Extended Abstract
Background and Purpose
Chronic low back pain (CLBP) is a leading cause of disability worldwide, affecting over half a billion people globally. It negatively impacts spinal and adjacent joint movements, resulting in functional limitations. Beyond disability, CLBP imposes substantial economic burdens on individuals and societies, even contributing to a global reduction in productivity. Faulty movement patterns have been associated with CLBP. Individuals with back pain often adopt compensatory movement patterns to perform tasks. Recently, non-invasive and non-pharmacological approaches for managing non-specific CLBP have gained prominence. Experts now recommend exercise therapy and manual therapy as the primary treatments for these patients. This study aimed to investigate the effects and durability of a course of Dynamic Neuromuscular Stability (DNS) exercises on basic movement patterns in individuals aged 30–50 with non-specific CLBP.
 
Methods
Thirty-six individuals with non-specific CLBP were randomly assigned to two groups of 18 participants each after purposeful sampling. Pain intensity was assessed using the Visual Analog Scale (VAS), and basic movement patterns were evaluated using the Functional Movement Screen (FMS). After the initial assessment, the control group continued their routine activities, while the exercise group performed exercises based on the DNS approach three times per week (one in-person session and two at-home sessions) for eight weeks.
In the in-person sessions, the trainer demonstrated the correct execution of each position after a five-minute warm-up and provided relevant explanations. Simultaneously, a trainer’s assistance recorded the correct demonstration of movements from various angles. Then, all participants performed the exercise protocol under the supervision of the trainer (40–50 minutes). After a five-minute cool-down at the end of the session, the trainer arranged a schedule for two at-home sessions with the participants on Saturday and Monday of each week. The recorded videos were sent to a dedicated WhatsApp group. At the beginning of each in-person session (every Thursday), after the warm-up and with a focus on joint centration and correct breathing, new exercises were introduced based on participant abilities and progress. Post-tests and follow-up assessments were conducted on both groups.
A mixed-design repeated measures ANOVA (3×2) was used to analyze interaction effects. In case of interaction effects, repeated measures ANOVA was used to examine within-group changes, and independent t-tests were used to compare between-group differences at the significance level of 0.05.
Results
Sixteen participants in the control group and thirteen participants in the exercise group completed the study. Mauchly's test of sphericity indicated the similarity of pain variances between the two groups (X² (2) = 1.85, P = 0.40). Mixed-design analysis of variance revealed a significant time × group interaction (F (2,54) = 3.23, P = 0.05, η² = 0.11). Intergroup comparisons indicated a significant difference in pain between the two groups in the post-test (F (1,27) = 11.94, P < 0.01, d = 1.29). For detailed examination of the interaction effect, repeated measures ANOVA was used for each group. The results demonstrated a significant trend in pain changes in the exercise group (F (2,24) = 5.31, P = 0.01, η² = 0.31), but not in the control group (F (2,30) = 0.57, P = 0.57, η² = 0.04). Bonferroni post hoc test revealed a significant difference between pre-test and post-test in the exercise group (P < 0.001), with no significant differences between pre-test and follow-up or post-test and follow-up (P > 0.05).
In assessing FMS, Mauchly’s test indicated the similarity of variances between groups (X² (2) = 0.35, P = 0.84). Mixed-design ANOVA revealed a significant time × group interaction (F (2,54) = 11.29, P ˂ 0.001, η² = 0.29). Intergroup comparisons indicated a significant difference in FMS between groups in the post-test (F (1,27) = 10.23, P < 0.01, d = -1.19). Repeated measures ANOVA demonstrated a significant trend in FMS changes in the exercise group (F (2,24) = 10.99, P ˂ 0.001, η² = 0.48), but not in the control group (F (2,30) = 2.75, P = 0.08, η² = 0.15). Bonferroni post hoc revealed significant pre-post difference only in the exercise group.
Conclusion
This study demonstrated that DNS exercises significantly improved pain and FMS in individuals with non-specific CLBP. Moreover, the positive effects persisted even after a two-month detraining period, albeit with a slight statistically non-significant decrease. DNS exercises may work by enhancing core stability via reflexive or subcortical mechanisms. DNS places particular emphasis on subcortical levels, aiming to restore functional stability by focusing on core stability and reactivating natural movement patterns stored in the central nervous system. DNS exercises represent motor control training shown to alleviate pain and improve function in non-specific CLBP, often outperforming traditional therapy. Therefore, DNS is recommended for these patients.
Article Message
Chronic low back pain is a leading disability cause worldwide and is associated with adverse health, social, and economic consequences. Therapeutic exercise is non-invasive and safe. This study shows DNS exercises improve pain and functional movements, emphasizing maintenance of physical activity to sustain benefits.
Ethical Considerations
This study obtained written informed consent, ensuring confidentiality and voluntary participation. The Research Ethics Committee of University of Isfahan approved the study (IR.UI.REC.1400.119). This clinical trial is registered under IRCT20240107060646N1.
Authors’ Contributions
·         Alireza Rabieezadeh: Conceptualization, exercise protocol execution, data collection
·         Reza Mahdavinejad: Supervision and manuscript review
·         Morteza Sadehi: Data analysis and interpretation
·         Meysam Adimi: Participant recruitment
Conflict of Interest
Funded by the Center for Strategic Studies and Research of the Ministry of Sport and Youth.
participants.
 
Acknowledgement
The authors would like to express their gratitude to all those who participated in this research for sharing their valuable insights.