Effects of Multifidus Lift Exercise on Endurance, Pain, and Disability in University Students With Low Back Pain
NCT ID: NCT07182825
Last Updated: 2025-09-19
Study Results
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Basic Information
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NOT_YET_RECRUITING
NA
40 participants
INTERVENTIONAL
2025-10-01
2026-02-28
Brief Summary
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This study will investigate a simple modification of the traditional "bird-dog" exercise, called the "Multifidus Lift Exercise." In this version, participants maintain the contralateral knee about 10 cm above the ground while in a four-point kneeling position. This adjustment is expected to increase multifidus activation and improve back endurance.
University students aged 18-25 with nonspecific low back pain will participate in a 6-week supervised program, performing the exercise twice weekly. A healthy control group without low back pain will also be included. The main outcome will be back extensor muscle endurance (Biering-Sørensen Test). In participants with back pain, pain intensity (Visual Analog Scale) and functional disability (Oswestry Disability Index) will also be measured.
The study aims to determine whether this low-cost, practical, and time-efficient exercise can improve muscle endurance, reduce pain, and decrease disability in young adults with low back pain. Results may provide evidence for an effective and accessible preventive and therapeutic approach in student populations.
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Detailed Description
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Objectives and Research Questions. Primary objective: determine the effect of a 6-week supervised MLE program (2 sessions/week) on lumbar extensor endurance (Biering-Sørensen test). Secondary objectives (NSLBP group): assess changes in pain (10-cm VAS) and functional disability (Oswestry Disability Index, Turkish validated version). Key research questions test whether MLE increases endurance and reduces pain/disability in NSLBP, and whether endurance differs between NSLBP and healthy students.
Design and Setting. Single-center, interventional, non-randomized, parallel-group, pre-post design conducted at the Physiotherapy \& Rehabilitation Exercise Hall, Selçuk University (Konya, Türkiye). Two cohorts will be observed under the same intervention protocol: (1) university students (18-25 y) with NSLBP and (2) healthy controls without recent low back pain. Allocation is based on current status (no randomization). Masking is not feasible (exercise behavior). Primary purpose: treatment/rehabilitation.
Intervention (Exercise Protocol). All participants receive an initial brief training on isolated multifidus activation and motor control principles. Each supervised session includes standardized warm-up (5 min brisk walk; mobilization; hamstring stretch), the MLE performed slowly and with breath control, and cool-down (static stretches). Repetition progression: weeks 1-2: 8-10 reps; weeks 3-4: 10-12; weeks 5-6: 12-15, emphasizing form and endurance. A 3-week pilot (2 sessions/week) mirrors the 6-week protocol in compressed form (wk1→8-10; wk2→10-12; wk3→12-15) to estimate effect size for main-study sample size planning.
Outcomes and Assessments. Primary outcome is Biering-Sørensen endurance time (seconds) in both groups. Secondary outcomes in NSLBP include VAS pain and ODI (%). Measurements occur at baseline and post-intervention. Adverse symptoms prompting immediate pause (e.g., dizziness, undue fatigue) are recorded session-wise.
See "Outcome Measures" and "Time Frame" modules for exact definitions and schedules.
Participants and Eligibility. Target population: Selçuk University students aged 18-25. Two cohorts (NSLBP vs healthy) are defined by clinical status and physician clearance for exercise. Inclusion/exclusion criteria address red flags, recent surgery or neurological deficits, pregnancy, regular analgesic use, high-load sports, and recent structured exercise that could confound endurance.
Complete criteria are provided in the "Eligibility" module.
Sample Size and Pilot-Informed Planning. The pilot (n≈20; 10 NSLBP/10 healthy) will provide effect size estimates (Cohen's d) to power the main study via G\*Power. The anticipated main-study enrollment will be balanced across cohorts per power analysis.
Statistical Analysis (Summary). Analyses will use two-tailed α=0.05 with 95% CIs (IBM SPSS). Descriptives will summarize baseline characteristics. Normality will guide test selection. Between-group comparisons for endurance (NSLBP vs healthy) will use t-test or Mann-Whitney U. Within-group pre-post changes (endurance for both groups; VAS/ODI for NSLBP) will use paired t-tests or Wilcoxon signed-rank. Where appropriate, repeated-measures ANOVA (with Greenhouse-Geisser adjustment) will model time effects; ANCOVA may adjust for baseline imbalances. Exploratory Pearson/Spearman correlations will assess relationships among endurance, pain, and disability; multiple linear regression may evaluate predictors of disability change.
Safety and Monitoring. This is a low-risk, behavioral exercise intervention. Sessions are supervised by study staff; standardized stop rules (e.g., onset of dizziness, dyspnea, undue fatigue, new pain flare) are applied. A formal Data Monitoring Committee is not planned; safety is monitored by the investigative team at each session. Adverse events and withdrawals are documented.
Ethics and Oversight. Ethics approval was granted by the Selçuk University Faculty of Health Sciences Ethics Committee for Non-Interventional Clinical Investigations (Decision/Approval No: 2025/674; Meeting No: 05; Ref: 2025/05; Date: 30/04/2025). Participation is voluntary with written informed consent. Data are handled under the Declaration of Helsinki and applicable regulations (including Turkish KVKK). De-identified, aggregate results will be disseminated.
Data Handling and Dissemination. De-identified data will be analyzed and reported in aggregate. Individual participant data sharing is not planned. Findings will be prepared for peer-reviewed publication and scientific meetings, and may inform practical, community-oriented exercise programs for student populations.
Conditions
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Study Design
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NON_RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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NSCLBP Students - Modified Multifidus Lift Exercise
University students aged 18-25 years with nonspecific chronic low back pain. Participants will perform the supervised modified Multifidus Lift Exercise protocol, twice weekly for 6 weeks. Each session includes warm-up, exercise progression (8-15 repetitions depending on week), and cool-down. Outcomes: lumbar extensor endurance (primary), pain intensity (VAS), and functional disability (ODI).
Modified Multifidus Lift Exercise (MLE)
A supervised stabilization exercise protocol designed to selectively activate the lumbar multifidus muscle. In the quadruped position, the contralateral knee is maintained approximately 10 cm above the ground while the participant performs controlled trunk stabilization. Sessions are conducted twice weekly for 6 weeks, each including warm-up (5 minutes brisk walk, mobilization, hamstring stretch), the modified Multifidus Lift Exercise with progressive repetitions (weeks 1-2: 8-10, weeks 3-4: 10-12, weeks 5-6: 12-15), and cool-down (static stretches). All sessions are supervised to ensure correct form, breathing control, and safety.
Healthy Students - Modified Multifidus Lift Exercise
Healthy university students aged 18-25 years without low back pain in the past 3 months. Participants will perform the same supervised modified Multifidus Lift Exercise protocol, twice weekly for 6 weeks, with identical warm-up, exercise progression, and cool-down. Outcome: lumbar extensor endurance (Biering-Sørensen Test).
Modified Multifidus Lift Exercise (MLE)
A supervised stabilization exercise protocol designed to selectively activate the lumbar multifidus muscle. In the quadruped position, the contralateral knee is maintained approximately 10 cm above the ground while the participant performs controlled trunk stabilization. Sessions are conducted twice weekly for 6 weeks, each including warm-up (5 minutes brisk walk, mobilization, hamstring stretch), the modified Multifidus Lift Exercise with progressive repetitions (weeks 1-2: 8-10, weeks 3-4: 10-12, weeks 5-6: 12-15), and cool-down (static stretches). All sessions are supervised to ensure correct form, breathing control, and safety.
Interventions
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Modified Multifidus Lift Exercise (MLE)
A supervised stabilization exercise protocol designed to selectively activate the lumbar multifidus muscle. In the quadruped position, the contralateral knee is maintained approximately 10 cm above the ground while the participant performs controlled trunk stabilization. Sessions are conducted twice weekly for 6 weeks, each including warm-up (5 minutes brisk walk, mobilization, hamstring stretch), the modified Multifidus Lift Exercise with progressive repetitions (weeks 1-2: 8-10, weeks 3-4: 10-12, weeks 5-6: 12-15), and cool-down (static stretches). All sessions are supervised to ensure correct form, breathing control, and safety.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
Currently enrolled as a university student at Selçuk University
Willing to participate voluntarily and sign informed consent form
Medically suitable for exercise participation
For NSCLBP group:
History of nonspecific chronic low back pain within the past 3 months
Physician confirmation of nonspecific low back pain
Oswestry Disability Index (ODI) ≥ 21% (moderate disability)
Visual Analog Scale (VAS) score ≥ 3.5
For Healthy control group:
No history of low back pain within the past 3 months
Physician confirmation of no contraindications for exercise
Exclusion Criteria
History of spinal surgery
Neurological deficits within the past 3 months (e.g., muscle weakness, reflex loss, paresthesia)
Systemic infection or systemic disease affecting participation
Cardiovascular or pulmonary disease contraindicating exercise
Clinical "red flag" symptoms (e.g., saddle anesthesia, bowel/bladder incontinence, fever, known cancer)
Pregnancy
Regular use of analgesics, muscle relaxants, or anti-inflammatory medications
Participation in regular exercise programs in the past 3 months
Active involvement in sports directly affecting lumbar muscles (e.g., fitness, pilates, yoga, swimming)
Inability to comply with exercise sessions or study protocol
18 Years
25 Years
ALL
Yes
Sponsors
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The Scientific and Technological Research Council of Turkey
OTHER
Mehmet Akif Guler
OTHER
Responsible Party
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Mehmet Akif Guler
PhD, Lecturer
Locations
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Selçuk University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
Konya, Konya, Turkey (Türkiye)
Countries
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Central Contacts
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Facility Contacts
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References
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Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, Frat T, Kiraz S, Krd N, Kayhan H, Yakut Y, Guler C. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004 Mar 1;29(5):581-5; discussion 585. doi: 10.1097/01.brs.0000113869.13209.03.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005 Aug;14(7):798-804. doi: 10.1111/j.1365-2702.2005.01121.x.
Stevens VK, Vleeming A, Bouche KG, Mahieu NN, Vanderstraeten GG, Danneels LA. Electromyographic activity of trunk and hip muscles during stabilization exercises in four-point kneeling in healthy volunteers. Eur Spine J. 2007 May;16(5):711-8. doi: 10.1007/s00586-006-0181-1. Epub 2006 Aug 1.
Smeets R, Koke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S158-73. doi: 10.1002/acr.20542. No abstract available.
Shafshak TS, Elnemr R. The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain. J Clin Rheumatol. 2021 Oct 1;27(7):282-285. doi: 10.1097/RHU.0000000000001320.
Sarafadeen R, Ganiyu SO, Ibrahim AA. Effects of spinal stabilization exercise with real-time ultrasound imaging biofeedback in individuals with chronic nonspecific low back pain: a pilot study. J Exerc Rehabil. 2020 Jun 30;16(3):293-299. doi: 10.12965/jer.2040380.190. eCollection 2020 Jun.
Pitcher MJ, Behm DG, Mackinnon SN. Neuromuscular fatigue during a modified biering-sorensen test in subjects with and without low back pain. J Sports Sci Med. 2007 Dec 1;6(4):549-59. eCollection 2007.
Pirouzi S, Emami F, Taghizadeh S, Ghanbari A. Is Abdominal Muscle Activity Different from Lumbar Muscle Activity during Four-Point Kneeling? Iran J Med Sci. 2013 Dec;38(4):327-33.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9. Epub 2016 Oct 11.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. doi: 10.1002/acr.20543. No abstract available.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952. doi: 10.1097/00007632-200011150-00017.
Demoulin C, Vanderthommen M, Duysens C, Crielaard JM. Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine. 2006 Jan;73(1):43-50. doi: 10.1016/j.jbspin.2004.08.002.
Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014 Dec;155(12):2545-2550. doi: 10.1016/j.pain.2014.09.014. Epub 2014 Sep 17.
Related Links
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Güler MA, Demirdel E, Albayrak İ, Nayman A. The Relationship between Core Stability, Pain and Disability in Persons with Chronic Non-Specific Low Back Pain. Selçuk Sağlık Dergisi. 2023;4(3):420-431.
Other Identifiers
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1919B012413996
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
SUTUBITAK996
Identifier Type: -
Identifier Source: org_study_id
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