Used
  • CSE: Ultrasound (3MHz for 10 mins @ 50 %) and sensory TENS (Continuous for 10 mins)
  • CG: Ultrasound (3MHz for 10 mins @ 50%) and TENS (Continuous for 10 mins)
  • *CSE used pressure biofeedback
  • MHP for 15 mins and IFC for 20 mins (4,000Hz with modulation) for all subjects
  • *Pressure biofeedback used for all groups
  • CSE: n/a
  • PNF: n/a
  • CG: 5-10 mins of Ultrasound (1MHz @ continuous 1.5-2.5 W/cm2)
  • *Pressure biofeedback used for CSE group
  • CSE: SWD, intermittent lumbar traction
  • CG: SWD, intermittent lumbar traction
  • Both groups had identical parameters for additional treatments
  • *Pressure biofeedback used for CSE group
Outcome
  • Significantly less pain with CSE (p<0.01)
  • CSE showed greater reduction in pain (p<0.01)
  • Mean VAS change of 3.08 for CSE vs 1.71 for CG
  • LS group had significantly decreased VAS pain (p<0.01), lumbar flexion/extension increased (p<0.01) and greater core strength (p<0.01)
  • DS and Pilates: no significant differences compared to other groups
  • CSE and PNF showed improvement in pain, functional disability (p<0.01)
  • Pain mean difference (NRS scale):
CSE vs CG =2.12
PNF vs CG=1.07
  • Both groups improved from baseline on VAS (p<0.01) and ODI (p<0.01)
  • CSE had mean VAS change of 4.93 vs. CG=4.73
  • Both groups improved in joint reposition error, balance, decreased pain (p<0.05)
  • CSE had mean VAS change of 4.28 vs STE=4.61 (p<0.01)
PEDro Score 5 7 8 5 7