J Bodyw Mov Ther. 2025 Dec;45:1041-1052. doi: 10.1016/j.jbmt.2025.10.025. Epub 2025 Oct 27.
ABSTRACT
BACKGROUND: Chronic low back pain (CLBP) frequently results in impaired coactivation of the transverse abdominal and multifidus muscles due to pain, disuse, and compensatory strategies. Understanding these alterations is critical for the development of targeted rehabilitation interventions. This study aims to evaluate the effects of water kinetic chain exercises on enhancing muscle coactivation, alleviating pain, and improving quality of life in men with chronic non-specific low back pain.
METHODS: A double-blind randomized controlled trial was conducted with 60 male participants aged between 40 and 60 years, all diagnosed with chronic nonspecific low back pain (CNSLBP). The participants were randomly assigned to one of three groups: one group performed closed kinetic chain exercises in water (CKCE), another group engaged in open kinetic chain exercises in water (OKCE), and a control group received no intervention. To assess muscle coactivation (Mca), surface electromyography was employed to monitor the transverse abdominal (TA) and multifidus (MF) muscles during side plank with hip abduction (SPHA) tasks. Pain intensity and quality of life (QoL) were evaluated using the visual analog scale (VAS) and 36-Item Short-Form Health Survey (SF-36). The intervention lasted for eight weeks, with three sessions per week, and differences between groups were analyzed using analysis of covariance (ANCOVA).
RESULTS: The analysis revealed that both the OKCE and CKCE groups exhibited significant improvements in the Mca, TrA and MF muscles from pre-test to post-test (P = 0.001). Furthermore, the ANCOVA results indicated a significant difference between the groups concerning Mca, TVA, and MF (F2 = 10.96, p = 0.001, η2 = 0.278), highlighting a robust effect of the intervention, and no significant differences were revealed in Mca, Mca, TrA and MF between the OKCE and CKCE groups (p = 0.068). In addition to improvements in muscle coactivation, both groups reported a significant reduction in pain levels and enhancements in QoL following the interventions (P = 0.001). However, it is important to note that no significant difference was found in the levels of pain and QoL between the OKCE and CKCE groups (P = 0.448), suggesting that while both interventions were effective, the type of exercise did not differentially impact these outcomes.
CONCLUSION: The findings of this study underscore the importance of addressing the impaired coactivation of the transverse abdominal and multifidus muscles in men suffering from chronic non-specific low back pain. By implementing water kinetic chain exercises, we can effectively enhance muscle coactivation, which may lead to significant reductions in pain and improvements in overall quality of life. These results highlight the potential of targeted rehabilitation interventions in managing CLBP, suggesting that incorporating aquatic therapy into treatment plans could offer a promising approach for individuals struggling with this debilitating condition. Future research should continue to explore the long-term benefits and mechanisms underlying these improvements to further refine rehabilitation strategies for CLBP. Ethics Committee Bu-Ali Sina University (IR. BASU. REC.1402.011.) Iranian Registry of Clinical Trials IRCT20230430058033N1.
PMID:41316555 | DOI:10.1016/j.jbmt.2025.10.025
