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Low back pain (LBP) is a major global public health problem. Evidence shows that LBP is also related to cognitive, psychological, and lifestyle factors. Fu’s subcutaneous needling (FSN) has been used for the treatment of musculoskeletal problems for many years. This prospective randomized controlled trial aimed to evaluate the clinical efficacy and fear avoidance beliefs of FSN in the treatment of patients with chronic non-specific LBP. Ninety participants with chronic non-specific LBP were randomly divided into the FSN and the traditional acupuncture (TA) groups (n = 45) and received either FSN or TA treatment for three consecutive days from December 2021 to March 2023. The primary outcome was pain intensity measured by the visual analogue scale (VAS). Secondary outcomes were trunk extensor endurance (TEE), lumbar range of motion (ROM), and the Fear Avoidance Beliefs Questionnaire (FABQ). Outcome measurements were made before the first treatment and after each treatment. Follow-up assessments of VAS and FABQ scores were conducted one month after treatment. The FSN group had significantly lower VAS and FABQ scores at each time point after intervention compared to the TA group (P < 0.01). The scores of TEE and lumbar ROM were higher in the FSN group than those in the TA group (P < 0.01). Repeated measures analysis of variance (ANOVA) showed significant time effects, group effects, and interaction effects for VAS, TEE, lumbar ROM, and FABQ in both groups (P < 0.01). One month after treatment, the FSN group had significantly lower VAS and FABQ scores compared to the TA group (P < 0.05). This study suggested that FSN was superior to TA in terms of clinical efficacy and fear-avoidance beliefs in the treatment of chronic non-specific LBP. FSN could be used as an effective clinical treatment. •Low back pain (LBP) is a major public health problem with limited activity, imposing a significant economic burden.•Fu’s subcutaneous needling (FSN) therapy is a new acupuncture technique used to treat musculoskeletal pain disorders.•This clinical trial evaluates the efficacy and fear avoidance belief of FSN in treating chronic non-specific LBP patients.•Muscles with myofascial trigger points (MTrPs) around the lumbar spine played a more significant role in symptomatic LBP.•It is effective in relieving LBP and improving outcomes by eliminating MTrPs in muscles after FSN treatment.

PurposeA multidimensional classification approach suggests that motor control impairment subgroups exist in non-specific chronic low back pain (NSCLBP). Differences in sitting lumbar posture have been identified between two such subgroups [flexion pattern (FP) and active extension pattern (AEP)] and healthy individuals; however, functional spinal movement has not been explored. This study will evaluate whether NSCLBP subgroups exhibit regional spinal kinematic differences, compared to healthy individuals, during functional tasks.MethodsObservational, cross-sectional study design. Spinal kinematics of 50 NSCLBP subjects (27 FP, 23 AEP) and 28 healthy individuals were investigated using 3D motion analysis (Vicon™) during functional tasks [reaching upwards, step down, step up, lifting, and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor]. Mean sagittal angle for the total thoracic, total lumbar, upper thoracic, lower thoracic, upper lumbar, and lower lumbar regions between groups was compared.ResultsSignificant differences were observed in lower thoracic and upper lumbar regions between NSCLBP subgroups during most tasks. Significant differences were observed between the FP and healthy group in the lower thoracic region during stand-to-sit-to-stand tasks and bending (and returning from) to retrieve a pen from the floor. All significant results demonstrated the FP group to operate in comparatively greater flexion.ConclusionsThe thoraco-lumbar spine discriminated between FP and AEP, and FP and healthy groups during functional tasks. FP individuals demonstrated more kyphotic thoraco-lumbar postures, which may be pain provocative. No significant differences were observed between AEP and healthy groups, suggesting that alternative mechanisms may occur in AEP.

Purpose Little information exists on the potential differential response to functional restoration between non-specific chronic low back pain (NSCLBP) individuals with and those without Modic type 1 changes. Therefore, this case-control study investigated the response profile of NSCLBP patients with and without Modic type 1 changes undergoing functional restoration. Methods The present study included patients participating in a functional restoration program (day-hospital program lasting five weeks) at a French tertiary care center from 2009 to 2019. Each case with Modic type 1 changes was matched to one to two controls without Modic type 1 changes by sex, working incapacity, and lumbar spine surgery history. The primary effectiveness outcome was the Quebec Back Pain Disability Scale (QBPDS) score (0-100, with higher scores indicating higher disability). There were multiple secondary outcomes, such as subjective improvement and return to work. Results The study included 83 patients (cases: median [IQR] age 47.8 [11.6] years, 77.4% women; controls: median [IQR] age 46.0 [16.2] years, 75.0% women). At three months, there were no statistically significant differences between cases and controls in the QBPDS score (34.0 versus 31.5), subjective improvement (67.7% versus 69.2%), return to work in those who were not working at the inclusion (72.7% versus 52.6%), and the consumption of different analgesics. Conclusion The response profile of NSCLBP adults undergoing functional restoration did not statistically differ between the groups with and without Modic type 1 changes. These findings suggest that patients may benefit from such a program irrespective of their Modic type 1 status.

Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back pain. A review of the literature was carried out using the databases SPORTDiscuss, Medline and Google Scholar. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is beneficial for rehabilitation of non-specific chronic low back pain. Increasing core muscular strength can assist in supporting the lumbar spine. Improving the flexibility of the muscle-tendons and ligaments in the back increases the range of motion and assists with the patient’s functional movement. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain.

According to the current recommendations on the management of chronic non-specific low back pain (CNLBP), the intervention in this group of patients should include a programme of exercises. Pilates is a system of exercises widely used in patients with low back pain. The practices based on this method have promoted the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. During each exercise, specific principles of this method should be followed to restore or sustain the motor control of the lumbar spine and proper body posture. The aim of this study is to present the current state of knowledge concerning the application of Pilates method in the management of CNLBP as well as to define factors (eg, duration, frequency, exercises performed on a mat or specific equipment) influencing the effectiveness of Pilates in these individuals.

Background and Objectives: Chronic low back pain is a widespread condition, particularly in older populations, contributing to physical, mental, and social burdens. Traditional treatments, such as medications and surgery, carry long-term risks, including dependency, side-effects, and complications from invasive procedures. Additionally, healthcare accessibility is limited due to high costs, long waiting times, and geographic disparities in healthcare services, particularly in rural areas. For these reasons, non-pharmacological approaches that address both physical and psychological aspects are increasingly recognized as effective. This study aimed to evaluate the effectiveness of a marine resource-based healing program in Taean, South Korea, in improving pain, physical function, and mental health in patients with non-specific chronic low back pain. Materials and Methods: This randomized controlled trial involved 46 participants with non-specific chronic low back pain (mean age, 68.7 ± 5.1 years), randomly allocated to either an experimental group (marine healing program) or a control group (core exercises). The experimental group participated in a 4-night, 5-day intervention comprising heated peat pack therapy, mindfulness meditation, core exercises, and local tourism. The control group performed core exercises without additional interventions. Key outcomes included pain, muscle properties, functional disability, lower extremity function, balance, gait, and depression. Results: The experimental group demonstrated significant reductions in resting pain (p < 0.001), improved pressure pain threshold at L3 (p < 0.001), decreased L3 muscle tone (p = 0.015), and improved functional disability scores (p < 0.001). Functional gains were observed in lower extremity function scores (p < 0.001), balance (sway area: p = 0.046), gait velocity (p < 0.001), and depression levels (p < 0.001). Conclusions: The marine healing program significantly improved pain, functional abilities, and mental well-being in patients with non-specific chronic low back pain, highlighting its potential as an integrative approach to chronic low back pain management. Further studies are recommended to explore long-term and generalized effects.

Reduced lumbar multifidus (LM) cross-sectional area (CSA) has been linked with non-specific chronic low back pain (NCLBP); hence, lumbar stabilization exercise (LSE) is typically used as treatment. Real-time ultrasound imaging (RUSI) biofeedback can enhance performance and retention in LM activation. This study aimed to compare the effects of LSE with or without RUSI-biofeedback in patients with NCLBP. A single-blind, three-arm, parallel randomized controlled trial involving 90 participants, randomized into LSE RUSI-biofeedback, LSE no-biofeedback , or minimal intervention ( n  = 30 per group) was conducted. All interventions were administered twice weekly for 8 weeks, and outcomes (LM-CSA, pain, disability, and quality of life) were evaluated before and at 8-week and 20-week follow-ups. Compared to LSE no-biofeedback and minimal intervention, LSE RUSI-biofeedback demonstrated a greater increase ( p  < 0.05) in LM-CSA at 8 weeks (mean [95%CI] difference: 0.81 [0–1.62] and 1.79 [0.91–2.65], respectively) and at 20 weeks (1.61 [0.79–2.42] and 2.66 [1.79–2.53], respectively). LSE RUSI-biofeedback showed a greater improvement ( p  < 0.05) in mental health scores at 8 weeks (3.63 [0.32–6.94]) and 20 weeks (7.34 [4.03–10.60]) compared to LSE no-biofeedback . However, LSE no-biofeedback showed a greater physical health scores at 20 weeks (− 4.89 [− 7.92 to − 1.86]) compared to LSE RUSI-biofeedback . No significant differences ( p  > 0.05) were found between LSE RUSI-biofeedback and LSE no-biofeedback for pain or disability. The increase in LM-CSA significantly correlated with changes in pain (r = − 0.40 to − 0.50, p  < 0.05) and disability (r = − 0.38 to − 0.42, p  < 0.05). In conclusion, LSE with or without RUSI-biofeedback improved LM-CSA, pain, disability, and quality of life. However, LSE RUSI-biofeedback led to a greater increase in LM-CSA. Such an increase appears to be related to changes in pain and disability. Trial registration: The study was registered in the Pan African Clinical Trials Registry (16/01/2018; PACTR201801002980602).

Chronic non-specific low back pain (CNLBP) is the most common musculoskeletal problem. The purpose of this study was to investigate the effects of advanced physiotherapeutic exercise programs on imaging findings and inflammatory biomarkers in soccer players with CNLBP. In total, 60 CNLBP participants were divided into virtual reality exercise (VRE; n = 20), isokinetic exercise (IKE; n = 20), and conventional exercise (n = 20) groups. Pain intensity, imaging findings (muscle cross-sectional area (CSA) and muscle thickness), and changes in inflammatory biomarkers (CRP, TNF-α, IL-2, IL-4, and IL-6) were measured at baseline and after four weeks. After four weeks of intervention, there was a significant improvement (p = 0.001) in pain intensity for the VRE vs. IKE (0.7; CI 95% 0.38 to 1.07) and VRE vs. conventional (3.0 CI 95% 2.68 to 3.31) groups. The IKE group showed a greater number of significant changes in muscle CSA and muscle thickness than the other two groups (p < 0.001). Moreover, the VRE group showed significant improvement in inflammatory biomarker measures compared with the other two groups (p < 0.001). In CNLBP, virtual and isokinetic exercises had equal effects on reducing pain intensity. Isokinetic exercise is beneficial in increasing the muscle CSA and thickness, and virtual exercises are helpful for attenuating the inflammation process in soccer players with CNLBP.

Background Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group. Methods Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO 4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days. Results Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP. Conclusions The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO 4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach. Trial registration ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Purpose Chronic non-specific low back pain (CNLBP) is a complex and heterogeneous condition, and it is necessary to explore new treatment approaches. We evaluated whether the addition of dry cupping therapy to guideline‑based conventional therapy would further improve clinical outcomes in CNLBP. Methods Thirty-six patients with CNLBP were recruitedand randomly divided into two groups: the control group and the intervention group. The intervention group received cupping therapy in addition to the control group (core stabilization exercises, spinal manipulation and education) for 4 weeks. The primary outcome was the visual analog scale (VAS) for pain intensity. Secondary outcomes were the Roland Morris disability questionnaire (RMDQ), and pressure pain thresholds (PPT) at bilateral Shenshu (BL23), Qihaishu (BL24), and Dachangshu (BL25) acupuncture points. Results At week 4 the between‑group difference in resting pain was trivial (median difference 0.0 cm, 95% CI − 1.0 to 1.0). Neither clinically important nor statistically significant differences were detected in disability or PPTs. Both groups improved substantially from baseline. Conclusion In this randomized trial, adding dry cupping to conventional therapy offered no additional benefit over conventional therapy alone for pain, disability or PPT in CNLBP. Larger, multicentre trials with longer follow‑up and standardized negative pressures are warranted. Trial registration : ChiCTR2300069398, http://www.chictr.org.cn , Registration Date: March 15, 2023.