Journal Information
Vol. 23. Issue 2.
Pages 181-186 (01 March 2019)
Download PDF
More article options
Vol. 23. Issue 2.
Pages 181-186 (01 March 2019)
DOI: 10.1016/j.bjpt.2018.11.006
Full text access
Evidence of stabilizing exercises for low back- and pelvic girdle pain – a critical review
Britt Stuge
Corresponding author

Correspondence address: Division of Orthopaedic Surgery, Oslo University Hospital, Bygg 72, 2. etg, Pb. 4956 Nydalen, 0424 Oslo, Norway.
Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway

  • The evidence of core stabilization exercises is controversial.

  • Exercises need to be understood in the bio-psycho-social context.

  • Individually tailor the exercises to the patient's needs and capability.

  • Adherence might increase when the patients understand the aim of the exercises.

  • Exercises need to guided and supervised to secure performance and quality.

Article information
Full Text
Download PDF
Figures (1)

Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) have been associated with an alteration in the strategy for lumbopelvic stabilization. Different core stabilization approaches exist, the evidence is however controversial.


This paper discusses how to improve the evidence of exercises for women suffering from LBP and PGP during and after pregnancy. Exercises should be understood in a context, where the bio-psycho-social perspective directs the prescription of exercises, targeting both psychological and physical factors. The type of exercise probably should be individually tailored to the needs and capability of the individual and it is not only about the most appropriate exercise, it is about dosage and delivery of the exercises, and it is about performance. To promote adherence the use of patient preferences, with self-defined movement goals, may be a motivational basis for behavior change. Communication skills may facilitate positive beliefs and provide a motivational foundation for empowerment, self-efficacy and for self-management. To learn by discovery where the patient learns through their own experiences, might motivate the patients to active engagement and to behavioral change. Adherence probably will increase when the patients understand the aim and the rationale behind the exercises they are prescribed. However, with high adherence to exercises that maintains an inappropriate motor pattern, LBP and PGP possibly could proceed into chronicity.


Exercises need to be meaningful to the patient, relevant for daily activities, individualized according to patient preferences, guided and supervised to secure performance and quality.

Low back pain
Pelvic girdle pain
Physical therapy
Full Text

Women with low back pain (LBP) and pelvic girdle pain (PGP) report a significantly lower health-related quality of life than that reported by healthy women.1,2 A major factor affecting the women's quality of life is lack of physical ability and a greater loss of physical condition seems to be not a cause but rather a consequence of LBP and PGP in pregnancy.3 Although exercise is recommended during pregnancy, pregnant women are tending to reduce their levels of physical activity.4,5 Whereas most women recover after delivery, a number of women continue living with disabling PGP for months and years. Discouragement, isolation and loneliness may be part of women's lives with pain and limited physical activity.6

LBP is usually defined as pain between the twelfth rib and the gluteal fold,7 whereas PGP is defined as pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints.8 Even though similar and overlapping features may be ascribed to LBP and to PGP, it is maintained that a distinction should be made.8,9 PGP generally arises in relation to pregnancy and is reported to be the most common condition, affecting 50% of the symptomatic patients. LBP affects about one-third and one-sixth report PGP and LBP combined.10 Women with PGP experience more intense pain and greater disability than women with LBP in pregnancy.11,12

The etiology and pathogenesis of PGP is unclear and probably multifactorial, including psychosocial factors. Underlying causes may include hormonal and biomechanical aspects, inadequate motor control and stress on ligament structures.13 Increased shear forces across the pelvic joints have been suggested to be one factor for pain in women with PGP.8 The pelvis serves to transfer load from the trunk to the legs, and for the load to be effectively transferred and for the shear forces to be minimized across the joints, the pelvis needs to be stabilized. An impaired load transfer during activities may result in overload of the ligaments of the pelvis and hence have an influence on PGP.14,15 Changes in spinal curvature and posture may be caused by pregnancy and both increased lumbar lordosis16 and a flattening of the lumbar spine or a lumbar kyphosis is reported to be prevalent during pregnancy.17,18 Frequent or sustained pain-provoking postures and movements might influence the pelvic ligaments and in turn link to other symptoms.

PGP have been associated with an alteration in the strategy for lumbopelvic stabilization with insufficient as well as excessive motor activation of the lumbopelvic and surrounding musculature.19 Hence, impaired motor control patterns may be a possible mechanism for ongoing pain and disability in patients with persistent PGP.20 Also, positive changes in motor control have been found to be associated with relief of pain and disability.21,22 While the role of muscle function in LBP in the general population is debated, an association between reduced muscle function and LBP and/or PGP in pregnant women is reported.23 In pregnant women with LBP and/or PGP, both lower levels of trunk muscle endurance and hip extension muscle strength24 and increased muscle activity during the active straight leg raise test are reported.25 Consequently, an association between muscle dysfunction and LBP and PGP during and after pregnancy may exist.

Specific exercises for motor control and stability have been recommended for PGP postpartum.8 The level of evidence is, however, limited, as few randomized controlled trials have been performed. The effectiveness of motor control and stability exercises for the treatment of LBP and PGP postpartum has been investigated in one systematic review.26 Different interventions were compared and with no firm conclusion of evidence.22,27–29 Also, group fitness classes for pregnant women showed in a randomized controlled trial no effect on the prevalence of LBP and PGP during pregnancy or postpartum.30

Despite limited evidence of effect, core stabilization exercises have grown in popularity31 and different core stabilization approaches exist.32,33 Exercises on unstable surfaces, as illustrated in Fig. 1, is an example of a stabilizing exercise commonly used and prescribed for LBP and PGP in many countries over the last years. We may however question: Why are patients recommended such exercises? What is the aim of the exercise? Does it help for LBP and PGP? What about the quality of the exercise? Does performance matter? Furthermore, do patients adhere to such exercises and will adherence to exercises be sufficient for reducing LBP and PGP? Finally, what about the evidence?

Figure 1.

Example of a core stabilizing exercise.

ExercisesEvidence of exercises

Exercise may be defined as physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation.34 Supervised exercise therapy has been recommended as first-line treatment for chronic LBP the last 10 years.35 Still, evidence show that exercise therapy only has moderate effect on LBP, no clear evidence of effect on PGP, and it seems like one form of exercise is not superior to other forms of exercises.36–41 However, the last decade stabilizing exercises or motor control exercises has blamed over us worldwide as the choice of optimal exercises for LBP and PGP. Stabilizing exercises has been referred to as exercise interventions that aim to improve function of specific trunk muscles thought to control inter-segmental movement of the spine and enable the patient to regain control and coordination of the spine and pelvis using principles of motor learning.42 Core stabilizing exercises has for years been the focus for researchers, fitness centers, patients and for clinicians. Although stabilizing exercises have become very popular, the evidence is controversial. Some recent reviews conclude that stabilization exercises are more effective than general exercise, while others state the opposite.43–46 Hence, even core stabilization exercises do not give convincing evidence of effect. However, an agreed definition of core stabilization exercises does not exist.

Aim of the exercise

The internationally endorsed Consensus on Exercise Reporting Template (CERT) is a 16-item checklist to improve the reporting of exercise programs and hopefully also the design and implementation of exercise programs.47,48 The CERT has recently shown to have good inter-rater agreement and to comprehensively evaluate reporting of exercise interventions.49 The checklist contains the following 7 categories: materials (what), provider (who), delivery (how), location (where), dosage (when, how much), tailoring (what, how) and compliance (how well/planned and actual). However, as commented by the authors of the CERT an explicit statement of the aim of the exercise, ‘why’ is missing.50 The aim of an exercise probably will influence on the design and the outcomes of an exercise intervention, and the aim of the exercise might be of significant importance for the patient's motivation and hence on adherence.

Consequently, what are the aim and the relevance of stabilizing exercises standing on unstable surfaces? An exercise standing on unstable surfaces, such as in Fig. 1, could be labeled a stabilizing exercise or a motor control exercise. Definitely, subjects standing on unstable surfaces have to activate muscles not to fall off, but is it necessarily an optimal motor control exercise? Could the performance of the exercise be maladaptive to the women's pain behaviors and complaints? Increased co-contraction with hyperactivity of core muscles and excessively guarded spinal movement with inability to relax spinal muscles are reported among LBP patients.51,52 Hence, the value of core stability exercises that promote bracing or excessively increasing trunk muscle activation could be questioned.53 It could also be questioned whether the women illustrated in Fig. 1 are doing the same exercise with similar motor pattern and similar to what is shown by the instructor? Or is it likely that they use different motor patterns? If increased activity of the extensor muscles and a lumbar lordosis increase the LBP for a woman, would we expect an exercise where this motor pattern is maintained, to reduce the woman's LBP? Opposite, if a flexion pattern provokes PGP for a woman will an exercise where she sustains a flexion pattern be a good exercise for her PGP? Probably not.

There is a lack of evidence linking the effects of exercise in LBP to changes in the musculoskeletal system,54,55 but performance of an exercise may result in increased pain or in persistence of pain.56 Quality and performance of exercises are considered as important aspects in reducing LBP and PGP.48,57 Inappropriate exercise can do more harm than good, with the definition of inappropriate varying according to the individual. Subsequently, what about high adherence to inappropriate exercises? It might be that the women stop exercising because they do not understand why they should do the exercise or because it does not reduce their LBP and PGP? And maybe they should be advised to stop, because the exercise maintains their inappropriate motor pattern. Stabilizing exercises could also create negative cognitions about instability and increase fear-avoidance.50

Individualization and adherence

Exercises should be understood in a context, where the bio-psycho-social perspective guides the prescription of exercises, targeting both psychological and physical factors.58 The type of exercise probably should be individually tailored to the needs and abilities of the individual, and it is not only about the most appropriate exercise, it's about dosage (frequency, duration, intensity) and delivery (group, individualized, home-based) of the exercises.36,40,48 And it's about quality (performance, supervision) of the exercise, how are the exercises performed, do the patient need to be supervised?

One randomized controlled trial has shown significant and long-lasting positive effects of a treatment program for postpartum PGP, including stabilizing exercises.2,22 Why did this study show positive effects? This was an individualized and multidimensional treatment program focusing motor control and functional exercises, and necessarily integrated cognitive aspects within a bio-psycho-social framework. The exercises focused gradually progression of motor control and strength, performed without provoking pain, which has been shown to be important for adherence.59 Furthermore, the aim of the exercises had a functional approach based on the women's needs. The women learned to normalize pain provocative daily life activities, postures and movements to avoid flare-ups of pain.

The exercises were individualized and supervised. The aim of the exercise was clear to the patient (whether it was about control, strength or endurance), and performance (how) with relaxation to avoid muscle guarding was emphasized. An exercise diary was used for dosage and to show progression; consequently to increase motivation and adherence, and adherence was surprisingly high. Despite a busy life taking care of children, suffering from persistent pain postpartum, the women reported accomplishing on average 80% of their home based exercise program. And why was that? Adherence is very much about the way the exercises are provided.60 To promote adherence the use of patient preferences, with self-defined movement goals, may be a motivational basis for behavior change.53,60 Other important components are implementation (individually designed, supervised, home based exercises) and performance feedback (correcting movement patterns). Furthermore, communication skills may facilitate positive beliefs and provide a motivational foundation for empowerment, self-efficacy and for self-management and empowerment.61–63

The updated LBP guidelines from the National Institute for Health and Care Excellence (NICE) show a clear emphasis on facilitating self-management strategies.64 The guideline suggests that patient's needs, preferences and capability should be taken into account. It is of significant importance that health care providers not consider themselves as experts or teachers and consider the patients as ‘empty bottles’. Learning by Discovery65,66 encourages active engagement, promotes motivation, and promotes autonomy, responsibility and independence. It develops creativity and problem solving skills and tailoring learning experiences. To learn by discovery hopefully will motivate the patients to active engagement and to behavioral change. The patient learns through their own experiences. For example when a patient reports pain while standing, guiding them to change position and then question if the change influenced on their pain, and if it did, the patient discovers a difference, which probably will motivate them to perform changes during daily life and while performing exercises. In other words, the design of an exercise program probably will influence on program effectiveness.

Design of exercise studies

Today there is a wide variation among studies in how exercises are named and implemented and because most trials do not adequately report intervention details, information can be difficult to obtain.49 When comparing exercise therapy, we might question why studies show controversial results? It could be, because we are comparing ‘apples and pears’? In a study by Macedo et al.,38 it is shown that two studies, by O'Sullivan et al.67 and Stuge et al.,2,22 showed significant and long-term effect of an exercise intervention. What do these two studies have in common? First of all, they included sub-groups of LBP and PGP. Both studies also focused individual exercises incorporated into functionally daily life activities that commonly aggravated the patients’ symptoms, and the exercises were supervised and delivered as home exercises on daily basis.

It has been shown that therapy that is specifically directed at well-defined sub-groups leads to improved effectiveness of interventions.68 Lumping heterogeneous LBP and PGP patients into an exercise study will help in getting sufficient power for the study, but will a “one-size-fits-all” approach be optimal treatment for the individual patient?68,69 It could be questioned whether unidimensional care such as a “stay active” approach will target underlying mechanisms of LBP and PGP? The most effective exercise therapy to improve pain and function in chronic LBP has shown to be individually designed treatment programs that were supervised and delivered as home exercise with regular therapist follow-up to encourage adherence.36 Adherence probably will increase when the patients understand the aim and the rationale behind the individual exercise they are prescribed, but are adherence enough?

With high adherence to exercises that maintains an inappropriate motor pattern, LBP and PGP possibly could proceed into chronicity. Exercises might be labeled motor control exercises, but with an inappropriate performance it may result in stiffness and rigidity, quite commonly seen in patients doing stabilizing exercises. Increased co-contraction of trunk stabilizing muscles during tasks that provoke pain and an inability to relax muscles are reported in both LBP and in PGP.70,71 The exercises may be more about strength than about motor control. Patients may comply with their prescribed exercises; they get strong, but also stiff and rigid and with no improvement in pain and function. Neuromuscular control or core stability is needed to perform daily life activities, but only low levels of muscle contraction are needed to stabilize the spine.72 So, when are patients strong enough? Is it a good choice to continue doing the same exercises when the exercises do not reduce LBP and PGP? Furthermore, which muscles do we need to strengthen?

Bending and lifting are daily functional activities which may be challenging for patients with LBP and PGP. The quadriceps muscle was paid attention to years ago where rehabilitation of low-back-injured workers focused the quadriceps muscles,73,74 and recent studies highlight exercises incorporated into functional tasks.75–77 Most functional tasks involve the use of lower extremities, however it is often seen that women with PGP adapt to an inappropriate motor pattern where they, e.g. reduce using their lower extremities and compensate with the arms when standing up and sitting down on a chair. So, maybe the essential exercise for LBP and PGP is to primarily strengthen the lower extremities, thighs and buttocks? The quadriceps muscle exertion is the weak link for the squat technique74 and squats can be performed as home based exercises incorporated into functional tasks. Not all patients with LBP and PGP will however, benefit equally from exercises,78,79 hence patients should be encouraged to engage in regular exercises they personally enjoy with self-identified functional goals and meaningful movements.53


In conclusion, to increase from moderate to strong evidence of exercises, adherence of exercises is essential. To enhance adherence, exercises need to be meaningful to the patient, relevant for daily activities, individualized according to patient preferences, guided and supervised to secure performance and quality. Speak to the patient's heart and brain and tell them to practice what ‘they want to be good at, and no exercise is better than the way it is performed. Maybe, if mentioned aspects are taken into consideration, future randomized controlled trials will show strong effect of exercise programs for LBP and PGP.

Conflicts of interest

The author declares no conflicts of interest.

C. Olsson, L. Nilsson-Wikmar.
Health-related quality of life and physical ability among pregnant women with and without back pain in late pregnancy.
Acta Obstet Gynecol Scand, 83 (2004), pp. 351-357
B. Stuge, M.B. Veierød, E. Lærum, N. Vøllestad.
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A two-year follow-up of a randomized clinical trial.
Spine (Phila Pa 1976), 29 (2004), pp. E197-E203
E. Thorell, P. Kristiansson.
Pregnancy related back pain, is it related to aerobic fitness? A longitudinal cohort study.
BMC Pregnancy Childbirth, 12 (2012), pp. 30
D.B. Fell, K.S. Joseph, B.A. Armson, L. Dodds.
The impact of pregnancy on physical activity level.
Matern Child Health J, 13 (2009), pp. 597-603
K.M. Owe, W. Nystad, K. Bo.
Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study.
Scand J Med Sci Sports, 19 (2009), pp. 637-645
J. Engeset, B. Stuge, L. Fegran.
Pelvic girdle pain affects the whole life – a qualitative interview study in Norway on women's experiences with pelvic girdle pain after delivery.
BMC Res Notes, 7 (2014), pp. 686
C.E. Dionne, K.M. Dunn, P.R. Croft, et al.
A consensus approach toward the standardization of back pain definitions for use in prevalence studies.
Spine (Phila Pa 1976), 33 (2008), pp. 95-103
A. Vleeming, H.B. Albert, H.C. Ostgaard, B. Sturesson, B. Stuge.
European guidelines for the diagnosis and treatment of pelvic girdle pain.
Eur Spine J, 17 (2008), pp. 794-819
H.C. Ostgaard, G. Zetherstrom, E. Roos-Hansson, B. Svanberg.
Reduction of back and posterior pelvic pain in pregnancy.
Spine (Phila Pa 1976), 19 (1994), pp. 894-900
W.H. Wu, O.G. Meijer, K. Uegaki, et al.
Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence.
Eur Spine J, 13 (2004), pp. 575-589
A. Gutke, H.C. Ostgaard, B. Oberg.
Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning.
Spine (Phila Pa 1976), 31 (2006), pp. E149-E155
H.S. Robinson, A.M. Mengshoel, E.K. Bjelland, N.K. Vollestad.
Pelvic girdle pain, clinical tests and disability in late pregnancy.
Man Ther, 15 (2010), pp. 280-285
P.B. O'Sullivan, D.J. Beales.
Diagnosis and classification of pelvic girdle pain disorders. Part 2: illustration of the utility of a classification system via case studies.
Man Ther, 12 (2007), pp. e1-e12
C.J. Snijders, A. Vleeming, R. Stoeckart.
Transfer of lumbosacral load to iliac bones and legs. 1. Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise.
Clin Biomech (Bristol, Avon), 8 (1993), pp. 285-294
P.H. Eichenseer, D.R. Sybert, J.R. Cotton.
A finite element analysis of sacroiliac joint ligaments in response to different loading conditions.
Spine (Phila Pa 1976), 36 (2011), pp. E1446-E1452
M.E. Franklin, T. Conner-Kerr.
An analysis of posture and back pain in the first and third trimesters of pregnancy.
J Orthop Sports Phys Ther, 28 (1998), pp. 133-138
K. Moore, G.A. Dumas, J.G. Reid.
Postural changes associated with pregnancy and their relationship with low-back pain.
Clin Biomech (Bristol, Avon), (1990), pp. 169-174
N. Okanishi, N. Kito, M. Akiyama, M. Yamamoto.
Spinal curvature and characteristics of postural change in pregnant women.
Acta Obstet Gynecol Scand, 91 (2012), pp. 856-861
P.B. O'Sullivan, D.J. Beales.
Diagnosis and classification of pelvic girdle pain disorders – Part 1: a mechanism based approach within a biopsychosocial framework.
Man Ther, 12 (2007), pp. 86-97
D.J. Beales, P.B. O'Sullivan, N.K. Briffa.
Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects.
Spine (Phila Pa 1976), 34 (2009), pp. 861-870
P.B. O'Sullivan, D.J. Beales.
Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.
Man Ther, 12 (2007), pp. 209-218
B. Stuge, E. Lærum, G. Kirkesola, N. Vøllestad.
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A randomized controlled trial.
Spine (Phila Pa 1976), 29 (2004), pp. 351-359
G.A. Dumas, A. Leger, A. Plamondon, K.M. Charpentier, A. Pinti, M. McGrath.
Fatigability of back extensor muscles and low back pain during pregnancy.
Clin Biomech (Bristol, Avon), 25 (2010), pp. 1-5
A. Gutke, H.C. Ostgaard, B. Oberg.
Association between muscle function and low back pain in relation to pregnancy.
J Rehabil Med, 40 (2008), pp. 304-311
G.M. de, A.L. Pool-Goudzwaard, C.W. Spoor, C.J. Snijders.
The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects.
Man Ther, 13 (2008), pp. 68-74
C.W. Ferreira, F. Alburquerque-Sendin.
Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: a systematic review.
Physiother Theory Pract, 29 (2013), pp. 419-431
J.M. Mens, C.J. Snijders, H.J. Stam.
Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial.
Phys Ther, 80 (2000), pp. 1164-1173
C.H. Bastiaenen, R.A. de Bie, J.W. Vlaeyen, et al.
Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery.
BMC Pregnancy Childbirth, 8 (2008), pp. 19
A. Gutke, J. Sjodahl, B. Oberg.
Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial.
J Rehabil Med, 42 (2010), pp. 929-935
L.A. Haakstad, K. Bo.
Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial.
J Rehabil Med, 47 (2015), pp. 229-234
S.D. Liddle, B.G. David, J.H. Gracey.
Physiotherapists’ use of advice and exercise for the management of chronic low back pain: a national survey.
Man Ther, 14 (2009), pp. 189-196
P. Bruno.
The use of “stabilization exercises” to affect neuromuscular control in the lumbopelvic region: a narrative review.
J Can Chiropr Assoc, 58 (2014), pp. 119-130
J. Brumitt, J.W. Matheson, E.P. Meira.
Core stabilization exercise prescription, part I: current concepts in assessment and intervention.
Sports Health, 5 (2013), pp. 504-509
C.E. Garber, B. Blissmer, M.R. Deschenes, et al.
American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
Med Sci Sports Exerc, 43 (2011), pp. 1334-1359
O. Airaksinen, J.I. Brox, C. Cedraschi, et al.
Chapter 4 European guidelines for the management of chronic nonspecific low back pain.
Eur Spine J, 15 (2006), pp. S192-S300
J.A. Hayden, M.W. van Tulder, G. Tomlinson.
Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.
Ann Intern Med, 142 (2005), pp. 776-785
P.H. Ferreira, M.L. Ferreira, C.G. Maher, R.D. Herbert, K. Refshauge.
Specific stabilisation exercise for spinal and pelvic pain: a systematic review.
Aust J Physiother, 52 (2006), pp. 79-88
L.G. Macedo, R.J. Smeets, C.G. Maher, J. Latimer, J.H. McAuley.
Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review.
Phys Ther, 90 (2010), pp. 860-879
B.T. Saragiotto, C.G. Maher, T.P. Yamato, et al.
Motor control exercise for chronic non-specific low-back pain.
Cochrane Database Syst Rev, (2016), pp. CD012004
R. Shiri, D. Coggon, K. Falah-Hassani.
Exercise for the prevention of low back and pelvic girdle pain in pregnancy: a meta-analysis of randomized controlled trials.
Eur J Pain, 22 (2018), pp. 19-27
M. O’Keeffe, A. Hayes, K. McCreesh, H. Purtill, K. O'Sullivan.
Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis.
Br J Sports Med, 51 (2017), pp. 126-132
J.A. Hides, G.A. Jull, C.A. Richardson.
Long-term effects of specific stabilizing exercises for first-episode low back pain.
Spine (Phila Pa 1976), 26 (2001), pp. E243-E248
X.Q. Wang, J.J. Zheng, Z.W. Yu, et al.
A meta-analysis of core stability exercise versus general exercise for chronic low back pain.
M.G. Bystrom, E. Rasmussen-Barr, W.J. Grooten.
Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis.
Spine (Phila Pa 1976), 38 (2013), pp. E350-E358
B.E. Smith, C. Littlewood, S. May.
An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.
BMC Musculoskelet Disord, 15 (2014), pp. 416
M. Gomes-Neto, J.M. Lopes, C.S. Conceicao, et al.
Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic review and meta-analysis.
Phys Ther Sport, 23 (2017), pp. 136-142
S.C. Slade, C.E. Dionne, M. Underwood, et al.
Consensus on Exercise Reporting Template (CERT): modified Delphi study.
Phys Ther, 96 (2016), pp. 1514-1524
S.C. Slade, C.E. Dionne, M. Underwood, R. Buchbinder.
Consensus on Exercise Reporting Template (CERT): explanation and elaboration statement.
Br J Sports Med, 50 (2016), pp. 1428-1437
S.C. Slade, S. Finnegan, C.E. Dionne, M. nderwood, R. uchbinder.
The Consensus on Exercise Reporting Template (CERT) applied to exercise interventions in musculoskeletal trials demonstrated good rater agreement and incomplete reporting.
J Clin Epidemiol, (2018),
pii: S0895-4356(18)30088-X
P. Kent, P.B. O'Sullivan, J. Keating, S.C. Slade.
Evidence-based exercise prescription is facilitated by the Consensus on Exercise Reporting Template (CERT).
Br J Sports Med, 52 (2018), pp. 147-148
W. Dankaerts, P. O'Sullivan, A. Burnett, L. Straker, P. Davey, R. Gupta.
Discriminating healthy controls and two clinical subgroups of nonspecific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model.
Spine (Phila Pa 1976), 34 (2009), pp. 1610-1618
S. Lewis, P. Holmes, S. Woby, J. Hindle, N. Fowler.
Changes in muscle activity and stature recovery after active rehabilitation for chronic low back pain.
Man Ther, 19 (2014), pp. 178-183
P. Stilwell, K. Harman.
Contemporary biopsychosocial exercise prescription for chronic low back pain: questioning core stability programs and considering context.
J Can Chiropr Assoc, 61 (2017), pp. 6-17
F. Steiger, B. Wirth, E.D. de Bruin, A.F. Mannion.
Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review.
Eur Spine J, 21 (2012), pp. 575-598
A.Y. Wong, E.C. Parent, M. Funabashi, G.N. Kawchuk.
Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review.
L.V. Lima, T.S.S. Abner, K.A. Sluka.
Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena.
J Physiol, 595 (2017), pp. 4141-4150
M. Friedrich, T. Cermak, P. Maderbacher.
The effect of brochure use versus therapist teaching on patients performing therapeutic exercise and on changes in impairment status.
Phys Ther, 76 (1996), pp. 1082-1088
A. Hall, H. Richmond, B. Copsey, et al.
Physiotherapist-delivered cognitive-behavioural interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review.
Disabil Rehabil, 40 (2018), pp. 1-9
K. Jack, S.M. McLean, J.K. Moffett, E. Gardiner.
Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.
Man Ther, 15 (2010), pp. 220-228
E. Aboagye.
Valuing individuals’ preferences and health choices of physical exercise.
Pain Ther, 6 (2017), pp. 85-91
C. Lonsdale, A.M. Hall, A. Murray, et al.
Communication skills training for practitioners to increase patient adherence to home-based rehabilitation for chronic low back pain: results of a Cluster Randomized Controlled Trial.
Arch Phys Med Rehabil, 98 (2017), pp. 1732-1743
P.J.A. Nicolson, K.L. Bennell, F.L. Dobson, G.A. Van, M.A. Holden, R.S. Hinman.
Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis.
Br J Sports Med, 51 (2017), pp. 791-799
B. Stuge, A. Bergland.
Evidence and individualization: important elements in treatment for women with postpartum pelvic girdle pain.
Physiother Theory Pract, 27 (2011), pp. 557-565
Low Back Pain and Sciatica in Over 16s: Assessment and Management.
National Institute for Health and Care Excellence: Clinical Guideline, (2016),
J.S. Bruner.
The act of discovery.
Harv Educ Rev, 31 (1961), pp. 21-32
J.S. Bruner.
The Process of Education.
Harvard University Press, (2009),
P.B. O'Sullivan, G.D. Phyty, L.T. Twomey, G.T. Allison.
Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis.
Spine (Phila Pa 1976), 22 (1997), pp. 2959-2967
N.V. Karayannis, G.A. Jull, P.W. Hodges.
Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey.
BMC Musculoskelet Disord, 13 (2012), pp. 24
N.E. Foster, J.C. Hill, E.M. Hay.
Subgrouping patients with low back pain in primary care: are we getting any better at it?.
W. Dankaerts, P. O'Sullivan.
The validity of O'Sullivan's classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): overview of a series of studies and review of the literature.
B. Stuge, K. Saetre, H.B. Ingeborg.
The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls.
Man Ther, 18 (2013),
E. Lederman.
The myth of core stability.
J Bodyw Mov Ther, 14 (2010), pp. 84-98
J.H. Trafimow, O.D. Schipplein, G.J. Novak, G.B. Andersson.
The effects of quadriceps fatigue on the technique of lifting.
Spine (Phila Pa 1976), 18 (1993), pp. 364-367
K.B. Hagen, K. Harms-Ringdahl.
Ratings of perceived thigh and back exertion in forest workers during repetitive lifting using squat and stoop techniques.
Spine (Phila Pa 1976), 19 (1994), pp. 2511-2517
P. O'Sullivan.
Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism.
Man Ther, 10 (2005), pp. 242-255
K.V. Fersum, W. Dankaerts, P.B. O'Sullivan, et al.
Integration of subclassification strategies in randomised controlled clinical trials evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review.
Br J Sports Med, 44 (2010), pp. 1054-1062
K. O'Sullivan, W. Dankaerts, L. O'Sullivan, P.B. O'Sullivan.
Cognitive functional therapy for disabling nonspecific chronic low back pain: multiple case–cohort study.
Phys Ther, 95 (2015), pp. 1478-1488
G.E. Hicks, J.M. Fritz, A. Delitto, S.M. McGill.
Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program.
Arch Phys Med Rehabil, 86 (2005), pp. 1753-1762
N.E. Foster, J.R. Anema, D. Cherkin, et al.
Prevention and treatment of low back pain: evidence, challenges, and promising directions.
Lancet, 391 (2018), pp. 2368-2383

This paper is part of a Special Issue on Women's Health Physical Therapy.

Copyright © 2019. Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia
Brazilian Journal of Physical Therapy

Subscribe to our newsletter

Article options
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.