Comparison of Moderate Load Eccentric Core Exercises and Pilates in Patients With Non-Specific Low Back Pain

Low back pain (LBP) is the most prevalent musculoskeletal condition worldwide, affecting an estimated 619 million people and ranking among the leading causes of disability across all ages. It reduces quality of life, productivity, and mental well-being, creating a major socioeconomic burden. The biopsychosocial model describes LBP as a multifactorial disorder influenced by biological, psychological, and social factors, emphasizing the need for interdisciplinary management. According to the WHO, LBP is defined as pain occurring between the 12th rib and inferior gluteal folds, with or without referred pain, and is classified as acute (<6 weeks), subacute (6-12 weeks), or chronic (>12 weeks).

Most LBP is nonspecific (≈90%), with no structural cause, and influenced by inactivity, obesity, smoking, and psychosocial stress. In 2019, LBP ranked 6th in DALYs for females, highlighting a greater burden among women. Impaired trunk muscle activation and proprioception contribute to motor control deficits, abnormal recruitment patterns, and recurrent pain. Core musculature plays a central role: Bergmark classified spinal muscles into deep stabilizers (e.g., multifidus, transversus abdominis) and superficial movers (e.g., extensors), both essential for spinal stability. Weakness of extensors predisposes to initial episodes of LBP, while dysfunction of deep stabilizers is associated with chronicity. Exercise therapy is a key intervention. Eccentric training has gained attention for superior neuromuscular adaptations, increasing strength, muscle fiber size, and coordination, with evidence from athletic populations showing functional benefits beyond concentric training. Pilates provides a holistic approach emphasizing controlled movement, breathing, and core activation, improving alignment, flexibility, proprioception, and quality of life. Core stabilization exercises (CSE) specifically target proprioception and motor control, reducing lumbar joint position error, pain, and disability.

Several randomized controlled trials support these interventions. Puntumetakul et al. reported that CSE significantly reduced lumbar JPE, pain, and disability compared to thermal therapy. Zirek et al. found that six weeks of Pilates decreased pain and disability and improved quality of life in chronic LBP. Su Su Hlaing et al. showed that core stabilization and strengthening improved proprioception and muscular thickness of TrA and multifidi. Antonelli et al. demonstrated that Pilates improved pelvic alignment, trunk stability, and reduced pain. Moradi et al. confirmed that modified Pilates led to greater improvements in motor control, pain, and functional recovery compared to traditional exercises.

Inclusion criteria

• • Adults 18 to 45 years

• Both genders
• Low back (from T12 to buttock line) pain for more than 3 months
• Non-specific low back pain i.e. signs or symptoms not attributable to any specific structure
• Low back pain on 3-8 NPRS

Exclusion criteria

• • Acute flare Low Back Pain

• Low back pain on NPRS (>8)
• Thoracic pain
• Centralization and peripheralization of pain
• Leg symptoms when walking, eased in flexion (Signs of stenosis)
• Pain due to repetitive movement
• Paresthesia/numbness
• Structural deformity (scoliosis, spondylosis, spondylolisthesis)
• Curve reversal
• Pregnancy
• Post-surgery (within 6 months of abdominal, spinal, or lower limb surgery)
• Degenerative or inflammatory spinal diseases
• Malignancy