Effects of Pain Neuroscience Education Combined with Dynamic Neuromuscular Stabilization on Movement Control and Clinical Outcomes in Individuals with Chronic Non-Specific Low Back Pain: A Three-Arm Randomized Controlled Trial

Sina Saeed Askari; Mansour  Sahebozamani; Saeid  Bahiraei; Mehdi  Abbasnejad

Authors

Sina Saeed Askari Department of Sports Injury and Biomechanics, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran https://orcid.org/0009-0004-9983-6138
Mansour Sahebozamani Department of Sports Injury and Biomechanics, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran Author https://orcid.org/0009-0006-6337-1097
Saeid Bahiraei Department of Sports Injury and Biomechanics, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran Author https://orcid.org/0000-0002-1553-1571
Mehdi Abbasnejad Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran Author https://orcid.org/0000-0003-2570-5288

Keywords:

Chronic non-specific low back pain, pain neuroscience education, dynamic neuromuscular stabilization, lumbar motor control, pain; disability, quality of life

Abstract

Purpose: This study aimed to compare the effects of pain neuroscience education combined with dynamic neuromuscular stabilization, dynamic neuromuscular stabilization alone, and conventional core exercise on lumbar motor control, pain intensity, functional disability, and quality of life in individuals with chronic non-specific low back pain.

Methods and Materials: This three-arm randomized controlled trial included 54 adults aged 25–40 years with chronic non-specific low back pain who were randomly allocated to PNE + DNS, DNS, or conventional core exercise groups (n = 18 each). All groups completed an 8-week supervised intervention with three sessions per week. Outcomes were assessed at pre-test, post-test, and 2-month follow-up using a six-test lumbar movement-control battery, visual analogue scale, Roland–Morris Disability Questionnaire, and SF-36. Data were analyzed using 3 × 3 mixed-model repeated-measures ANOVA with Bonferroni-adjusted pairwise comparisons.

Findings: Significant Time × Group interactions were found for lumbar motor control, F(3.156, 80.488) = 7.004, p < 0.001, ηp² = 0.215; pain, F(3.388, 86.388) = 53.282, p < 0.001, ηp² = 0.676; disability, F(4, 102) = 29.750, p < 0.001, ηp² = 0.538; and quality of life, F(3.383, 86.261) = 105.071, p < 0.001, ηp² = 0.805. Bonferroni comparisons showed significant pre-test-to-post-test and pre-test-to-follow-up improvements in the PNE + DNS group across all outcomes (all p < 0.001), while the DNS group showed significant but generally smaller and less sustained improvements.

Conclusion: Combining pain neuroscience education with dynamic neuromuscular stabilization produced broader and more sustained improvements in movement control and clinical outcomes than DNS alone or conventional core exercise in individuals with chronic non-specific low back pain.

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References

Adenis, N., Wieczorek, V., Corbinau, S., Mortain, L., Tiffreau, V., & Thevenon, A. (2026). Pain Neuroscience Education versus Spinal Physiology and Ergonomics Education in Multidisciplinary Rehabilitation for Chronic Low Back Pain: 12-Month Follow-Up of a Randomized Controlled Trial. Physiotherapy Theory and Practice, 1-12. https://doi.org/10.1080/09593985.2026.2706161

Alvani, E., Sheikhi, B., Letafatkar, A., & Rossettini, G. (2024). Effects of Pain Neuroscience Education Combined with Neuromuscular Exercises on Pain, Functional Disability and Psychological Factors in Chronic Low Back Pain: A Study Protocol for a Single-Blind Randomized Controlled Trial. PLoS One, 19(11), e0309679. https://doi.org/10.1371/journal.pone.0309679

Bilterys, T., Kregel, J., Nijs, J., Meeus, M., Danneels, L., & Cagnie, B. (2022). Influence of Education Level on the Effectiveness of Pain Neuroscience Education: A Secondary Analysis of a Randomized Controlled Trial. Musculoskeletal Science and Practice, 57(102494). https://doi.org/10.1016/j.msksp.2021.102494

Blanco-Giménez, P., Vicente-Mampel, J., Gargallo, P., Baraja-Vegas, L., Bautista, I., & Ros-Bernal, F. (2024). Clinical Relevance of Combined Treatment with Exercise in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. Scientific reports, 14(1), 17042. https://doi.org/10.1038/s41598-024-67798-8

Ferrer-Peña, R., Gil-Martínez, A., Pardo-Montero, J., Jiménez-Penick, V., Gallego-Izquierdo, T., & La Touche, R. (2016). Adaptation and Validation of the Spanish Version of the Graded Chronic Pain Scale. Reumatología Clínica (English Edition), 12(3), 130-138.

Frank, C., Kobesova, A., & Kolar, P. (2013). Dynamic Neuromuscular Stabilization & Sports Rehabilitation. International Journal of Sports Physical Therapy, 8(1), 62-77.

García Cancela, J., Conde Vázquez, O., Navarro Ledesma, S., & Pruimboom, L. (2025). The Effectiveness of Pain Neuroscience Education in People with Chronic Non-Specific Low Back Pain: An Umbrella Review with Meta-Analysis. Annals of Physical and Rehabilitation Medicine, 68(8), 102020. https://doi.org/10.1016/j.rehab.2025.102020

Ghavipanje, V., Rahimi, N. M., & Akhlaghi, F. (2022). Six Weeks Effects of Dynamic Neuromuscular Stabilization (DNS) Training in Obese Postpartum Women with Low Back Pain: A Randomized Controlled Trial. Biological Research For Nursing, 24(1), 106-115.

Huang, H., Xie, H., Zhang, G., Xiao, W., Ge, L., Chen, S., Zeng, Y., Wang, C., & Li, H. (2025). Effects of Dynamic Neuromuscular Stabilization Training on the Core Muscle Contractility and Standing Postural Control in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. BMC Musculoskeletal Disorders, 26(1), 213. https://doi.org/10.1186/s12891-025-08417-1

Kaushik, M., & Ahmad, I. (2024). Bridging Dynamic Neuromuscular Stabilization Synergism with Movement Control Impairment Related Non-Specific Low Back Pain: Scoping Review. Journal of Musculoskeletal and Neuronal Interactions, 24(4), 420-432.

Kim, K. S., An, J., Kim, J. O., Lee, M. Y., & Lee, B. H. (2022). Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial. Journal of Personalized Medicine, 12(2), 303. https://doi.org/10.3390/jpm12020303

Kolar, P., Sulc, J., Kyncl, M., Sanda, J., Cakrt, O., Andel, R., Kumagai, K., & Kobesova, A. (2012). Postural Function of the Diaphragm in Persons with and without Chronic Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), 352-362. https://doi.org/10.2519/jospt.2012.3830

Kong, L., Zhang, Z., Li, Y., Zhu, X., Fan, J., Meng, L., & Zhang, Q. (2024). Effects of Dynamic Neuromuscular Stabilization/Vojta Therapy on Pain Intensity and Physical Function in Individuals with Low Back Pain: A Systematic Review and Meta-Analysis. Iranian Journal of Public Health, 53(9), 1910-1923. https://doi.org/10.18502/ijph.v53i9.16447

Lendraitienė, E., Styraitė, B., Šakalienė, R., Misytė, G., & Bilevičiūtė-Ljungar, I. (2024). Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study. Journal of clinical medicine, 13(7), 2081. https://doi.org/10.3390/jcm13072081

Louw, A., Zimney, K., O'Hotto, C., & Hilton, S. (2016). The Clinical Application of Teaching People about Pain. Physiotherapy Theory and Practice, 32(5), 385-395.

Luomajoki, H., Kool, J., De Bruin, E. D., & Airaksinen, O. (2008). Movement Control Tests of the Low Back: Evaluation of the Difference between Patients with Low Back Pain and Healthy Controls. BMC Musculoskeletal Disorders, 9(1), 170. https://doi.org/10.1186/1471-2474-9-170

Ma, X., Chen, R., Li, W., & Huang, P. (2024). A Systematic Review and Meta-Analysis of Pain Neuroscience Education for Chronic Low Back Pain: Short-Term Outcomes of Pain and Disability. Physiotherapy Theory and Practice, 40(9), 2130-2149. https://doi.org/10.1080/09593985.2023.2232003

Medina-Viedma, L., Cortés-Pérez, I., Obrero-Gaitán, E., Osuna-Pérez, M. C., Díaz-Fernández, Á., López-Ruiz, M. C., & Zagalaz-Anula, N. (2025). Effectiveness of Pain Neuroscience Education in Reducing Pain, Disability, Kinesiophobia, and Catastrophizing in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Medical Sciences, 13(4), 290. https://doi.org/10.3390/medsci13040290

Moseley, G. L., & Vlaeyen, J. W. S. (2015). Beyond Nociception: The Imprecision Hypothesis of Chronic Pain. Pain, 156(1), 35-38. https://doi.org/10.1097/j.pain.0000000000000014

Rabieezadeh, A., Mahdavinejad, R., Sedehi, M., & Adimi, M. (2024). The Effects of an 8-Week Dynamic Neuromuscular Stabilization Exercise on Pain, Functional Disability, and Quality of Life in Individuals with Non-Specific Chronic Low Back Pain: A Randomized Clinical Trial with a Two-Month Follow-Up Study. BMC Sports Science, Medicine and Rehabilitation, 16(161). https://doi.org/10.1186/s13102-024-00948-9

Rezazadeh, F., Aali, S., & Imani, F. (2025). Effects of Dynamic Neuromuscular Stabilization on Lower Limb Muscle Activity, Pain, and Disability in Individuals with Chronic Low Back Pain: A Randomized Controlled Trial. Medicina, 61(11), 1961. https://doi.org/10.3390/medicina61111961

Shamsi, M. B., Sarrafzadeh, J., & Jamshidi, A. (2015). Comparing Core Stability and Traditional Trunk Exercise on Chronic Low Back Pain Patients Using Three Functional Lumbopelvic Stability Tests. Physiotherapy Theory and Practice, 31(2), 89-98.

Trost, Z., France, C. R., & Thomas, J. S. (2008). Exposure to Movement in Chronic Back Pain: Evidence of Successful Generalization across a Reaching Task. Pain, 137(1), 26-33. https://doi.org/10.1016/j.pain.2007.08.020

Vera-Garcia, F. J., Irles-Vidal, B., Prat-Luri, A., García-Vaquero, M. P., Barbado, D., & Juan-Recio, C. (2020). Progressions of Core Stabilization Exercises Based on Postural Control Challenge Assessment. European Journal of Applied Physiology, 120(3), 567-577.

Wettstein, M., Eich, W., Bieber, C., & Tesarz, J. (2019). Pain Intensity, Disability, and Quality of Life in Patients with Chronic Low Back Pain: Does Age Matter? Pain Medicine, 20(3), 464-475. https://doi.org/10.1093/pm/pny062

World Health, O. (2023). WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings (978-92-4-008178-9).