McGill Versus Sahrmann's Exercises for Chronic Non-Specific Low Back Pain

Chronic non-specific low back pain (CNSLBP) is one of the leading causes of disability worldwide and is associated with persistent pain, reduced spinal mobility, impaired motor control, and limitations in daily activities. Unlike specific low back pain, CNSLBP has no identifiable pathological cause, making rehabilitation through exercise therapy the primary treatment approach. Current clinical guidelines recommend exercise-based interventions to improve pain, function, and quality of life; however, there is no consensus regarding the most effective exercise protocol for individuals with chronic non-specific low back pain.

Among the commonly prescribed physiotherapy interventions are the McGill stabilization exercise program and Sahrmann's movement-based exercise protocol. The McGill approach focuses on enhancing spinal stability by improving core muscle endurance and minimizing excessive spinal loading through spine-sparing stabilization exercises. In contrast, Sahrmann's protocol emphasizes correction of movement impairments, restoration of normal lumbopelvic movement patterns, and activation of deep stabilizing muscles to improve motor control and functional movement.

Although both rehabilitation approaches have demonstrated beneficial effects when studied individually, direct comparative evidence regarding their effectiveness in improving pain, lumbar range of motion, and functional disability remains limited. Existing studies have primarily evaluated each intervention separately or compared them with conventional physiotherapy rather than with each other. Consequently, clinicians have limited evidence to guide the selection of the most appropriate exercise protocol for patients with chronic non-specific low back pain.

This randomized controlled trial is designed to compare the clinical effectiveness of McGill stabilization exercises and Sahrmann's movement-based exercise protocol in adults with chronic non-specific low back pain. Clinical outcomes will be evaluated using validated measures of pain intensity, lumbar range of motion, and functional disability before and after the intervention period. The findings are expected to clarify whether one exercise approach provides superior improvements in patient outcomes and functional recovery.

The results of this study will contribute to evidence-based physiotherapy practice by providing comparative evidence on two widely used rehabilitation protocols. Identifying the more effective intervention may assist physiotherapists in selecting appropriate exercise programs, improving clinical decision-making, optimizing rehabilitation outcomes, and supporting the development of standardized conservative management strategies for individuals with chronic non-specific low back pain.

Inclusion criteria

• Adults aged 20-50 years.
• Male and female participants.
• Diagnosed with chronic non-specific low back pain lasting more than 12 weeks.
• Pain intensity of 3-4 on the Numeric Pain Rating Scale (NPRS) at baseline.
• Able and willing to participate in the exercise program and attend all treatment sessions.
• Willing to provide written informed consent.

Exclusion criteria

• History of spinal surgery.
• Presence of neurological deficits.
• Structural spinal deformities.
• Pregnancy or within 6 months postpartum.
• Presence of red flag signs or systemic illness (e.g., fracture, infection, malignancy, inflammatory disorders).
• Individuals unable or unwilling to participate in the exercise program or complete the study protocol.