Comparison of Abdominal Expansion and Abdominal Drawing-In Training With Manual and Verbal Cueing in Chronic Non-Specific Low Back Pain

This study aims to investigate the interactive effects of two core stability training strategies-abdominal drawing-in manoeuvre (ADIM) and Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE)-and two instructional approaches (verbal cueing and manual facilitation) on training outcomes in individuals with chronic non-specific low back pain. A 2×2 factorial randomized controlled trial design will be employed. Ninety-six participants with chronic non-specific low back pain will be randomly allocated, using block randomization, to one of four intervention groups in equal proportions. All groups will receive a 4-week intervention program, with training conducted twice per week. Outcome measures will be assessed at four time points: before the intervention (baseline), immediately after the first training session, at the completion of the 4-week intervention, and at a 3-month follow-up, to evaluate short-term and mid-term effects as well as the sustainability of training outcomes.

Inclusion Criteria: * Adults aged 18 years or older. * Clinically diagnosed with chronic non-specific low back pain, with symptoms persisting for more than 12 weeks. * Able to understand the study procedures and comply with the full intervention and assessment protocol. Exclusion Criteria: * History of surgery involving the lower back or lower extremities. * Presence of neurological symptoms, such as numbness or tingling sensations. * Signs or symptoms of nerve root compression. * History of any surgical procedure within the past 3 months. * Diagnosis of cancer. * Presence of major medical or psychiatric disorders. * Presence of systemic inflammatory disease. * Pregnancy. * Structural scoliosis of the spine. * Inability to ambulate or stand independently, or other conditions deemed unsuitable for participation. * Participation in any movement control-based exercise training within the past year. * Accumulated experience of more than 4 weeks of abdominal drawing-in manoeuvre (ADIM) training or Dynamic Neuromusculoskeletal Stabilization abdominal expansion (DNS-AE) training within the past year.