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Perturbation Training for Nonspecific Low Back Pain: A Randomized Controlled Trial.

Tuğba Akgüller Eker1, Yasin Yetişyiğit2, Yıldız Analay Akbaba3

  • 1Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Turkey.

Journal of Athletic Training
|March 6, 2026
PubMed
Summary

Adding perturbation training to trunk exercises significantly improved trunk-muscle endurance and reduced disability in patients with low back pain (LBP). This approach enhanced function and patient satisfaction over an 8-week period.

Keywords:
exercisespine

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Area of Science:

  • Physical Therapy
  • Rehabilitation Medicine
  • Musculoskeletal Disorders

Background:

  • Low back pain (LBP) is a prevalent condition often managed with trunk-stabilization exercises.
  • Unstable conditions and perturbation-based training may offer additional benefits for LBP management.
  • Further research is needed to validate the efficacy of adding perturbations to exercise programs for LBP.

Purpose of the Study:

  • To evaluate the impact of perturbation training on trunk-muscle endurance in patients with nonspecific LBP.
  • To assess the effects of perturbation training on disability, pain, functional mobility, quality of life, fear-avoidance beliefs, and patient satisfaction.
  • To compare the outcomes of a standard exercise group (EG) with a perturbation group (PG).

Main Methods:

  • A randomized controlled trial was conducted with 44 patients diagnosed with nonspecific LBP.
  • Participants were assigned to either an 8-week trunk-based exercise group (EG) or a 4-phase perturbation training group (PG).
  • Primary outcomes included trunk endurance and LBP-related disability; secondary outcomes comprised pain intensity, functional mobility, quality of life, fear-avoidance beliefs, and satisfaction.

Main Results:

  • Both groups demonstrated significant improvements across all measured variables (P < .05).
  • The perturbation group (PG) showed superior improvements in trunk-muscle endurance (flexors, extensors, lateral flexors) and Oswestry Disability Index scores (P = .005).
  • The PG also exhibited greater improvements in the timed up-and-go test (P = .03) and Fear-Avoidance Beliefs Questionnaire scores, along with higher patient satisfaction (P = .03).

Conclusions:

  • An 8-week exercise program incorporating perturbation training yields greater improvements in trunk-muscle endurance compared to standard exercises alone.
  • Perturbation training significantly enhances functional mobility, reduces fear-avoidance beliefs, and increases patient satisfaction in individuals with nonspecific LBP.
  • Adding perturbations to trunk-based exercise programs is a beneficial strategy for managing low back pain and improving patient outcomes.