Effect of Coordinated Locomotor Training on Lumbopelvic Stability and Pain Limitations in Runners With Mechanical Low Back Pain: A Randomized Controlled Trial

Background: Mechanical low back pain is one of the most common musculoskeletal conditions affecting individuals globally. Lumbopelvic instability is linked to persistent pain and dysfunction in individuals with low back pain. During running, an anterior pelvic tilt is associated with an increased degree of lumbar lordosis, creating mechanical stress from repetitive loading. This stress can lead to running-related low back pain and other overuse symptoms. Novice runners are particularly vulnerable due to poor lumbopelvic control, altered biomechanics, and weak core stability.

Coordinated Locomotor Training is a neuromotor exercise approach designed to enhance synchronization of upper and lower limb movements while promoting activation of trunk and abdominal musculature. By stimulating contraction of abdominal muscles through upper and lower extremity motions in various postures, Coordinated Locomotor Training has been shown to improve postural control. However, there is limited research on the use of Coordinated Locomotor Training in novice runners, particularly for improving lumbopelvic stability and reducing pain limitations.

Study Design: This is a randomized controlled trial with double blinding (participants and outcome assessors will be blinded to group assignment). The study will be conducted at three university settings in Faisalabad, Pakistan: The University of Faisalabad, Government College University of Faisalabad, and Agriculture University of Faisalabad.

Participant Screening: Potential participants will be screened against inclusion and exclusion criteria. Inclusion criteria include age 18 to 30 years, novice runner status (less than one year of consistent running experience), history of mechanical low back pain for 6 to 12 weeks (sub-acute phase), pain intensity between 4 and 6 on the Numeric Pain Rating Scale, running frequency of 2 to 4 sessions per week with total weekly mileage less than 25 kilometers, pain aggravated by mechanical activities such as running, lifting, and prolonged standing and relieved by rest, and willingness to provide written informed consent. Exclusion criteria include participation in any structured core training or rehabilitation program within the past 3 months, history of spinal surgery or specific spinal pathology such as disc herniation or spondylolisthesis, presence of pain radiating below the knee or neurological symptoms including numbness, tingling, or weakness, current lower limb injury affecting running performance, severe pain intensity greater than 6 on the Numeric Pain Rating Scale, pregnancy or postpartum period within the last 6 months, and unwillingness to participate.

Randomization: Participants will be randomly assigned to one of two groups using a computer-generated random sequence. Allocation concealment will be maintained using sealed opaque envelopes.