Ten minutes of core stabilisation exercise result in local exercise-induced hypoalgesia

Key points

1. 01Local lumbar pressure pain thresholds increased by 18.79% after exercise versus 0.01% after a rest control session
2. 02No significant change in pain sensitivity was detected at remote sites (forehead and thumb pad) after exercise
3. 03Pain catastrophizing was the only factor significantly linked to the exercise pain response, with higher catastrophizing predicting smaller hypoalgesia (rho = -0.381)
4. 04The exercise protocol required no equipment and was rated as only 'somewhat hard' (RPE 13.07 on the 6-20 Borg scale)
5. 05No adverse effects such as nausea, dizziness, or pain flare-ups were reported

How it was conducted

Design

Randomised controlled crossover trial with three visits and a 1-week washout between sessions

Participants

30 adults (age 42.3 +/- 10.5 years) with diagnosed unspecific chronic low back pain, average pain NRS 4.2/10 over prior 12 weeks

Exercise session

10 minutes of isometric bodyweight exercises: forearm plank, static swimmers, right-side plank, left-side plank, and supine bridge; each held 30 s with 10 s rest, three rounds

Control session

10 minutes of quiet seated rest in a secluded room

Primary outcome

Pressure pain thresholds (PPT) measured in N/cm2 at 8 lumbar sites (local) and 2 remote sites (forehead, thumb pad) immediately before and after each session

Correlation analyses

Spearman correlations between change in PPT and pain intensity, BMI, kinesiophobia, catastrophizing, physical activity, and perceived exertion

What they found

• Time x Intervention interaction for PPTlocal: F(1,29) = 31.823, p < 0.001, partial eta-squared = 0.523
• PPTlocal post-exercise: 67.5 +/- 26.1 N/cm2 vs pre-exercise 56.6 +/- 20.6 N/cm2 (p < 0.001); relative increase 18.79% +/- 12.64%
• PPTlocal post-control: 58.4 +/- 23.3 N/cm2 vs pre-control 58.5 +/- 24.0 N/cm2 (p = 0.894); relative change 0.01% +/- 8.84%
• Time x Intervention interaction for PPTremote: F(1,29) = 6.845, p = 0.014, partial eta-squared = 0.191; post-hoc showed no pre-post difference after exercise (p = 0.103) but a slight decrease after control (p = 0.031)
• PPTremote relative change: 2.25% +/- 9.89% (exercise) vs -2.26% +/- 7.06% (control)
• Individual lumbar landmarks showed relative increases ranging from 14.8% (L2/3 right) to 24.8% (L3/4 right)
• Measurement site x Intervention interaction for delta-PPT: F(1,29) = 19.725, p < 0.001, partial eta-squared = 0.405; local delta-PPT significantly larger than remote delta-PPT in exercise session (p < 0.001)
• Catastrophizing correlation with delta-PPTlocal (exercise session): rho = -0.381, p = 0.038; no other factors reached significance

Limitations

• Pain sensitivity was only measured immediately post-exercise; duration of the hypoalgesic effect is unknown
• The PPT examiner was not blinded to the intervention, introducing potential experimenter bias
• PPT measurement is semi-objective and participant-dependent, with possible bias from manual pressure application and pain summation between consecutive measurements
• The supervised laboratory setting may not reflect real-world exercise adherence or safety without supervision

Why it matters

For patients

A short bodyweight floor exercise routine done at home may offer meaningful, immediate low back pain relief without any equipment.

For clinicians

A 10-minute isometric core stabilisation circuit can be considered as a brief adjunct pain management tool for patients with chronic unspecific low back pain, with the caveat that high catastrophizers may respond less.

For readers

This is the first study to show that brief core stabilisation exercise produces local exercise-induced hypoalgesia in chronic low back pain patients, supporting its use as a rapid, non-pharmacological pain intervention.