Abstract

DOI:10.36678/IJMAES.2026.V12I03.02

INTRODUCTION

Low back pain (LBP) is a common and disabling musculoskeletal problem. It may present with pain, muscle tension or stiffness and can affect physical function, occupational activities and quality of life. Chronic low back pain is generally defined in the thesis as pain persisting for 12 weeks or more. The condition has a substantial functional and economic burden and is influenced by physical as well as psychological factors ^1–4.

The relationship between pain and disability in LBP is complex because pain is subjective and multidimensional. Disability may be reflected in limitations in self-care, walking, lifting, sitting, standing, sleeping, travelling, social activities and work-related tasks⁵. The thesis describes CLBP as a condition in which alterations in trunk muscle activation and spinal stability may contribute to persistent symptoms.

The trunk musculature contributes to spinal stability through coordinated activity of deep and superficial muscle systems. The deep trunk muscles, particularly the transversus abdominis and lumbar multifidus, have an important role in controlling intervertebral motion. In people with LBP, altered motor-control strategies and delayed or reduced activation of deep muscles have been described in the literature reviewed in the thesis ^6–9.

Motor control exercise is directed toward restoring the coordinated activation of the deep trunk muscles. The approach begins with isolated activation in low-load positions and progresses to tasks requiring coordination of deep and superficial trunk muscles while maintaining a neutral lumbar position. The thesis review reports evidence supporting motor control exercise for reducing pain and disability in CLBP ^10–13.

McGill’s stabilization approach is based on creating spinal stability through low-load exercises that recruit muscles surrounding the spine. The commonly described McGill “Big Three” are the curl-up, side plank and bird-dog. The approach aims to develop spinal stiffness and stability while minimizing excessive spinal loading. Previous work reviewed in the thesis has reported beneficial effects of McGill stabilization exercises on pain and functional disability ¹⁴.

Interferential therapy (IFT) is used as an electrotherapeutic intervention for musculoskeletal pain. The thesis describes its use in both treatment groups so that the exercise programs could be compared with IFT as a common component ^15,16. Although both motor control and McGill stabilization exercises are used clinically for CLBP, the thesis identified a need to compare their effects when combined with the same IFT protocol.

Therefore, the present study was undertaken to compare motor control exercises and McGill’s stabilization exercises, both combined with IFT, on pain and disability in patients with chronic low back pain.

METHODOLOGY

Study design and setting: A comparative study was conducted in the physiotherapy outpatient department of Raja Rajeswari Medical College and Hospital, Bengaluru. The total study duration was 10 months. Individual treatment was delivered over six weeks, with three sessions per week.

Ethical considerations: Institutional Ethical Committee clearance was obtained from Raja Rajeswari Medical College and Hospital, Bengaluru. The study was registered with Rajiv Gandhi University of Health Sciences under registration number 09_T055_148888. Written informed consent was obtained from all participants before participation.

Participants and sampling: Fifty subjects diagnosed with chronic low back pain were screened. Forty participants who fulfilled the eligibility criteria and agreed to participate were included. The thesis describes purposive sampling and allocation into two groups of 20 participants each, with alternate allocation during the treatment period. Participants were blinded to the intervention group after allocation, and no dropouts were reported.

Eligibility criteria: Participants were aged 25–35 years, had chronic low back pain of ≥12 weeks associated with intervertebral disc prolapse (stage 1: degeneration), VAS scores of 4–6, QBPDS scores of 20–40, low-risk Start Back Screening Tool scores as specified in the thesis, and BMI of 18.5–24.9 kg/m². Both male and female participants were eligible. Exclusion criteria included previous spinal or rib fracture/injury, spinal or limb deformity, recent abdominal or spinal surgery or implants, pregnancy, specific spinal pathology, relevant comorbidities preventing exercise participation, visual impairment or hearing loss, and obesity.

Outcome measures: Pain intensity was assessed using the visual analog scale (VAS), a 10-cm scale ranging from no pain to extreme pain. Disability was assessed using the Quebec Back Pain Disability Scale (QBPDS), a 20-item self-administered measure of activities affected by low back pain; higher scores indicate greater disability. The Start Back Screening Tool was used during screening.

Procedure: On day 1, participants underwent pre-intervention assessment of VAS and QBPDS. The allocated intervention was then provided three times per week for six weeks. The post-intervention assessment was completed at the end of the sixth week. A single therapist delivered the intervention and performed the pre- and post-intervention assessments. Each session lasted approximately 60 minutes and included 10 minutes of IFT, a 5-minute warm-up, 30–40 minutes of exercise training, rest periods, and a 2-minute cool-down. Both groups received the same IFT before exercise for the first 10 days.

IFT protocol: Participants were positioned prone with the painful area exposed. Tender points were identified by palpation and electrodes were positioned using a crossfire arrangement around the painful lumbar region. The thesis records use of a Vectrostrim IFT machine, a 4-kHz carrier frequency, burst frequency of 1–10 Hz, vector sweep of 900 V, patient-tolerated intensity, trapezoid waveform and 10-minute treatment duration.

Group A: Motor control exercises: The motor control program began with 6–8 cycles of cat-camel movement in quadruped. Participants were taught abdominal drawing-in manoeuvre (ADIM) to activate the deep abdominal musculature. Progression moved from low-load positions to sitting, standing and quadruped activities, followed by more challenging static, dynamic and functional tasks. Exercises described in the thesis included ADIM, bridging, straight-leg raise with ADIM, bird-dog and its progression, and side plank and its progression. The program emphasized maintaining a neutral spine and controlled activation of the trunk muscles.

Group B: McGill’s stabilization exercises: Participants were first trained to identify and maintain a neutral spinal posture. The program began with cat-camel movement and ADIM, followed by the McGill stabilization exercises. The thesis protocol included curl-up, curl-up progression, bird-dog, bird-dog progression, side plank and side plank progression. The exercises were progressed according to the treatment schedule while maintaining spinal control.

Statistical analysis: Data were analyzed using R software version 4.4 and Microsoft Excel. Descriptive statistics were used for age, BMI, VAS and QBPDS, while frequency distributions were used for categorical variables. Paired-sample t-tests were used for within-group comparisons and independent-samples t-tests for between-group comparisons. Statistical significance was set at p<0.05.

RESULTS

A total of 50 subjects were screened and 40 eligible participants completed the study, with 20 participants in each group. Both groups had an equal distribution of male and female participants (50% each). Baseline descriptive characteristics and outcome scores are presented below.

Table 1. Baseline demographic and outcome characteristics

Table 2. Within-group comparison of VAS and QBPDS scores.

Table 3. Between-group comparison of changes in outcome measures

Within-group analysis showed significant improvement in both groups for pain and disability. Group A showed a mean VAS reduction of 2.10 points and a mean QBPDS reduction of 12.40 points. Group B showed mean reductions of 1.45 and 8.85 points, respectively. The between-group comparisons demonstrated significantly greater mean reductions in both VAS and QBPDS in Group A.

DISCUSSION

The present study compared two exercise-based approaches for patients with chronic low back pain, with IFT provided as a common treatment component. Both groups demonstrated statistically significant reductions in pain and disability after six weeks. The greater reductions observed in the motor control group suggest that a program emphasizing specific activation and coordination of deep trunk muscles may provide additional benefit in this selected sample.

Pain intensity was similar between groups at baseline, with mean VAS scores of 4.90 in Group A and 4.95 in Group B. After treatment, the mean VAS decreased to 2.80 in Group A and 3.50 in Group B. The between-group difference in mean change was statistically significant (p=0.019), with a larger mean reduction in Group A. This finding is consistent with the literature summarized in the thesis, including evidence that motor control exercise can reduce pain in people with chronic low back pain ¹⁰.

The improvement may be related to the primary aim of motor control exercise: retraining the deep trunk muscles separately and then integrating them into more demanding tasks. The thesis review emphasizes the role of transversus abdominis and multifidus in intervertebral control and describes altered activation strategies in CLBP [6–9]. Gradual progression from ADIM in low-load positions to functional tasks may therefore improve the patient’s ability to control lumbar movement during activity ¹¹.

Disability also improved significantly in both groups. QBPDS scores decreased from 25.85 to 13.45 in Group A and from 26.65 to 17.80 in Group B. The between-group comparison showed a greater mean reduction with motor control exercise (12.40 versus 8.85; p=0.038). The findings are in agreement with the thesis literature review, which reports beneficial effects of motor control exercise on disability and functional outcomes in CLBP ^12,13.

McGill’s stabilization exercises also produced significant improvements. The McGill approach used in this study incorporated the curl-up, side plank and bird-dog, together with neutral-spine training and ADIM. Previous work reviewed in the thesis, particularly the study by Ghorbanpour et al., reported improvements in pain and functional disability following McGill stabilization exercise. The current results similarly indicate that McGill stabilization exercises are a useful exercise-based approach, although the motor control program produced larger mean changes in this study ^14-17.

IFT was applied identically in both groups and therefore does not explain the difference between the exercise programs. The thesis describes IFT as a common component intended to address pain before exercise. The systematic review cited in the thesis provides evidence concerning the use of interferential current therapy in musculoskeletal pain ^18-20.

Taken together, the findings indicate that both approaches can improve pain and disability over six weeks, while motor control exercises combined with IFT may offer a greater short-term effect than McGill stabilization exercises combined with IFT in the studied population. The result should be interpreted within the characteristics of the sample and the methodological limitations of the study ^{21, 22}.

Limitations:

The sample size was small, limiting generalizability.

The study used a limited set of outcome measures and did not directly assess deep and superficial trunk muscle activation.

Long-term follow-up was not performed.

Recommendations:

Future studies should include longer follow-up periods.

Larger samples and broader participant characteristics should be considered to improve generalizability.

Future studies may incorporate objective measures of deep and superficial trunk muscle activation.

CONCLUSION

The present study found that both motor control exercises with IFT and McGill’s stabilization exercises with IFT significantly improved pain and disability in patients with chronic low back pain. However, motor control exercises combined with IFT produced significantly greater reductions in VAS and QBPDS scores than McGill’s stabilization exercises combined with IFT over the six-week intervention period.

Acknowledgement: The author expresses gratitude to the institution, clinical staff, participants and all individuals who supported the completion of the study. The thesis acknowledges the guidance provided during the research process.

Conflict Of Interest: The thesis reports no conflict of interest.

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