Regarding to the Article 'Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain'

I read the article entitled “Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain” by Moon et al. [1] with interest. However, I would like to offer some comments regarding its results and methodology reported. Moon et al. [1] compared ‘Lumbar Stabilization’ exercises with ‘Dynamic Lumbar Strengthening’ exercises. However the exercises pictured for each are very similar (i.e., both are a selection of floorand ball-based exercises). This similarity of training protocols is highlighted by the authors when they stated “Although no formal definition of lumbar stabilization exercises exists, the approach is aimed at improving the neuromuscular control, strength [our emphasis], and endurance of the muscles that are central to maintaining the dynamic spinal and trunk stability.” The similarity between what should have been protocols aimed at different aspects of lumbar spine function (strength OR stabilization) may explain the lack of differences for most outcomes between the two. Exercises to conditioning lumbar extensor musculature (erector spinae and multifidus) have been recently reviewed [2]. Muscular activation for floorand ballbased exercises is highly variable between those selected by Moon et al. [1]. In addition, there is little evidence that these exercises offer conditioning effect for these muscles. However, asymptomatic participants were considered in the recent review [2]. The study by Moon et al. [1] suggests that these exercises in both groups may condition the lumbar extensors. However, the recent review [2] reported that isolated lumbar extension (ILEX) training using machines to provide appropriate pelvic restraint may be optimal. In symptomatic participants, Udermann et al. [3] examined the effect of similar exercises as used by Moon et al. [1] using McKenzie techniques in comparison to combined McKenzie and ILEX over a 4-week intervention and reported no significance difference in the improvements of ILEX strength. However, they did note that acute pain relief might explain such findings. Moon et al. [1] utilised a longer intervention (8 weeks). Therefore, it is reasonable to conclude at least some improvement in ILEX strength might be due to lumbar extensors conditioning. In another study by Helmhout et al. [4] who compared ILEX Corresponding author: James Steele Centre for Health, Exercise and Sport Science, Southampton Solent University, East Park Terrace, Southampton, United Kingdom, SO14 0YN Tel: +44-2380-319606, E-mail: [email protected]