In 2014, a study conducted by Assen Romanov Aleksiev, et. al., is a randomized prevention trial aimed at comparing the long-term effects of strengthening versus flexibility exercises in managing recurrent low back pain (LBP). Additionally, it evaluates the impact of incorporating abdominal bracing into these exercise routines. Given the ongoing debate about the most effective exercise types and parameters for recurrent LBP, this study provides critical insights into the potential benefits of abdominal bracing, which is known to increase trunk stiffness but whose long-term effects on recurrent LBP had not been previously evaluated.

The study involved 600 patients with recurrent LBP, who were randomized into four groups of 150 each. The first group, with an average age of 42.5 ± 12.7 years, performed strengthening exercises. The second group, aged 41.3 ± 11.5 years on average, engaged in flexibility exercises. The third group, averaging 41.0 ± 13.2 years, combined strengthening exercises with abdominal bracing during daily activities and exercises. The fourth group, with an average age of 40.6 ± 12.3 years, performed flexibility exercises and used abdominal bracing. The outcomes measured included the frequency, intensity, and duration of pain, as well as the frequency, intensity, and duration of exercises, recorded at the study’s start and after 10 years.

All groups exhibited improvements in pain frequency, intensity, and duration, as well as in exercise frequency during the first two years. However, from the second to the tenth year, these improvements diminished. No significant differences were observed between the strengthening and flexibility exercise groups. Notably, groups that incorporated abdominal bracing showed better outcomes compared to those that did not use bracing. The study found that the intensity, frequency, and duration of pain were correlated with each other and with exercise frequency, but not with the duration or intensity of the exercises.

The findings indicate that exercise frequency is more crucial than the type, duration, or intensity of the exercises for managing recurrent LBP. This suggests that regular engagement in physical activity is vital for long-term pain management and prevention of recurrence. The results emphasize the importance of consistent exercise routines over the specific nature of the exercises performed.

Abdominal bracing significantly enhances the effects of exercise by increasing trunk stiffness and encouraging frequent trunk muscle contractions and co-contractions without disrupting daily activities. This “preliminary muscle back belt on demand” acts as a reminder and motivator for patients to exercise more regularly. Therefore, incorporating frequent exercise and abdominal bracing appears to be an effective long-term strategy for preventing recurrent LBP.

Reference: Aleksiev, A. R. (2014). Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain.