By Eric Wahlander, Director and Senior Physiotherapist, Nordic Physio Gladstone
Lower back pain is one of the most common reasons people come to see us. Most adults will have it at some point in their lives, and for some it keeps coming back. One question I get asked a lot is whether “core” or stability exercises actually help. It’s a question I spent a good part of my final year of physiotherapy study on.
In 2013 I completed my physiotherapy thesis at Luleå University of Technology in Sweden: a literature review of stability training for segmental instability and lower back pain. It’s written in Swedish (under the spelling Eric Wåhlander) and you can read the original on DiVA, the Swedish academic archive. Here’s what it looked at, what it found, and how the evidence has moved on since.
What is stability training?
Your back is supported by two broad groups of muscles. The larger, outer muscles move your trunk. A deeper group sits close to the spine, including transversus abdominis (the deepest abdominal muscle) and the lumbar multifidus (small muscles running along the spine). Their job is to control the position of each spinal segment and keep movement smooth.
Research has shown that people with lower back pain often have reduced strength and control in these deep muscles. Stability training, also called segmental stabilisation or motor control exercise, aims to retrain them. It usually starts with learning to activate the deep muscles gently and in isolation, then builds up to holding that control while you move, lift and load.
It’s often recommended for what’s called segmental instability, where one level of the lower spine moves more than it should in a particular direction. Combined with the extra strain on the joint and surrounding tissues, that excess movement is thought to contribute to ongoing pain.
What my thesis looked at
The question was simple: how effective is stability training compared with other physiotherapy treatments for lower back pain? The last review on the topic had been done in 2005, so I set out to summarise everything published since.
Between August and October 2012 I searched four research databases (PubMed, AMED, CINAHL and Cochrane). I included studies of people with lower back pain or segmental instability, and excluded back pain caused by pregnancy or by diseases such as arthritis. Of 26 relevant studies found, five met the criteria. Each was rated for quality on the PEDro scale, a standard tool for judging physiotherapy trials. Scores ranged from 4 to 8 out of 10.
What the studies found
All five studies reported less pain in the people who did stability training:
- Stability training vs general trunk strengthening (França et al., 2010; 30 people). Both groups improved, but the stability group improved more on pain, disability and deep abdominal muscle activation.
- Stability training vs stretching (França et al., 2011; 30 people). Both groups had less pain, again with larger improvements in the stability group.
- Stability training added to routine exercises such as planks (Javadian et al., 2012; 30 people with segmental instability). Both groups improved. In the stability group, average pain fell from 45 to 24 on a 100-point scale, and kept falling to 18 at a follow-up 12 weeks after training ended.
- Cricket players on a 13-week program (Hides et al., 2008). Players with back pain reported less pain, and ultrasound showed the multifidus muscles had grown.
- A small seven-week program (Carpes et al., 2008; 6 people) also reported reduced pain.
My conclusion at the time: in these studies, stability training gave better results than stretching, general trunk strengthening and general strength training. But I also had to be honest about the limits:
- The studies were small, with 6 to 30 participants.
- In some, the comparison group’s exercises overlapped with stability training. In one, participants were doing several other types of training at the same time.
- Very few alternative treatments had been compared head to head.
So the evidence pointed in a positive direction, but it wasn’t strong enough to say stability training was clearly superior. More and larger studies were needed.
What we know now
Those larger studies have since been done, and they’ve refined the picture:
- A 2016 Cochrane review (29 trials, 2,431 people with chronic lower back pain) found that motor control (stability) exercise does help compared with minimal treatment. However, it works about as well as other forms of exercise and manual therapy, not better. The authors concluded the choice of exercise should depend on the patient’s and therapist’s preferences.
- The World Health Organization’s 2023 guideline on chronic lower back pain says a structured exercise program may be offered as part of care for adults, including older people.
- Australia’s Low Back Pain Clinical Care Standard (2022) emphasises staying active, understanding your pain, and avoiding unnecessary scans. Passive approaches like bed rest tend to slow recovery.
In other words, the most important thing is that you do a structured, progressive exercise program, and keep doing it. Which type matters less than whether it suits you and your back.
How this shapes what we do at Nordic Physio
That’s why we don’t hand everyone the same sheet of “core exercises”. Your treatment starts with an assessment: how your back pain started, what aggravates it, how you move and load your spine, and what you need to get back to, whether that’s a 12-hour shift, lifting at home or getting back on the court. From there we build a graded program. It may include stability work for the deep trunk muscles where that suits the problem, along with strength, movement and practical advice for work and daily life.
As a former professional basketball player who has been through spinal surgery myself, I know how much a structured, well-explained program matters when your back isn’t cooperating.
When to see a doctor first
Some back pain needs medical assessment rather than physiotherapy. Seek prompt medical attention if you have:
- numbness around the groin or buttocks
- difficulty controlling your bladder or bowels
- progressive weakness in a leg
- back pain with fever, unexplained weight loss, a history of cancer, or after a significant injury
Book an appointment
You don’t need a referral to see a physio privately. Book online or call the clinic on (07) 4962 1255. We’re at Shop 11, Palms Shopping Fair, 172 Goondoon Street, Gladstone. For more on how we treat back pain, see our lower back pain page.
This article is general information only and isn’t a substitute for an individual assessment. Results vary from person to person.
References
- Wåhlander E. Stabilitetsträning för segmentell instabilitet och ländryggssmärta: en litteraturstudie [Stability training for segmental instability and low back pain: a literature review]. Bachelor’s thesis, Luleå University of Technology; 2013.
- Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database of Systematic Reviews 2016; CD012004.
- World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023.
- Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC; 2022.
- França FR, et al. (2010, 2011); Javadian Y, et al. (2012); Hides JA, et al. (2008); Carpes FP, et al. (2008), as reviewed in the thesis.