Effect of core stability exercises and Russian Electrical Stimulation on non-specific low back pain: randomized controlled trial

Effect of core stability exercises and Russian Electrical Stimulation on non-specific low back pain: randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of core stability exercises and Russian Electrical Stimulation on non-specific low back pain: randomized controlled trial Noura Nayel, Hesham Ezzat, Sabreen Ahmed, Haitham Saleh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6005327/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Low back pain (LBP) is a major public health concern resulting from aging and the growth of the global population. and is one of the primary causes of disability in our society. Purpose: This study aimed to distinguish the efficacy of integrating core stability exercises (CSEs) with Russian current (RC) exercises on pain, quality of life, the muscle thickness of the lumbar multifidus (LM) muscle, the transversus abdominis (TrA) muscle and lumbar spine stability in patients with nonspecific low back pain (NSLBP) Methods: Fifty patients with NSLBP were randomly assigned to two groups: group 1 (the study group, n = 25) received CSE and RC three times a week for six weeks, whereas group 2 (the control group, n = 25) received CSE only. Pain was evaluated via the visual analog scale (VAS), functional disability was evaluated via the Oswestry Disability Index (ODI), TrA and LM thickness were evaluated via ultrasonography, and the stability score of the lumbar spine was determined via a spinal mouse device. Results: There was a significant decrease in the VAS score and ODI and an increase in the stability score, TrA, and LM thickness, especially in group 1. Conclusion: RC accompanied by CSE provides greater improvement than CSE alone in the treatment of LBP, increases functional ability, increases TrA and LM thickness, and improves the stability of the lumbar spine. Trial Registration: The study was registered on clinicaltrials.gov (NCT06495099) on 02/07/2024. nonspecific low back pain Russian current core stability exercises spinal mouse Figures Figure 1 Figure 2 Figure 3 Introduction Low back pain (LBP) is a prevalent musculoskeletal disease and pain disorder that affects 80% of the population at some stage [ 1 ]. It ranks as the second most common cause of work absences and a leading reason for seeking medical attention [ 2 ]. Generally, low back pain is classified as either nonspecific (90%) or specific (10%) based on its documented cause. The prevailing manifestation of low back pain is nonspecific and is used when the specific pathoanatomical cause of discomfort cannot be determined [ 3 ]. According to the duration of discomfort, symptoms are classified as acute (lasting less than 6 weeks), subacute (6–12 weeks), or chronic (lasting more than 12 weeks) [ 4 ]. Approximately half of the general population is affected by chronic low back pain (CLBP). Within their lifespan, almost 70% of adults encounter at least one instance of low back pain. [ 5 ]. Recent reports emphasize the rising incidence of non-specific low back pain (NSLBP) in young and middle-aged individuals [ 6 ]. This issue is particularly concerning for students, as research indicates that university students may be more susceptible to these problems due to their prolonged screen use and lack of physical exercise during their daily routines [ 7 ]. Furthermore, poor sitting posture can increase mechanical strain on the spine and elevate static load on the lumbar joint ligaments [ 8 ]. Prolonged sitting can result in reduced lumbar lordosis and an increase in posterior pelvic tilt, potentially leading to discomfort or pain. [ 9 ]. Researchers classify approximately 85% of LBP as nonspecific, meaning that it does not involve inflammation, anatomical alterations, or a specific underlying ailment [ 10 ]. LBP is frequently associated with abnormalities in neuromuscular activity, restricted lumbar muscle flexibility, and decreased spinal mobility [ 11 ]. Physical and psychological risk factors, including extended standing or walking, heavy lifting, poor posture, and inactivity, are the most significant contributors to the development of nonspecific low back pain (NSLBP). Additional risk factors for nonspecific low back pain (NSLBP) are obesity and an unhealthy lifestyle. [ 12 ]. Patients with chronic (NSLBP) often exhibit weakness and delayed activation of deep stabilizing muscles such as the lumbar multifidus (LM) and transversus abdominis (TrA), leading to postural instability and spinal dysfunction [ 2 ]. There are various evidence-based treatment options available for effectively managing lower back pain (LBP), which include medications and physical therapy interventions such as electrotherapy, kinesio taping, exercise programs, and manual therapy [ 13 ]. Core stabilization exercise (CSE), sometimes known as specific stabilization exercise or motor control exercise, is favored as a physical therapy intervention. This training approach is frequently employed in clinical environments to specifically address lower back pain [ 14 ]. The main objective of CSE is to augment neuromuscular control and to fortify and enhance the endurance of the local trunk muscles, namely, the lumbar multifidus (LM) and transversus abdominis (TrA), to facilitate the restoration of their regular functions aimed at preserving segmental stability of the spine [ 15 ]. When intra-abdominal pressure increases in patients with lumbar instability, the deep stabilizing muscles contract with the thoracolumbar fascia to contribute to spinal stability [ 14 ]. It is widely recognized that electrotherapy possesses analgesic properties, can reduce inflammation, enhance range of motion, and contribute to muscle strengthening [ 16 ]. The Russian current (RC) is an asymmetrical sinusoidal or bipolar current train with a frequency of 2500 Hz, modulated in bursts at 50 Hz. In this manifestation, medium-frequency neuromuscular electrical stimulation (NMES) is distinguished by robust and synchronized muscle contractions, which result in advantages such as increased muscular strength and hypertrophy [ 17 ]. The objective of this study was to examine the impact of Russian electrical stimulation, together with core stability exercises, on pain control, quality of life, the thickness of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles, and the stability of the lumbar spine in individuals with nonspecific low back pain. Hypothesis The addition of Russian electrical stimulation to core stability exercises does not appear to have a significant effect on reducing pain intensity, improving quality of life, altering TrA and LM thickness, or enhancing lumbar spine stability. Materials and methods Study design This single-blinded randomized controlled trial ( participants were blinded to their treatment group ) took place in the outpatient clinic of the Faculty of Physical Therapy at Deraya University and strictly followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The study was designed, executed, and reported following the CONSORT 2010 statement to ensure transparency and completeness in trial reporting. This prospective randomized controlled trial was conducted with prior approval from the ethical committees of the faculty of physical therapy at Deraya University, with approval number DCSR-02024-06 and clinical trials.gov identifier NCT06495099 on 09/07/2024. The trial was first registered on 02/7/2024, and all procedures followed the appropriate guidelines and regulations. The inclusion criteria were as follows NSLBP patients aged 20–25 years who had experienced symptoms for more than 3 months and BMI from 18.5–24.9. With pain ratings above four on the visual analog scale (VAS). An age-related disability score of 19% or higher was given by the Oswestry Disability Questionnaire. The exclusion criteria included neurological or musculoskeletal illnesses impacting the lumbar spine; pregnancy and lactation; a history of lumbar spine surgery; indications of lumbar radiculopathy or myelopathy; and indications of severe pathology, such as malignancy, inflammatory disorders, or infection. Sample size A sample size calculation was conducted via G. Power (version 3.1.9.7), and the findings indicated that each group needed a sample size of 25 people. The computations were performed with a significance level of α = 0.05, a statistical power of 80%, and an effect size of 0.88. Participants From a pool of 58 individuals with nonspecific low back pain (NSLBP), fifty patients were chosen from the outpatient clinic of Deraya University in Minya. These patients were referred by physicians who met the inclusion criteria and agreed to participate in the study by signing the consent form. They were then randomly assigned to two groups via the closed envelope method (Fig. 1). All the subjects provided informed consent for both study participation and the publication of identifiable information/images in an online open-access journal. Patients were allocated into two main groups. Group 1 (study group, n = 25) was given Russian electrical stimulation accompanied by core stability exercises three times a week for six weeks. Group 2 (control group, n = 25) was given core stability exercises three times a week for six consecutive weeks, and reassessment of the patients was performed after the last session of the planned treatment period. Both groups were assessed by the VAS score, the ODI, ultrasonography, and the use of a spinal mouse device before and after treatment. Assessment tools The visual analog scale (VAS) is a reliable and valid instrument for evaluating pain. The visual analog scale (VAS) is used as a measurement tool for lower back pain (LBP) and uses a 10 cm line segmented into categories ranging from 0–10. A score of 0 indicates no pain, and a score of 10 represents the most severe agony possible [ 18 ]. Each patient's functional impairment level was evaluated via the Oswestry Disability Index, a reliable and valid instrument for assessing functional disability in individuals suffering from low back pain. The values of the index range from 0–100% and are classified into distinct categories for interpretation: disability scores ranging from 0–19% indicate minimal disability, 20–39% indicate moderate disability, 40–59% indicate severe disability, 60–79% indicate crippling disability, and scores ranging from 80–100% indicate people who are confined to bed [ 19 ]. Ultrasound imaging is a highly reliable and valid method for assessing the transverse abdominis and lumbar multifidus muscle thickness in patients with chronic low back pain (CLBP). All muscle thickness measurements in this study were performed by a single operator, ensuring high intra-rater reliability. Studies have consistently shown high ICCs for thickness measurements and contraction ratios in the transversus abdominis and lumbar multifidus muscles during both static (ICC = 0.71–0.99) and semi-dynamic conditions (ICC = 0.73–0.98).[ 20 ] To evaluate the LM and TrA muscles, ultrasonography was employed. With Mindray DP10 ultrasonography, the multifidus muscle was assessed in a prone posture with a cushion positioned under the abdomen to minimize lumbar lordosis, thereby improving transducer visibility. Patients were directed to maintain regular and rhythmic breathing, and photographs were captured upon completion of exhalation. The thickness of the lumbar muscle (LM) was measured between the fascial plane, which divides the muscle from the subcutaneous tissue, and the posterior-most section of the L4-5 facet joint [ 21 ]. (Fig. 2.1) To evaluate the abdominal muscles, a linear ultrasonic probe operating at a frequency of 10 MHz was laid horizontally across the abdominal wall. The probe was positioned at the midpoint between the iliac crest and the inferior angle of the rib cage. The subject was in a comfortable supine position, with a pillow placed under the knees. The probe was positioned with its medial edge approximately 10 cm from the midline. The probe's final position was fine-tuned to ensure that the transversus abdominis (TrA) medial edge was approximately 2 cm from the medial edge of the ultrasound image when the participant was in a relaxed state [ 21 ]. (Fig. 2.2) Characterization of lumbar spine stability and mobility was performed via a surface-based Spinal Mouse system (IDIAG M360©, Fehraltdorf, Switzerland). The Spinal Mouse device was manipulated in a paravertebral configuration along the spinous processes spanning from the C7 to S3 segments. Through this technique, the system was able to record the shape of the skin above the vertebral bodies in the sagittal planes to obtain important information about the alignment and curvature of the spine [ 22 ]. The Spinal Mouse serves as a valid and reliable instrument for the assessment of spinal curvatures, deformations, and mobility, as well as body positioning in both sagittal and frontal planes, particularly among individuals experiencing back or lower back complications. Its intraclass correlation coefficients (ICCs) range from 0.86 to 0.98 [ 23 ]. In contrast, motion capture systems offer advanced capabilities for detailed biomechanical analysis, emphasizing kinematic and kinetic evaluations, with ICC values exceeding 0.90 [ 24 ]. Furthermore, the isokinetic dynamometer is recognized for its exceptional reliability in quantifying muscle strength, exhibiting ICC values between 0.93 and 0.99 [ 25 ]. Intervention procedures Using ITO ES-5200 electrotherapy equipment from ITO Company in Tokyo, Japan, Russian electrical stimulation was performed at a frequency of 2500 Hz. The device employed a 50 Hz burst modulation and a duty cycle of 50%. The current strength was progressively increased to achieve accommodation to the current. The widely and most popular clinical protocol used with Russian current is the 10/50/10 approach [ 17 ], which is 10 = muscle contraction, lasting for 10 seconds. 50 seconds of off time (no contraction). 10 = Repeat the cycle 10 times. The treatment time is advised to be 20 minutes, and the current is administered once a day, three days per week for 6 weeks [ 17 ]. The stimulation intensity ranged from 31 to 58 mA. Initially, the amplitude was set at a minimum level sufficient to achieve a complete and sustained isometric contraction of the lumbar paraspinal muscles. Subsequently, the amplitude was progressively increased to the subject’s maximum tolerance to optimize muscle engagement. [ 26 ] The transversus abdominis (TrA) muscle electrode included a reference electrode 1 cm above the iliac crest at the mid-axillary line and an active electrode 2 cm above and 2 cm medial to the anterior superior iliac spine. A bilateral placement of four surface electrodes was made at the L4 and L5 spinous processes to stimulate the lumbar multifidus (LM) muscle. The electrodes were spaced approximately 2 cm apart. [ 21 ]. Core stabilization exercise (CSE) is a type of motor control exercise that focuses on activating and controlling deep spinal muscles, specifically the TrA and LM. The activation capacity of the transverse abdominus (TrA) was evaluated via the Stabilizer Pressure Biofeedback Unit (PBU; Chattanooga Group, Australia). The participants were positioned in the ventral decubitus position on a firm surface, with the device placed on the TrA (above the anterior superior iliac spines). Typically, the contraction of the abdominal muscles over the spinal cord causes a reduction in pressure of 4–10 mmHg. Before the participants were instructed to contract their muscles, the apparatus was inflated to a pressure of 70 mmHg. The participants were subsequently instructed to carefully retract their lower abdomen away from the pressure sensor while keeping their back and hips still. They were instructed to sustain this contraction for 10 seconds, as monitored by a timer [ 2 ]. Activation of the lumbar multifidus begins with first facilitating the lumbar multifidus (PBU held at 40 mmHg such that no pressure change = spinal control), taking a relaxed breath, and holding the chest toward the bed. Try to pull the sacrum toward the shoulders. Do not use thoracic extension. This leads to a decrease in pressure of 5–10 mmHg. Static diagonal: isometric opposite knee-to-hand push. Both hands were used to perform exercise, and one of them was monitored for spinal pressure. The knee was pushed toward the opposite hand isometrically and maintained for 10 seconds, after which the process was repeated 10 times. Under any pressure, the exercise should be stopped, and the process should be repeated correctly. Static diagonal heel lift: isometric knee-to-hand push + 2nd heel lift. This process was repeated as mentioned in the previous exercise plus lifting the second heel from the floor and holding it. Alternate single leg heel touch: As mentioned in the previous exercise, after lifting, both heels take the crook lying position with the hip flexed 90 degrees, keeping it as in previous exercises, and then lowering one heel to the floor and repeating. [ 27 ]. Criteria for advancing exercises based on the activation levels of the muscles include critical considerations. Following the establishment of neutral spine control in static positions, such as crook lying, one may progress to dynamic movements like static diagonal heel lifts and alternating single heel touches. All exercises should be pain-free; discomfort may suggest improper technique or excessive load. If exercises are performed without pain, the intensity or complexity may be gradually increased to further develop strength and control [ 27 ]. Table 1 shows the subject characteristics of groups 1 and 2 Table 1 Comparison of subject characteristics between Group 1 and Group 2 Group 1 Group 2 p value Mean ± SD Mean ± SD Age (in years) 22.64 ± 1.87 22.24 ± 1.94 0.46 Weight (in kilogram) 66.51 ± 11.16 68.53 ± 10.01 0.50 Height (cm) 165.84 ± 6.36 167.64 ± 7.91 0.38 BMI (kg/m²) 24.11 ± 3.42 24.27 ± 2.27 0.84 Sex, N (%) Females 15 (60%) 12 (48%) 0.39 Males 10 (40%) 13 (52%) SD, standard deviation; p-value, probability value Statistical analysis Comparative analysis of subject characteristics between groups was performed via an unpaired t test. A chi-square test was performed to compare the distribution of sexes among the groups. The statistical normality of the data was assessed via the Shapiro‒Wilk test. Levene's test for homogeneity of variances was performed to assess the uniformity of variances among groups. To examine the impact of therapy on the VAS score, ODI, stability score, TrA, and LM thickness, a mixed MANOVA was used. Following multiple comparisons, post hoc tests were conducted via the Bonferroni correction. For all the statistical tests, the significance level was set at p < 0.05. Quantitative analysis was performed via the Statistical Package for Social Studies (SPSS) version 25 for Windows, which was developed by IBM in Chicago, IL, USA. Results Subject characteristics: Table 1 shows the mean ± SD of the subjects’ demographic characteristics (age, height, weight, and BMI). None of the participants were lost or dropped out of any of the groups. There was no significant difference between the groups in terms of age, weight, height, BMI, or sex distribution (p > 0.05). Effects of treatment on the VAS score, ODI, stability score, TrA, and multifidus thickness: A mixed MANOVA revealed that therapy and time had a significant interaction effect (F = 66.16, p = 0.001, ηp² = 0.92). A statistically significant main effect of treatment was observed (F = 4.34, p = 0.001; ηp²= 0.42). The main effect of time was statistically significant (F = 268.69, p = 0.001; ηp ² = 0.0.98). Within-group comparison The results revealed a significant reduction in the VAS score and the ODI and a significant improvement in the stability score after therapy in both groups compared with the baseline scores (p > 0.001). The mean percentage changes in the VAS score, ODI, and stability score for Group 1 were 63.22%, 72.11%, and 23.91%, respectively. For Group 2, the corresponding percentage changes were 48.86%, 43.69%, and 12.83%, respectively. (Table 2 ). Compared with those before treatment, significant increases in the thicknesses of the right and left TrA and multifidus were observed in both groups following therapy (p > 0.001). Within Group 1, the thicknesses of the right and left TrA and multifidus increased by 37.50%, 27.27%, 22.77%, and 24.75%, respectively. In Group 2, the percentage increases were 9.09%, 9.37%, 6.90%, and 3.85%, respectively (Table 3 ). Between-group comparison No statistically significant difference was detected between the groups before treatment (p > 0.05, comparison between groups posttreatment revealed a significant difference in the VAS score and ODI and a significant increase in the stability score, TrA, and multifidus thickness in group 1 compared with those in group 2 (p < 0.05). (Table 2 – 3 ). Table 2 Mean VAS score, ODI score, and stability score before and after treatment in groups 1 and 2: Pre treatment Post treatment Mean ± SD Mean ± SD MD 95% CI % of change p value VAS Group 1 6.96 ± 1.21 2.56 ± 1.26 4.4 3.79: 5.01 63.22 0.001 Group 2 7.04 ± 1.02 3.60 ± 1.38 3.44 2.83: 4.05 48.86 0.001 MD -0.08 -1.04 95% CI -0.72: 0.56 -1.79: -0.29 p = 0.80 p = 0.008 ηp² 0.14 ODI (%) Group 1 32.84 ± 9.95 9.16 ± 4.33 23.68 20.13: 27.23 72.11 0.001 Group 2 33.60 ± 7.82 18.92 ± 4.01 14.68 11.13: 18.23 43.69 0.001 MD -0.76 -9.76 95% CI -5.85: 4.33 -12.13: -7.39 p = 0.77 p = 0.001 ηp² 0.59 Stability score (%) Group 1 45.46 ± 11.70 56.33 ± 10.52 -10.87 -13.04: -8.69 23.91 0.001 Group 2 43.25 ± 10.94 48.80 ± 12.55 -5.55 -7.72: -3.37 12.83 0.001 MD 2.21 7.53 95% CI -4.23: 8.65 0.95: 14.12 p = 0.49 p = 0.02 ηp² 0.10 SD, Standard deviation; MD, Mean difference; CI, Confidence interval; ηp² , partial eta-squared , p value, Probability value. , Table 3 Mean TrA and multifidus thickness before and after treatment in groups 1 and 2: Pre treatment Post treatment Mean ± SD Mean ± SD MD 95% CI % of change p value Right TrA thickness (cm) Group 1 0.32 ± 0.08 0.44 ± 0.07 -0.12 -0.13: -0.10 37.50 0.001 Group 2 0.33 ± 0.09 0.36 ± 0.10 -0.03 -0.05: -0.02 9.09 0.001 MD -0.01 0.08 95% CI -0.06: 0.04 0.02: 0.12 p = 0.73 p = 0.004 ηp² 0.16 Left TrA thickness (cm) Group 1 0.33 ± 0.07 0.42 ± 0.09 -0.09 -0.11: -0.08 27.27 0.001 Group 2 0.32 ± 0.09 0.35 ± 0.10 -0.03 -0.05: -0.02 9.37 0.001 MD 0.01 0.07 95% CI -0.04: 0.05 0.02: 0.12 p = 0.76 p = 0.01 ηp² 0.13 Right multifidus thickness (cm) Group 1 2.02 ± 0.41 2.48 ± 0.43 -0.46 -0.51: -0.42 22.77 0.001 Group 2 2.03 ± 0.52 2.17 ± 0.55 -0.14 -0.18: -0.10 6.90 0.001 MD -0.01 0.31 95% CI -0.28: 0.25 0.03: 0.59 p = 0.93 p = 0.03 ηp² 0.10 Left multifidus thickness (cm) Group 1 1.98 ± 0.43 2.047 ± 0.47 -0.49 -0.54: -0.45 24.75 0.001 Group 2 2.08 ± 0.56 2.16 ± 0.58 -0.08 -0.13: -0.03 3.85 0.001 MD -0.1 0.31 95% CI -0.38: 0.19 0.02: 0.62 p = 0.49 p = 0.03 ηp² 0.09 SD, Standard deviation; MD, Mean difference; CI, Confidence interval; ηp² , partial eta-squared , p value, Probability value. , Discussion The objective of this study was to investigate the effects of core stability exercises in addition to Russian electrical stimulation on pain, quality of life, transversus abdominis (TrA) and lumbar multifidus (LM) thickness and the stability of the lumbar spine in patients with nonspecific low back pain. The study findings indicated a notable reduction in the VAS score and ODI and substantial improvements in the stability score, TrA, and LM thickness after treatment in both groups compared with those before treatment (p > 0.001). The posttreatment comparison between groups revealed notable disparities in the VAS and ODI scores, as well as a substantial increase in the stability score. Specifically, the transversus abdominis (TrA) and lumbar multifidus (LM) muscles were thicker than those in the control group (p < 0.001). The reduction in VAS and ODi scores achieves the minimum clinically important difference, avital metric for assessing whether these changes hold significance for patients. Research on the effects of Russian current on lower back pain (LBP) remains limited; however, electrotherapy has been shown to modulate pain according to Melzack and Wall’s gate-control theory. This theory posits that noxious stimuli travel through myelinated A-delta and non-myelinated C fibers. The activation of non-nociceptive A-beta fibers can inhibit the transmission of these noxious stimuli from the spinal cord to the brain by engaging inhibitory interneurons. When applied with appropriate parameters, Russian current selectively stimulates A-beta fibers. Consequently, an increase in A-beta activity, resulting from any electrical stimulation, leads to a reduction in pain perception due to the relative activity of A-delta and C fibers compared to A-beta fibers [ 28 ]. Additional proposed explanations for the reduction in pain perception after transcutaneous electrical nerve stimulation (TENS) include the stimulation of descending inhibitory pathways in the central nervous system through endogenous opioid-mediated effects [ 29 ] or a reduction in proinflammatory cytokines such as IL-1 and IL-6 in the bloodstream [ 30 ]. Electrotherapeutic modalities, which utilize transdermal electric currents [ 31 ], are frequently employed by physiotherapists due to their positive impact on muscle function and favorable patient acceptance [ 32 ],[ 33 ],[ 34 ]. Neuromuscular electrical stimulation (NMES) activates nerve fibers in a designated sequence, starting with Aβ fibers, which produce the paresthesia sensation marking the sensory threshold. As NMES current amplitude increases, it may also engage C fibers that transmit nociceptive information. If the current surpasses the motor threshold, muscle contractions may occur [ 35 ]. The present study’s findings are consistent with Batistella et al.’s randomized trial involving 23 women aged 18–30, who were assigned to either a control or Russian current group for four weeks. Both groups exhibited significant reductions in VAS scores and the Oswestry low back disability index, although only the Russian current group maintained these improvements during follow-up [ 17 ]. Lee et al. (2017) reported notable changes in resistance, muscle thickness (measured via ultrasound), and pain levels (assessed with a Visual Analog Scale and pressure algometer) following Russian current therapy for quadriceps pain post-ACL reconstruction [ 36 ]. Furthermore, Çankaya et al. (2024) demonstrated that Russian current provides additional advantages in alleviating symptoms and enhancing pain management, functional mobility, and quality of life in individuals with patellofemoral pain [ 37 ]. Additionally, Rajan et al. (2018) identified a slight advantage of Russian current therapy over Interferential Therapy and Conventional Exercise in reducing pain and improving muscle strength in the short term among patients with postoperative lower limb fractures [ 38 ]. Among the various NMES modalities designed for muscle strengthening, medium-frequency currents such as Aussie (AC) and Russian (RC) currents are particularly noteworthy. Low-frequency currents, such as functional electrical stimulation (FES), are significant in their ability to enhance motor unit recruitment, resulting in improved muscle strength and pain reduction [ 39 ],[ 40 ]. Russian current can initiate depolarization of sensory and motor nerve fibers, activating fast type II motor units and facilitating muscle contractions that enhance muscle strength [ 41 ]. Heggannavar et al. (2014) demonstrated that Russian current stimulation is effective in strengthening quadriceps muscles and improving functional ability in individuals with primary osteoarthritis (OA) knee pain [ 42 ]. Additionally, Janarthanan et al. (2023) noted that the combination of Russian current and strengthening exercises led to improvements in pain, strength, and performance among sprinters with calf muscular strain [ 43 ]. Letícia Cittadin et al. (2020) mentioned that Russian current significantly increased muscle thickness in the non-dominant hand of healthy women [ 39 ], and a review by Pereira et al. (2022) indicated that Russian current was the most effective modality for promoting strength and thickness gains [ 44 ]. In contrast, Prabha et al. found no additional benefits from Russian current, suggesting that supervised exercises combined with Russian current were effective for managing primary knee osteoarthritis [ 28 ]. Patients with chronic non-specific low back pain (NSLBP) often experience delayed activation of deep stabilizing muscles, leading to postural instability and exacerbating pain and dysfunction [ 45 ]. This study reported a 23.91% improvement in stability scores in the experimental Russian current group, compared to a 12.83% improvement in the control group, attributed to Russian Electrical Stimulation (RES) enhancing muscle recruitment of weakened stabilizers [ 41 ]. However, limitations of core stability exercises include difficulties in activating deep stabilizing muscles due to neuromuscular inhibition [ 46 ]. RES can address this issue by directly activating motor neurons and promoting earlier engagement of stabilizers [ 41 ]. Naka et al. (2023) noted that patients with persistent neck and lower back pain undergoing suprathreshold electrotherapy six times weekly showed improved lumbar flexibility without corresponding improvements in pain or disability perceptions [ 47 ]. Despite positive findings, RES applications for NSLBP may cause adverse effects, including muscle fatigue, discomfort, skin irritation [ 41 ]. Conclusion This study adds to the existing literature regarding the efficacy of Russian electrical stimulation in conjunction with core stability exercises on pain management, quality of life, and the muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in patients experiencing nonspecific low back pain (NSLBP). The results demonstrate that the combination of Russian electrical stimulation and core stability exercises significantly alleviates pain intensity, with a reduction of 63.22% in the Visual Analog Scale (VAS) score, compared to a 48.86% decrease observed with core stability exercises alone. Furthermore, this combined intervention enhances functional outcomes, as evidenced by a 72.11% reduction in the Oswestry Disability Index (ODI) versus a 43.69% reduction with core stability exercises alone. After six weeks, muscle thickness showed a notable increase, with the TrA muscle increasing by 37.5% compared to 9.09%, and the multifidus muscle increasing by 22.77% versus 6.90% in the control group. Additionally, the stability score improved by 23.91% in the Russian current group compared to 12.83% in the control group. Limitations and Recommendations: This study presents several limitations that warrant further discussion for future research. First, the absence of long-term follow-up assessments limits understanding of whether Russian current (RC) leads to enduring neuromuscular adaptations; future studies should include follow-ups of 3 to 6 months. Second, the sample size of 50 participants is relatively small for a randomized controlled trial (RCT); despite conducting a power analysis (effect size = 0.88, power = 80%), larger trials are necessary to validate these findings. Third, the study population comprises only young adults, which restricts the generalizability of results to older individuals or those with severe spinal pathologies. Future investigations should evaluate the effects of RC in more diverse populations, including elderly patients, athletes, and individuals with varying body mass index (BMI) categories. Fourth, it is recommended that future research compare the efficacy of RC with other electrotherapy modalities such as transcutaneous electrical nerve stimulation (TENS) or interferential therapy, as well as examine the application of Russian current on other anatomical regions. Abbreviations CNSLBP: chronic non-specific low back pain CSE: Core stabilization exercise RES: Russian Electrical Stimulation VAS: Visual Analog Scale ODI: Oswestry Disability Index TrA: The transversus abdominis muscle LM: lumbar multifidus muscle CI: Confidence interval Declarations Acknowledgements The authors sincerely thank the outpatient clinic of Deraya University for permitting us to conduct this study. We also appreciate all the participants for their involvement in this research. Authors’ contributions The study concept was developed by N.N. The study design was created by N.N., H.E., and H.S. Data collection was carried out by N.N. and H.S. The intervention was implemented by N.N. under the supervision of H.S. Data analysis and interpretation were performed by N.N, H.E., and H.S. The initial manuscript drafting was completed by N.N, H.S., and S.A. A critical review of the manuscript draft was conducted by H.E., S.A., and H.S. All authors read and approved the final version of the manuscript. Funding This research was supported by the Faculty of Physical Therapy at Deraya University. The funding body had no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript. The authors declare that no additional external funding was received for this study. Data Availability The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request Ethics approval and consent to participate This prospective randomized controlled trial was conducted with prior approval from the ethical committees of the faculty of physical therapy at Deraya University, with approval number DCSR-02024-06, and conducted under the ethical standards of the institutional and national research committees, the 1964 Helsinki Declaration and its later amendments, and comparable ethical standards. Prior to participation, all subjects were provided with detailed information about the study, including its purpose, procedures, potential risks, and benefits. Before their inclusion in the study, written informed consent was obtained from all participants. Participants were assured that their participation was voluntary and that they could withdraw from the study without any consequences. Confidentiality and anonymity of the participants were maintained throughout the study. Consent for Publication All participants in this study provided written informed consent for the publication of their data and any accompanying images. Participants were informed that their personal information would remain confidential and that any identifying information would be anonymized to protect their privacy. The consent included permission for the publication of the study results in scientific journals and presentations at conferences. Participants were assured that their decision to participate or withdraw from the study would not affect their medical care or treatment. Competing Interests The authors declare that they have no financial or non-financial competing interests concerning this study. Specifically: Financial Interests : The authors have no financial relationships or affiliations with any organizations or entities that could be perceived as influencing the results or interpretation of this study. This includes, but is not limited to, employment, consultancies, stock ownership, honoraria, paid expert testimony, patents, and grants. Non-Financial Interests : The authors have no non-financial interests that could be perceived as influencing the results or interpretation of this study. This includes personal or professional relationships, affiliations, knowledge, or beliefs that could affect the objectivity of the research. All authors have approved the final manuscript and agree with its submission to this journal. The authors confirm that there are no conflicts of interest regarding the publication of this paper References Ganesan S, Acharya AS, Chauhan R, Acharya S. Prevalence and risk factors for low back pain in 1,355 young adults: a cross-sectional study. Asian spine J. 2017;11(4):610. França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain-a comparative study. Clinics. 2010;65(10):1013–7. Maher C, Underwood M, Buchbinder R. Nonspecific low back pain. Lancet. 2017;389(10070):736–47. Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of core stability in nonspecific chronic low back pain. J Funct morphology Kinesiol. 2021;6(2):37. Sirbu E, Onofrei RR, Szasz S, Susan M. Predictors of disability in patients with chronic low back pain. Archives Med Science: AMS. 2020;19(1):94. 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Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. J Orthop sports Phys therapy. 2019;49(6):464–76. Kett AR, Sichting F, Milani TL. The effect of sitting posture and postural activity on low back muscle stiffness. Biomech (Basel Switzerland). 2021;1(2):214–24. Almeida M, Saragiotto B, Richards B, Maher CG. Primary care management of non- specific low back pain: key messages from recent clinical guidelines. Med J Aust. 2018;208(6):272–5. Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22:1–13. Chen WS, Annaswamy TM, Yang W, Wang TG, Kwon DR, Chou LW. Physical agent modalities. Braddom's physical medicine and rehabilitation. Elsevier; 2021. pp. 338–63. Batistella CE, Bidin F, Giacomelli I, Nunez MA, Gasoto E, de Albuquerque CE, Flores LJF, Bertolini GRF. Effects of the Russian current in the treatment of low back pain in women: A randomized clinical trial. J Bodyw Mov Ther. 2020;24(2):118–22. Begum MR, Hossain MA. (2019). Validity and reliability of visual analogue scale (VAS) for pain measurement. J Med Case Rep Reviews, 2 (11). Yates M, Shastri-Hurst N. The Oswestry disability index. Occup Med. 2017;67(3):241–2. Bozorgmehr A, Takamjani IE, Akbari M, Salehi R, Mohsenifar H, Rasouli O. Reliability of ultrasound measurements of the lumbar multifidus and transversus abdominis muscles during lying and unstable sitting positions in individuals with and without chronic low back pain. J Biomedical Phys Eng. 2023;13(2):157. Baek SO, Cho HK, Kim SY, Jones R, Cho YW, Ahn SH. Changes in deep lumbar stabilizing muscle thickness by transcutaneous neuromuscular electrical stimulation in patients with low back pain. J Back Musculoskelet Rehabil. 2017;30(1):121–7. Csuhai ÉA, Nagy AC, Váradi Z, Veres-Balajti I. Functional analysis of the spine with the Idiag SpinalMouse System among sedentary workers affected by nonspecific low back pain. Int J Environ Res Public Health. 2020;17(24):9259. Topalidou A, Tzagarakis G, Souvatzis X, Kontakis G, Katonis P. Evaluation of the reliability of a new non-invasive method for assessing the functionality and mobility of the spine. Acta Bioeng Biomech. 2014;16(1):117–24. Hauenstein JD, Huebner A, Wagle JP, Cobian ER, Cummings J, Hills C, Wojtkiewicz L. Reliability of markerless motion capture systems for assessing movement screenings. Orthop J Sports Med. 2024;12(3):23259671241234339. Moussa AZB, Zouita SBSF, Salah FB, Behm DG, Chaouachi A. Isokinetic trunk strength, validity, reliability, normative data and relation to physical performance and low back pain: A review of the literature. Int J sports Phys therapy. 2020;15(1):160. Pugliese JM, Sions JM, Velasco TO, Hicks GE. Use of trunk muscle training and neuromuscular electrical stimulation to reduce pain and disability in an older adult with chronic low back pain: a case report. Physiother Theory Pract. 2019;35(8):797–804. Comerford M. (2012). Kinetic control: the management of uncontrolled movement. Churchill Livingstone . Prabha P, Sarkar B, Kumar P. Efficacy of Russian current on pain, strength of quadriceps and function in subjects with primary knee osteoarthritis: a randomized clinical trial. Int J Health Sci Res. 2019;9:140–8. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manage. 2014;4(3):197–209. do Almeida C, dos Santos Figueiredo TC, Filho FWB, de Abreu VC, Fonseca LC, F. L. A., Adami F. Effects of transcutaneous electrical nerve stimulation on proinflammatory cytokines: systematic review and meta-analysis. Mediat Inflamm. 2018;2018(1):1094352. Maffiuletti NA, Green DA, Vaz MA, Dirks ML. Neuromuscular electrical stimulation as a potential countermeasure for skeletal muscle atrophy and weakness during human spaceflight. Front Physiol. 2019;10:1031. Kocamaz D, Yakut H, Özberk S. Patients’ satisfaction with and awareness of electrical stimulation therapy. Physiotherapy Q. 2020;28(1):11–5. Pereira KE, Pereira KL, Stachelski RA, Azevedo MRB, de Carvalho AR, Bertolini GRF. KiloHertz currents on aspects of muscle function: A scoping review. J Bodyw Mov Ther. 2022;32:110–9. Linzmeyer A, Coracini CA, Bertolini GRF, Carvalho AR. Efeito da estimulação elétrica neuromuscular na função muscular em pacientes com dor lombar crônica: revisão sistemática. BrJP. 2022;5:161–7. Lefaucheur JP, Abbas SA, Lefaucheur-Ménard I, Rouie D, Tebbal D, Bismuth J, Nordine T. Small nerve fiber selectivity of laser and intraepidermal electrical stimulation: A comparative study between glabrous and hairy skin. Neurophysiol Clin. 2021;51(4):357–74. Lee DJ, Shim JH, Yoon SI, Park SJ. Effect of convergence-based Russian current and transcutaneous electrical nerve stimulation at quadriceps muscles on pain, strength, and performance in persons with anterior cruciate ligament reconstruction. J korea convergence Soc. 2017;8(1):77–87. Çankaya M, Karakaya İÇ, Yargiç PM, Karakaya MG. (2024). Effects of Russian and Aussie Currents Combined with Isokinetic Training on Symptoms, Pain, Functional Mobility and Quality of Life in Individuals with Patellofemoral Pain Syndrome: A Randomized, Placebo-Controlled Study. Am J Phys Med Rehabil, 10–1097. Rajan S, Kohli SS, Bhaisaheb S. Short-term and long-term effects of interferential therapy and Russian current on pain and quadriceps muscle strength in post operative lower limb fractures. Int J Health Sci Res. 2018;8:162–8. Cittadin GL, Ansolin GZ, Santana NPF, Tonini TL, Azevedo MRB, de Albuquerque CE, Bertolini GRF. Comparison between Russian and Aussie currents in the grip strength and thickness muscles of the non-dominant hand: a double-blind, prospective, randomized-controlled study. Turkish J Phys Med rehabilitation. 2020;66(4):423. Silva BCD, Coracini CA, Branco CL, Michelon MD, Bertolini GRF. Corrente Aussie em estudantes com cervicalgia crônica: um ensaio clínico randomizado. BrJP. 2018;1:202–6. Ward AR, Shkuratova N. Russian electrical stimulation: the early experiments. Phys Ther. 2002;82(10):1019–30. Heggannavar AB, Dharmayat S, Nerurkar S, Kamble S. Effect of Russian current on quadriceps muscle strength in subjects with primary osteoarthritis of knee: a randomized control trial. Int J Physiother Res. 2014;2(3):555–60. Janarthanan G, Silambarasan A. (2023). Effectiveness of Russian current and strengthening exercise on pain strength and performance in sprinters with calf muscle strain. J Sport Med Doping Stud, 13 . Pereira KE, Pereira KL, Stachelski RA, Azevedo MRB, de Carvalho AR, Bertolini GRF. KiloHertz currents on aspects of muscle function: A scoping review. J Bodyw Mov Ther. 2022;32:110–9. Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain Physician. 2016;19(7):E985–99. Sions JM, Crippen DAC, Hicks GE, Alroumi AM, Manal TJ, Pohlig RT. Exploring neuromuscular electrical stimulation intensity effects on multifidus muscle activity in adults with chronic low back pain: an ultrasound imaging–informed investigation. Clin Med Insights: Arthritis Musculoskelet Disorders. 2019;12:1179544119849570. Naka A, Kotz C, Gutmann E, Pramhas S, Schukro RPJ, Ristl R, Sator S. (2023). Effect of Regular Electrotherapy on Spinal Flexibility and Pain Sensitivity in Patients with Chronic Non-Specific Neck Pain and Low Back Pain: A Randomized Controlled Double-Blinded Pilot Trial. Medicina, 59 (5). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6005327","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437614908,"identity":"f8a53b72-3cc0-4531-89ee-069f9674628b","order_by":0,"name":"Noura Nayel","email":"","orcid":"","institution":"Deraya University","correspondingAuthor":false,"prefix":"","firstName":"Noura","middleName":"","lastName":"Nayel","suffix":""},{"id":437614909,"identity":"e4746cb6-9209-4588-ad95-761e089649b8","order_by":1,"name":"Hesham 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randomization\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6005327/v1/579ddb99cfb0c7dbda87254a.jpeg"},{"id":80044654,"identity":"deaf253b-0be9-4ff2-b8fe-6aa37eca9743","added_by":"auto","created_at":"2025-04-07 09:40:40","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22389,"visible":true,"origin":"","legend":"\u003cp\u003e2.1: LM thickness measurement\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6005327/v1/3f7a222fdb3fc001bda5d07e.jpeg"},{"id":80046129,"identity":"435d7efb-d736-4b9c-8afa-2c747895e386","added_by":"auto","created_at":"2025-04-07 09:48:40","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23988,"visible":true,"origin":"","legend":"\u003cp\u003e2.2: TRA thickness measurement\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6005327/v1/9ddbc5ca2e12118872236b18.jpeg"},{"id":80048557,"identity":"dd03fc00-9339-4f7e-b49c-b78ce60eed35","added_by":"auto","created_at":"2025-04-07 10:04:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1844557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6005327/v1/8020c9bd-7bbb-44ae-8285-e50d2baae0e3.pdf"},{"id":80044650,"identity":"3585cb29-2542-4b3e-96e4-a15046b09045","added_by":"auto","created_at":"2025-04-07 09:40:40","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14467,"visible":true,"origin":"","legend":"","description":"","filename":"DATA.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6005327/v1/0a4df9c348bab2a0475e783b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of core stability exercises and Russian Electrical Stimulation on non-specific low back pain: randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLow back pain (LBP) is a prevalent musculoskeletal disease and pain disorder that affects 80% of the population at some stage [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It ranks as the second most common cause of work absences and a leading reason for seeking medical attention [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGenerally, low back pain is classified as either nonspecific (90%) or specific (10%) based on its documented cause. The prevailing manifestation of low back pain is nonspecific and is used when the specific pathoanatomical cause of discomfort cannot be determined [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the duration of discomfort, symptoms are classified as acute (lasting less than 6 weeks), subacute (6\u0026ndash;12 weeks), or chronic (lasting more than 12 weeks) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Approximately half of the general population is affected by chronic low back pain (CLBP). Within their lifespan, almost 70% of adults encounter at least one instance of low back pain. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent reports emphasize the rising incidence of non-specific low back pain (NSLBP) in young and middle-aged individuals [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This issue is particularly concerning for students, as research indicates that university students may be more susceptible to these problems due to their prolonged screen use and lack of physical exercise during their daily routines [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, poor sitting posture can increase mechanical strain on the spine and elevate static load on the lumbar joint ligaments [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Prolonged sitting can result in reduced lumbar lordosis and an increase in posterior pelvic tilt, potentially leading to discomfort or pain. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearchers classify approximately 85% of LBP as nonspecific, meaning that it does not involve inflammation, anatomical alterations, or a specific underlying ailment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. LBP is frequently associated with abnormalities in neuromuscular activity, restricted lumbar muscle flexibility, and decreased spinal mobility [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysical and psychological risk factors, including extended standing or walking, heavy lifting, poor posture, and inactivity, are the most significant contributors to the development of nonspecific low back pain (NSLBP). Additional risk factors for nonspecific low back pain (NSLBP) are obesity and an unhealthy lifestyle. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with chronic (NSLBP) often exhibit weakness and delayed activation of deep stabilizing muscles such as the lumbar multifidus (LM) and transversus abdominis (TrA), leading to postural instability and spinal dysfunction [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are various evidence-based treatment options available for effectively managing lower back pain (LBP), which include medications and physical therapy interventions such as electrotherapy, kinesio taping, exercise programs, and manual therapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCore stabilization exercise (CSE), sometimes known as specific stabilization exercise or motor control exercise, is favored as a physical therapy intervention. This training approach is frequently employed in clinical environments to specifically address lower back pain [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The main objective of CSE is to augment neuromuscular control and to fortify and enhance the endurance of the local trunk muscles, namely, the lumbar multifidus (LM) and transversus abdominis (TrA), to facilitate the restoration of their regular functions aimed at preserving segmental stability of the spine [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. When intra-abdominal pressure increases in patients with lumbar instability, the deep stabilizing muscles contract with the thoracolumbar fascia to contribute to spinal stability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is widely recognized that electrotherapy possesses analgesic properties, can reduce inflammation, enhance range of motion, and contribute to muscle strengthening [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Russian current (RC) is an asymmetrical sinusoidal or bipolar current train with a frequency of 2500 Hz, modulated in bursts at 50 Hz. In this manifestation, medium-frequency neuromuscular electrical stimulation (NMES) is distinguished by robust and synchronized muscle contractions, which result in advantages such as increased muscular strength and hypertrophy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this study was to examine the impact of Russian electrical stimulation, together with core stability exercises, on pain control, quality of life, the thickness of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles, and the stability of the lumbar spine in individuals with nonspecific low back pain.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis\u003c/strong\u003e \u003cp\u003eThe addition of Russian electrical stimulation to core stability exercises does not appear to have a significant effect on reducing pain intensity, improving quality of life, altering TrA and LM thickness, or enhancing lumbar spine stability.\u003c/p\u003e \u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis single-blinded randomized controlled trial (\u003cem\u003eparticipants were blinded to their treatment group\u003c/em\u003e) took place in the outpatient clinic of the Faculty of Physical Therapy at Deraya University and strictly followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The study was designed, executed, and reported following the CONSORT 2010 statement to ensure transparency and completeness in trial reporting. This prospective randomized controlled trial was conducted with prior approval from the ethical committees of the faculty of physical therapy at Deraya University, with approval number DCSR-02024-06 and clinical trials.gov identifier NCT06495099 on 09/07/2024. The trial was first registered on 02/7/2024, and all procedures followed the appropriate guidelines and regulations.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe inclusion criteria were as follows\u003c/strong\u003e \u003cp\u003eNSLBP patients aged 20\u0026ndash;25 years who had experienced symptoms for more than 3 months and BMI from 18.5\u0026ndash;24.9. With pain ratings above four on the visual analog scale (VAS). An age-related disability score of 19% or higher was given by the Oswestry Disability Questionnaire.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe exclusion criteria included neurological or musculoskeletal illnesses impacting the lumbar spine; pregnancy and lactation; a history of lumbar spine surgery; indications of lumbar radiculopathy or myelopathy; and indications of severe pathology, such as malignancy, inflammatory disorders, or infection.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA sample size calculation was conducted via G. Power (version 3.1.9.7), and the findings indicated that each group needed a sample size of 25 people. The computations were performed with a significance level of α\u0026thinsp;=\u0026thinsp;0.05, a statistical power of 80%, and an effect size of 0.88.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eFrom a pool of 58 individuals with nonspecific low back pain (NSLBP), fifty patients were chosen from the outpatient clinic of Deraya University in Minya. These patients were referred by physicians who met the inclusion criteria and agreed to participate in the study by signing the consent form. They were then randomly assigned to two groups via the closed envelope method (Fig.\u0026nbsp;1). All the subjects provided informed consent for both study participation and the publication of identifiable information/images in an online open-access journal.\u003c/p\u003e \u003cp\u003ePatients were allocated into two main groups. Group 1 (study group, n\u0026thinsp;=\u0026thinsp;25) was given Russian electrical stimulation accompanied by core stability exercises three times a week for six weeks. Group 2 (control group, n\u003c/p\u003e \u003cp\u003e=\u0026thinsp;25) was given core stability exercises three times a week for six consecutive weeks, and reassessment of the patients was performed after the last session of the planned treatment period. Both groups were assessed by the VAS score, the ODI, ultrasonography, and the use of a spinal mouse device before and after treatment.\u003c/p\u003e\n\u003ch3\u003eAssessment tools\u003c/h3\u003e\n\u003cp\u003eThe visual analog scale (VAS) is a reliable and valid instrument for evaluating pain. The visual analog scale (VAS) is used as a measurement tool for lower back pain (LBP) and uses a 10 cm line segmented into categories ranging from 0\u0026ndash;10. A score of 0 indicates no pain, and a score of 10 represents the most severe agony possible [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEach patient's functional impairment level was evaluated via the Oswestry Disability Index, a reliable and valid instrument for assessing functional disability in individuals suffering from low back pain. The values of the index range from 0\u0026ndash;100% and are classified into distinct categories for interpretation: disability scores ranging from 0\u0026ndash;19% indicate minimal disability, 20\u0026ndash;39% indicate moderate disability, 40\u0026ndash;59% indicate severe disability, 60\u0026ndash;79% indicate crippling disability, and scores ranging from 80\u0026ndash;100% indicate people who are confined to bed [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003eUltrasound imaging is a highly reliable and valid method for assessing the transverse abdominis and lumbar multifidus muscle thickness in patients with chronic low back pain (CLBP). All muscle thickness measurements in this study were performed by a single operator, ensuring high intra-rater reliability. Studies have consistently shown high ICCs for thickness measurements and contraction ratios in the transversus abdominis and lumbar multifidus muscles during both static (ICC\u0026thinsp;=\u0026thinsp;0.71\u0026ndash;0.99) and semi-dynamic conditions (ICC\u0026thinsp;=\u0026thinsp;0.73\u0026ndash;0.98).[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] To evaluate the LM and TrA muscles, ultrasonography was employed. With Mindray DP10 ultrasonography, the multifidus muscle was assessed in a prone posture with a cushion positioned under the abdomen to minimize lumbar lordosis, thereby improving transducer visibility. Patients were directed to maintain regular and rhythmic breathing, and photographs were captured upon completion of exhalation. The thickness of the lumbar muscle (LM) was measured between the fascial plane, which divides the muscle from the subcutaneous tissue, and the posterior-most section of the L4-5 facet joint [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. (Fig.\u0026nbsp;2.1)\u003c/p\u003e \u003cp\u003eTo evaluate the abdominal muscles, a linear ultrasonic probe operating at a frequency of 10 MHz was laid horizontally across the abdominal wall. The probe was positioned at the midpoint between the iliac crest and the inferior angle of the rib cage. The subject was in a comfortable supine position, with a pillow placed under the knees. The probe was positioned with its medial edge approximately 10 cm from the midline. The probe's final position was fine-tuned to ensure that the transversus abdominis (TrA) medial edge was approximately 2 cm from the medial edge of the ultrasound image when the participant was in a relaxed state [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. (Fig.\u0026nbsp;2.2)\u003c/p\u003e \u003cp\u003eCharacterization of lumbar spine stability and mobility was performed via a surface-based Spinal Mouse system (IDIAG M360\u0026copy;, Fehraltdorf, Switzerland). The Spinal Mouse device was manipulated in a paravertebral configuration along the spinous processes spanning from the C7 to S3 segments. Through this technique, the system was able to record the shape of the skin above the vertebral bodies in the sagittal planes to obtain important information about the alignment and curvature of the spine [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The Spinal Mouse serves as a valid and reliable instrument for the assessment of spinal curvatures, deformations, and mobility, as well as body positioning in both sagittal and frontal planes, particularly among individuals experiencing back or lower back complications. Its intraclass correlation coefficients (ICCs) range from 0.86 to 0.98 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In contrast, motion capture systems offer advanced capabilities for detailed biomechanical analysis, emphasizing kinematic and kinetic evaluations, with ICC values exceeding 0.90 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, the isokinetic dynamometer is recognized for its exceptional reliability in quantifying muscle strength, exhibiting ICC values between 0.93 and 0.99 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eIntervention procedures\u003c/h3\u003e\n\u003cp\u003eUsing ITO ES-5200 electrotherapy equipment from ITO Company in Tokyo, Japan, Russian electrical stimulation was performed at a frequency of 2500 Hz. The device employed a 50 Hz burst modulation and a duty cycle of 50%. The current strength was progressively increased to achieve accommodation to the current. The widely and most popular clinical protocol used with Russian current is the 10/50/10 approach [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which is 10\u0026thinsp;=\u0026thinsp;muscle contraction, lasting for 10 seconds. 50 seconds of off time (no contraction). 10\u0026thinsp;=\u0026thinsp;Repeat the cycle 10 times. The treatment time is advised to be 20 minutes, and the current is administered once a day, three days per week for 6 weeks [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The stimulation intensity ranged from 31 to 58 mA. Initially, the amplitude was set at a minimum level sufficient to achieve a complete and sustained isometric contraction of the lumbar paraspinal muscles. Subsequently, the amplitude was progressively increased to the subject\u0026rsquo;s maximum tolerance to optimize muscle engagement. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] The transversus abdominis (TrA) muscle electrode included a reference electrode 1 cm above the iliac crest at the mid-axillary line and an active electrode 2 cm above and 2 cm medial to the anterior superior iliac spine. A bilateral placement of four surface electrodes was made at the L4 and L5 spinous processes to stimulate the lumbar multifidus (LM) muscle. The electrodes were spaced approximately 2 cm apart. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCore stabilization exercise (CSE) is a type of motor control exercise that focuses on activating and controlling deep spinal muscles, specifically the TrA and LM.\u003c/p\u003e \u003cp\u003eThe activation capacity of the transverse abdominus (TrA) was evaluated via the Stabilizer Pressure Biofeedback Unit (PBU; Chattanooga Group, Australia). The participants were positioned in the ventral decubitus position on a firm surface, with the device placed on the TrA (above the anterior superior iliac spines). Typically, the contraction of the abdominal muscles over the spinal cord causes a reduction in pressure of 4\u0026ndash;10 mmHg. Before the participants were instructed to contract their muscles, the apparatus was inflated to a pressure of 70 mmHg. The participants were subsequently instructed to carefully retract their lower abdomen away from the pressure sensor while keeping their back and hips still. They were instructed to sustain this contraction for 10 seconds, as monitored by a timer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eActivation of the lumbar multifidus begins with first facilitating the lumbar multifidus (PBU held at 40 mmHg such that no pressure change\u0026thinsp;=\u0026thinsp;spinal control), taking a relaxed breath, and holding the chest toward the bed. Try to pull the sacrum toward the shoulders. Do not use thoracic extension. This leads to a decrease in pressure of 5\u0026ndash;10 mmHg.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStatic diagonal: isometric opposite knee-to-hand push. Both hands were used to perform exercise, and one of them was monitored for spinal pressure. The knee was pushed toward the opposite hand isometrically and maintained for 10 seconds, after which the process was repeated 10 times. Under any pressure, the exercise should be stopped, and the process should be repeated correctly.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStatic diagonal heel lift: isometric knee-to-hand push\u0026thinsp;+\u0026thinsp;2nd heel lift. This process was repeated as mentioned in the previous exercise plus lifting the second heel from the floor and holding it.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAlternate single leg heel touch: As mentioned in the previous exercise, after lifting, both heels take the crook lying position with the hip flexed 90 degrees, keeping it as in previous exercises, and then lowering one heel to the floor and repeating. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eCriteria for advancing exercises based on the activation levels of the muscles include critical considerations. Following the establishment of neutral spine control in static positions, such as crook lying, one may progress to dynamic movements like static diagonal heel lifts and alternating single heel touches. All exercises should be pain-free; discomfort may suggest improper technique or excessive load. If exercises are performed without pain, the intensity or complexity may be gradually increased to further develop strength and control [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the subject characteristics of groups 1 and 2\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of subject characteristics between Group 1 and Group 2\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (in years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (in kilogram)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.51\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, N (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSD, standard deviation; p-value, probability value\u003c/h2\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eComparative analysis of subject characteristics between groups was performed via an unpaired t test. A chi-square test was performed to compare the distribution of sexes among the groups. The statistical normality of the data was assessed via the Shapiro‒Wilk test. Levene's test for homogeneity of variances was performed to assess the uniformity of variances among groups. To examine the impact of therapy on the VAS score, ODI, stability score, TrA, and LM thickness, a mixed MANOVA was used. Following multiple comparisons, post hoc tests were conducted via the Bonferroni correction. For all the statistical tests, the significance level was set at p \u0026lt;\u0026thinsp;0.05. Quantitative analysis was performed via the Statistical Package for Social Studies (SPSS) version 25 for Windows, which was developed by IBM in Chicago, IL, USA.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSubject characteristics:\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of the subjects\u0026rsquo; demographic characteristics (age, height, weight, and BMI). None of the participants were lost or dropped out of any of the groups. There was no significant difference between the groups in terms of age, weight, height, BMI, or sex distribution (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEffects of treatment on the VAS score, ODI, stability score, TrA, and multifidus thickness:\u003c/h2\u003e \u003cp\u003eA mixed MANOVA revealed that therapy and time had a significant interaction effect (F\u0026thinsp;=\u0026thinsp;66.16, p\u0026thinsp;=\u0026thinsp;0.001, ηp\u0026sup2; = 0.92). A statistically significant main effect of treatment was observed (F\u0026thinsp;=\u0026thinsp;4.34, p\u0026thinsp;=\u0026thinsp;0.001; ηp\u0026sup2;= 0.42). The main effect of time was statistically significant (F\u0026thinsp;=\u0026thinsp;268.69, p\u0026thinsp;=\u0026thinsp;0.001; ηp\u003cb\u003e\u0026sup2;\u003c/b\u003e= 0.0.98).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eWithin-group comparison\u003c/h2\u003e \u003cp\u003eThe results revealed a significant reduction in the VAS score and the ODI and a significant improvement in the stability score after therapy in both groups compared with the baseline scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001). The mean percentage changes in the VAS score, ODI, and stability score for Group 1 were 63.22%, 72.11%, and 23.91%, respectively. For Group 2, the corresponding percentage changes were 48.86%, 43.69%, and 12.83%, respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared with those before treatment, significant increases in the thicknesses of the right and left TrA and multifidus were observed in both groups following therapy (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001). Within Group 1, the thicknesses of the right and left TrA and multifidus increased by 37.50%, 27.27%, 22.77%, and 24.75%, respectively. In Group 2, the percentage increases were 9.09%, 9.37%, 6.90%, and 3.85%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBetween-group comparison\u003c/h2\u003e \u003cp\u003eNo statistically significant difference was detected between the groups before treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, comparison between groups posttreatment revealed a significant difference in the VAS score and ODI and a significant increase in the stability score, TrA, and multifidus thickness in group 1 compared with those in group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean VAS score, ODI score, and stability score before and after treatment in groups 1 and 2:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e% of change\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.79: 5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.83: 4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.72: 0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.79: -0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eODI (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.13: 27.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e72.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.13: 18.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.85: 4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-12.13: -7.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStability score (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.46\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-10.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-13.04: -8.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-7.72: -3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.23: 8.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95: 14.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSD, Standard deviation; MD, Mean difference; CI, Confidence interval; ηp\u0026sup2;\u003c/b\u003e \u003csup\u003e,\u003c/sup\u003e \u003cb\u003epartial eta-squared\u003c/b\u003e\u003csup\u003e,\u003c/sup\u003e \u003cb\u003ep value, Probability value.\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean TrA and multifidus thickness before and after treatment in groups 1 and 2:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e% of change\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRight TrA thickness (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.13: -0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.05: -0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.06: 0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02: 0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeft TrA thickness (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.11: -0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.05: -0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.04: 0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02: 0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRight multifidus thickness (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.51: -0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.18: -0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.28: 0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03: 0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeft multifidus thickness (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.047\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.54: -0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.13: -0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.38: 0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02: 0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eηp\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.09\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSD, Standard deviation; MD, Mean difference; CI, Confidence interval; ηp\u0026sup2;\u003c/b\u003e \u003csup\u003e,\u003c/sup\u003e \u003cb\u003epartial eta-squared\u003c/b\u003e\u003csup\u003e,\u003c/sup\u003e \u003cb\u003ep value, Probability value.\u003c/b\u003e,\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of this study was to investigate the effects of core stability exercises in addition to Russian electrical stimulation on pain, quality of life, transversus abdominis (TrA) and lumbar multifidus (LM) thickness and the stability of the lumbar spine in patients with nonspecific low back pain.\u003c/p\u003e \u003cp\u003eThe study findings indicated a notable reduction in the VAS score and ODI and substantial improvements in the stability score, TrA, and LM thickness after treatment in both groups compared with those before treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001). The posttreatment comparison between groups revealed notable disparities in the VAS and ODI scores, as well as a substantial increase in the stability score. Specifically, the transversus abdominis (TrA) and lumbar multifidus (LM) muscles were thicker than those in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The reduction in VAS and ODi scores achieves the minimum clinically important difference, avital metric for assessing whether these changes hold significance for patients.\u003c/p\u003e \u003cp\u003eResearch on the effects of Russian current on lower back pain (LBP) remains limited; however, electrotherapy has been shown to modulate pain according to Melzack and Wall\u0026rsquo;s gate-control theory. This theory posits that noxious stimuli travel through myelinated A-delta and non-myelinated C fibers. The activation of non-nociceptive A-beta fibers can inhibit the transmission of these noxious stimuli from the spinal cord to the brain by engaging inhibitory interneurons. When applied with appropriate parameters, Russian current selectively stimulates A-beta fibers. Consequently, an increase in A-beta activity, resulting from any electrical stimulation, leads to a reduction in pain perception due to the relative activity of A-delta and C fibers compared to A-beta fibers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additional proposed explanations for the reduction in pain perception after transcutaneous electrical nerve stimulation (TENS) include the stimulation of descending inhibitory pathways in the central nervous system through endogenous opioid-mediated effects [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] or a reduction in proinflammatory cytokines such as IL-1 and IL-6 in the bloodstream [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eElectrotherapeutic modalities, which utilize transdermal electric currents [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], are frequently employed by physiotherapists due to their positive impact on muscle function and favorable patient acceptance [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e],[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e],[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Neuromuscular electrical stimulation (NMES) activates nerve fibers in a designated sequence, starting with Aβ fibers, which produce the paresthesia sensation marking the sensory threshold. As NMES current amplitude increases, it may also engage C fibers that transmit nociceptive information. If the current surpasses the motor threshold, muscle contractions may occur [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The present study\u0026rsquo;s findings are consistent with Batistella et al.\u0026rsquo;s randomized trial involving 23 women aged 18\u0026ndash;30, who were assigned to either a control or Russian current group for four weeks. Both groups exhibited significant reductions in VAS scores and the Oswestry low back disability index, although only the Russian current group maintained these improvements during follow-up [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Lee et al. (2017) reported notable changes in resistance, muscle thickness (measured via ultrasound), and pain levels (assessed with a Visual Analog Scale and pressure algometer) following Russian current therapy for quadriceps pain post-ACL reconstruction [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Furthermore, \u0026Ccedil;ankaya et al. (2024) demonstrated that Russian current provides additional advantages in alleviating symptoms and enhancing pain management, functional mobility, and quality of life in individuals with patellofemoral pain [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Additionally, Rajan et al. (2018) identified a slight advantage of Russian current therapy over Interferential Therapy and Conventional Exercise in reducing pain and improving muscle strength in the short term among patients with postoperative lower limb fractures [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Among the various NMES modalities designed for muscle strengthening, medium-frequency currents such as Aussie (AC) and Russian (RC) currents are particularly noteworthy.\u003c/p\u003e \u003cp\u003eLow-frequency currents, such as functional electrical stimulation (FES), are significant in their ability to enhance motor unit recruitment, resulting in improved muscle strength and pain reduction [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e],[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Russian current can initiate depolarization of sensory and motor nerve fibers, activating fast type II motor units and facilitating muscle contractions that enhance muscle strength [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Heggannavar et al. (2014) demonstrated that Russian current stimulation is effective in strengthening quadriceps muscles and improving functional ability in individuals with primary osteoarthritis (OA) knee pain [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Additionally, Janarthanan et al. (2023) noted that the combination of Russian current and strengthening exercises led to improvements in pain, strength, and performance among sprinters with calf muscular strain [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Let\u0026iacute;cia Cittadin et al. (2020) mentioned that Russian current significantly increased muscle thickness in the non-dominant hand of healthy women [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], and a review by Pereira et al. (2022) indicated that Russian current was the most effective modality for promoting strength and thickness gains [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In contrast, Prabha et al. found no additional benefits from Russian current, suggesting that supervised exercises combined with Russian current were effective for managing primary knee osteoarthritis [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Patients with chronic non-specific low back pain (NSLBP) often experience delayed activation of deep stabilizing muscles, leading to postural instability and exacerbating pain and dysfunction [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This study reported a 23.91% improvement in stability scores in the experimental Russian current group, compared to a 12.83% improvement in the control group, attributed to Russian Electrical Stimulation (RES) enhancing muscle recruitment of weakened stabilizers [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. However, limitations of core stability exercises include difficulties in activating deep stabilizing muscles due to neuromuscular inhibition [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. RES can address this issue by directly activating motor neurons and promoting earlier engagement of stabilizers [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Naka et al. (2023) noted that patients with persistent neck and lower back pain undergoing suprathreshold electrotherapy six times weekly showed improved lumbar flexibility without corresponding improvements in pain or disability perceptions [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Despite positive findings, RES applications for NSLBP may cause adverse effects, including muscle fatigue, discomfort, skin irritation [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study adds to the existing literature regarding the efficacy of Russian electrical stimulation in conjunction with core stability exercises on pain management, quality of life, and the muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in patients experiencing nonspecific low back pain (NSLBP). The results demonstrate that the combination of Russian electrical stimulation and core stability exercises significantly alleviates pain intensity, with a reduction of 63.22% in the Visual Analog Scale (VAS) score, compared to a 48.86% decrease observed with core stability exercises alone. Furthermore, this combined intervention enhances functional outcomes, as evidenced by a 72.11% reduction in the Oswestry Disability Index (ODI) versus a 43.69% reduction with core stability exercises alone. After six weeks, muscle thickness showed a notable increase, with the TrA muscle increasing by 37.5% compared to 9.09%, and the multifidus muscle increasing by 22.77% versus 6.90% in the control group. Additionally, the stability score improved by 23.91% in the Russian current group compared to 12.83% in the control group.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Recommendations:\u003c/h2\u003e \u003cp\u003eThis study presents several limitations that warrant further discussion for future research. First, the absence of long-term follow-up assessments limits understanding of whether Russian current (RC) leads to enduring neuromuscular adaptations; future studies should include follow-ups of 3 to 6 months. Second, the sample size of 50 participants is relatively small for a randomized controlled trial (RCT); despite conducting a power analysis (effect size\u0026thinsp;=\u0026thinsp;0.88, power\u0026thinsp;=\u0026thinsp;80%), larger trials are necessary to validate these findings. Third, the study population comprises only young adults, which restricts the generalizability of results to older individuals or those with severe spinal pathologies. Future investigations should evaluate the effects of RC in more diverse populations, including elderly patients, athletes, and individuals with varying body mass index (BMI) categories. Fourth, it is recommended that future research compare the efficacy of RC with other electrotherapy modalities such as transcutaneous electrical nerve stimulation (TENS) or interferential therapy, as well as examine the application of Russian current on other anatomical regions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCNSLBP: chronic non-specific low back pain\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCSE: Core stabilization exercise\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRES: Russian Electrical Stimulation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVAS: Visual Analog Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eODI: Oswestry Disability Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrA: The transversus abdominis muscle\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;LM: lumbar multifidus muscle\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the outpatient clinic of Deraya University for permitting us to conduct this study. We also appreciate all the participants for their involvement in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study concept was developed by N.N. The study design was created by N.N., H.E., and H.S. Data collection was carried out by N.N. and H.S. The intervention was implemented by N.N. under the supervision of H.S. Data analysis and interpretation were performed by N.N, H.E., and H.S. The initial manuscript drafting was completed by N.N, H.S., and S.A. A critical review of the manuscript draft was conducted by H.E., S.A., and H.S. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research was supported by the Faculty of Physical Therapy at Deraya University. The funding body had no role in the design of the study, data collection, analysis, interpretation of data, or in writing the manuscript. The authors declare that no additional external funding was received for this study.\u003c/p\u003e\n\u003ch2\u003eData Availability\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective randomized controlled trial was conducted with prior approval from the ethical committees of the faculty of physical therapy at Deraya University, with approval number DCSR-02024-06, and conducted under the ethical standards of the institutional and national research committees, the 1964 Helsinki Declaration and its later amendments, and comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to participation, all subjects were provided with detailed information about the study, including its purpose, procedures, potential risks, and benefits. Before their inclusion in the study, written informed consent was obtained from all participants. Participants were assured that their participation was voluntary and that they could withdraw from the study without any consequences. Confidentiality and anonymity of the participants were maintained throughout the study.\u003c/p\u003e\n\u003ch3\u003eConsent for Publication\u003c/h3\u003e\n\u003cp\u003eAll participants in this study provided written informed consent for the publication of their data and any accompanying images. Participants were informed that their personal information would remain confidential and that any identifying information would be anonymized to protect their privacy.\u003c/p\u003e\n\u003cp\u003eThe consent included permission for the publication\u0026nbsp;of the study\u0026nbsp;results in scientific journals and presentations at conferences. Participants were assured that their decision\u0026nbsp;to\u0026nbsp;participate\u0026nbsp;or\u0026nbsp;withdraw\u0026nbsp;from\u0026nbsp;the\u0026nbsp;study\u0026nbsp;would\u0026nbsp;not\u0026nbsp;affect\u0026nbsp;their\u0026nbsp;medical\u0026nbsp;care or treatment.\u003c/p\u003e\n\u003ch3\u003eCompeting Interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no financial or non-financial competing interests concerning this study. Specifically:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Interests\u003c/strong\u003e: The authors have no financial relationships or affiliations with any organizations or entities that could be perceived as influencing the results or interpretation of this study. This includes, but is not limited to, employment, consultancies, stock ownership, honoraria, paid expert testimony, patents, and grants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-Financial Interests\u003c/strong\u003e: The authors have no non-financial interests that could be perceived as influencing the results or interpretation of this study. This includes personal or professional relationships, affiliations, knowledge, or beliefs that could affect the objectivity of the research.\u003c/p\u003e\n\u003cp\u003eAll authors have approved the final manuscript and agree with its submission to this journal. The authors confirm that there are no conflicts of interest regarding the publication of this paper\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGanesan S, Acharya AS, Chauhan R, Acharya S. Prevalence and risk factors for low back pain in 1,355 young adults: a cross-sectional study. 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Neurophysiol Clin. 2021;51(4):357\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee DJ, Shim JH, Yoon SI, Park SJ. Effect of convergence-based Russian current and transcutaneous electrical nerve stimulation at quadriceps muscles on pain, strength, and performance in persons with anterior cruciate ligament reconstruction. J korea convergence Soc. 2017;8(1):77\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ccedil;ankaya M, Karakaya İ\u0026Ccedil;, Yargi\u0026ccedil; PM, Karakaya MG. (2024). Effects of Russian and Aussie Currents Combined with Isokinetic Training on Symptoms, Pain, Functional Mobility and Quality of Life in Individuals with Patellofemoral Pain Syndrome: A Randomized, Placebo-Controlled Study. Am J Phys Med Rehabil, 10\u0026ndash;1097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajan S, Kohli SS, Bhaisaheb S. 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Structural changes of lumbar muscles in non-specific low back pain. Pain Physician. 2016;19(7):E985\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSions JM, Crippen DAC, Hicks GE, Alroumi AM, Manal TJ, Pohlig RT. Exploring neuromuscular electrical stimulation intensity effects on multifidus muscle activity in adults with chronic low back pain: an ultrasound imaging\u0026ndash;informed investigation. Clin Med Insights: Arthritis Musculoskelet Disorders. 2019;12:1179544119849570.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaka A, Kotz C, Gutmann E, Pramhas S, Schukro RPJ, Ristl R, Sator S. (2023). Effect of Regular Electrotherapy on Spinal Flexibility and Pain Sensitivity in Patients with Chronic Non-Specific Neck Pain and Low Back Pain: A Randomized Controlled Double-Blinded Pilot Trial. Medicina, \u003cem\u003e59\u003c/em\u003e(5).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"nonspecific low back pain, Russian current, core stability exercises, spinal mouse","lastPublishedDoi":"10.21203/rs.3.rs-6005327/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6005327/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eLow back pain (LBP) is a major public health concern resulting from aging and the growth of the global population. and is one of the primary causes of disability in our society.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThis study aimed to distinguish the efficacy of integrating core stability exercises (CSEs) with Russian current (RC) exercises on pain, quality of life, the muscle thickness of the lumbar multifidus (LM) muscle, the transversus abdominis (TrA) muscle and lumbar spine stability in patients with nonspecific low back pain (NSLBP)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFifty patients with NSLBP were randomly assigned to two groups: group 1 (the study group, n = 25) received CSE and RC three times a week for six weeks, whereas group 2 (the control group, n = 25) received CSE only. Pain was evaluated via the visual analog scale (VAS), functional disability was evaluated via the Oswestry Disability Index (ODI), TrA and LM thickness were evaluated via ultrasonography, and the stability score of the lumbar spine was determined via a spinal mouse device.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was a significant decrease in the VAS score and ODI and an increase in the stability score, TrA, and LM thickness, especially in group 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eRC accompanied by CSE provides greater improvement than CSE alone in the treatment of LBP, increases functional ability, increases TrA and LM thickness, and improves the stability of the lumbar spine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration: \u003c/strong\u003eThe study was registered on clinicaltrials.gov (NCT06495099) on 02/07/2024.\u003c/p\u003e","manuscriptTitle":"Effect of core stability exercises and Russian Electrical Stimulation on non-specific low back pain: randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-07 09:40:35","doi":"10.21203/rs.3.rs-6005327/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7558c61b-ecb0-4fea-b378-fc77426d4d18","owner":[],"postedDate":"April 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T09:40:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-07 09:40:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6005327","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6005327","identity":"rs-6005327","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}