Evaluation of the Effects of Multifidus Lift Exercise on Endurance, Pain, and Disability in University Students With Low Back Pain

Background and Rationale. Nonspecific low back pain (NSLBP) is highly prevalent in young adults and is associated with decreased academic performance, daily activity limitations, and reduced well-being. Stabilization exercises targeting segmental control-particularly the lumbar multifidus-are widely supported in rehabilitation literature. Conventional four-point kneeling ("bird-dog") activates multifidus and erector spinae; however, whether targeted modifications can yield greater multifidus activation remains insufficiently studied. This study evaluates a simple, low-cost modification termed the "Multifidus Lift Exercise" (MLE): in quadruped, the contralateral knee is maintained ~10 cm off the ground to bias multifidus recruitment. We hypothesize that MLE will improve lumbar extensor endurance and, in participants with NSLBP, reduce pain and disability.

Objectives and Research Questions. Primary objective: determine the effect of a 6-week supervised MLE program (2 sessions/week) on lumbar extensor endurance (Biering-Sørensen test). Secondary objectives (NSLBP group): assess changes in pain (10-cm VAS) and functional disability (Oswestry Disability Index, Turkish validated version). Key research questions test whether MLE increases endurance and reduces pain/disability in NSLBP, and whether endurance differs between NSLBP and healthy students.

Design and Setting. Single-center, interventional, non-randomized, parallel-group, pre-post design conducted at the Physiotherapy & Rehabilitation Exercise Hall, Selçuk University (Konya, Türkiye). Two cohorts will be observed under the same intervention protocol: (1) university students (18-25 y) with NSLBP and (2) healthy controls without recent low back pain. Allocation is based on current status (no randomization). Masking is not feasible (exercise behavior). Primary purpose: treatment/rehabilitation.

Intervention (Exercise Protocol). All participants receive an initial brief training on isolated multifidus activation and motor control principles. Each supervised session includes standardized warm-up (5 min brisk walk; mobilization; hamstring stretch), the MLE performed slowly and with breath control, and cool-down (static stretches). Repetition progression: weeks 1-2: 8-10 reps; weeks 3-4: 10-12; weeks 5-6: 12-15, emphasizing form and endurance. A 3-week pilot (2 sessions/week) mirrors the 6-week protocol in compressed form (wk1→8-10; wk2→10-12; wk3→12-15) to estimate effect size for main-study sample size planning.

Outcomes and Assessments. Primary outcome is Biering-Sørensen endurance time (seconds) in both groups. Secondary outcomes in NSLBP include VAS pain and ODI (%). Measurements occur at baseline and post-intervention. Adverse symptoms prompting immediate pause (e.g., dizziness, undue fatigue) are recorded session-wise.