Manual therapy combined with core muscle training for chronic non-specific low back pain in sedentary individuals: a study protocol for a single-center randomized controlled trial.

INTRODUCTION: Chronic non-specific low back pain (CNLBP) represents a major global public health challenge, with sedentary behavior serving as one of its primary risk factors. Although clinical guidelines recommend core muscle training as a first-line intervention, a treatment dilemma often persists in clinical practice: the efficacy of training is constrained by pre-existing biomechanical, neurophysiological, and psychobehavioral barriers. This study proposes a novel two-stage synergistic model, "Passive Preparation and Active Re-education," designed to overcome these bottlenecks and evaluate its effectiveness in a sedentary population.

METHODS AND ANALYSIS: This is a single-center, assessor-blinded randomized controlled trial. A total of 88 sedentary individuals with CNLBP will be randomly allocated (1:1) to either a control group receiving core stability exercise alone or an intervention group receiving manual therapy followed by core stability exercise. The program consists of 12 sessions over 4 weeks. Outcome measures will be assessed at baseline, week 2, and week 4, with additional follow-ups at 1 and 3 months. The primary outcome is the change in pain intensity measured by the Visual Analog Scale (VAS) at week 4. Secondary outcomes include disability assessed by the Roland-Morris Disability Questionnaire (RMDQ), psychological factors via the Fear-Avoidance Beliefs Questionnaire (FABQ), and muscle biomechanical properties measured using MyotonPRO and isokinetic systems.

DISCUSSION: The central hypothesis is that the integration of manual therapy and core stability exercise produces a synergistic, non-linear effect rather than a simple additive one. Manual therapy acts as a "passive preparation" to create a time-sensitive "therapeutic window" by reducing pain and muscle hypertonicity. By immediately introducing core stability exercise within this window, the model optimizes target muscle recruitment and movement quality. This comprehensive approach aims to achieve a more efficient reversal of the pathological cycle in sedentary populations.

CLINICAL TRIAL REGISTRATION: https://itmctr.ccebtcm.org.cn/mgt/, identifier ITMCTR2025002406.