Effects of Multifidus Lift Exercise on Endurance, Pain, and Disability in University Students With Low Back Pain

NCT07182825 | Not Yet Recruiting

• 2 other identifiers: SUTUBITAK9961919B012413996
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Nonspecific low back pain is a common musculoskeletal problem that also affects many young adults, including university students. It can negatively impact academic performance, daily life, and overall well-being. Research shows that stabilization exercises targeting the lumbar multifidus muscle play an important role in rehabilitation, but it is unclear whether modified versions of these exercises may provide additional benefits. 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.

Conditions

Low Back Pain; Non Specific Chronic Low Back Pain; Healthy Vollunteer

Keywords

Nonspecific Low Back Pain; Multifidus Muscle; Multifidus Lift Exercise; Bird-Dog Exercise (Modified); Spinal Stabilization Exercise; Endurance; Pain; Disability; Oswestry Disability Index (ODI); Visual Analog Scale (VAS); Biering-Sørensen Test; University Students; Young Adults; Healthy Controls

Outcome Measures

Primary Outcomes (1)

• Lumbar Extensor Muscle Endurance (Biering-Sørensen Test)

  Endurance of the lumbar extensor muscles will be assessed using the standardized Biering-Sørensen Test. Participants lie prone with the upper body unsupported beyond the table edge while the pelvis and lower limbs are stabilized. The duration (in seconds) that the participant can maintain the horizontal position without \>10° deviation is recorded.

  Baseline (pre-test) and after 6 weeks of intervention.

Secondary Outcomes (2)

• Pain Intensity (Visual Analog Scale, VAS)

  Baseline (pre-test) and after 6 weeks of intervention.

• Functional Disability (Oswestry Disability Index, ODI)

  Baseline (pre-test) and after 6 weeks of intervention.

Study Arms (2)

NSCLBP Students - Modified Multifidus Lift Exercise

EXPERIMENTAL

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).

Behavioral: Modified Multifidus Lift Exercise (MLE)

Healthy Students - Modified Multifidus Lift Exercise

EXPERIMENTAL

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).

Behavioral: Modified Multifidus Lift Exercise (MLE)

Interventions

Modified Multifidus Lift Exercise (MLE) BEHAVIORAL

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.

Also known as: Modified Bird-Dog Exercise, Multifidus Lift

Healthy Students - Modified Multifidus Lift Exercise; NSCLBP Students - Modified Multifidus Lift Exercise

Eligibility Criteria

• Age: 18 Years - 25 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18 and 25 years
• 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

You may not qualify if:

• Presence of radicular pain or nerve root compression symptoms
• 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

Sponsors & Collaborators

• Mehmet Akif Guler: lead
• The Scientific and Technological Research Council of Turkey: collaborator

Study Sites (1)

Selçuk University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Konya, Konya, 42130, Turkey (Türkiye)

Location

Related Publications (14)

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• 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.

  PMID: 16896840 BACKGROUND

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  PMID: 22588742 BACKGROUND

• 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.

  PMID: 31985722 BACKGROUND

• 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.

  PMID: 32724788 BACKGROUND

• 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.

  PMID: 24149491 BACKGROUND

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  PMID: 24293787 BACKGROUND

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  PMID: 27745712 BACKGROUND

• 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.

  PMID: 22588748 BACKGROUND

• 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.

  PMID: 17695343 BACKGROUND

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  PMID: 16461206 BACKGROUND

• 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.

  PMID: 25239073 BACKGROUND

Related Links

• 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.

MeSH Terms

Conditions

Low Back Pain; Pain

Condition Hierarchy (Ancestors)

Back Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Mehmet Akif Güler, PhD, PT

CONTACT

+90 542 464 4209; makif.guler@selcuk.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Masking Details: No masking will be implemented. Both participants and investigators are aware of the intervention assignment.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: PhD, Lecturer

Model Details: Two parallel groups will be studied: (1) university students aged 18-25 years with nonspecific chronic low back pain, and (2) healthy controls without low back pain. Both groups will receive the same 6-week supervised modified Multifidus Lift Exercise protocol. Group allocation is based on participants' clinical status; no randomization will be performed.

Study Record Dates

• First Submitted: September 14, 2025
• First Posted: September 19, 2025
• Study Start: October 1, 2025
• Primary Completion: January 31, 2026
• Study Completion: February 28, 2026
• Last Updated: September 19, 2025

Record last verified: 2025-09

Locations

TU (1)