Efficacy of an Augmented Active Control Exercise Programme on lumbar spinal mobility, trunk muscle endurance, and functional disability in lumbar disc prolapse: a randomised controlled trial

Abstract

Background. Lumbar disc prolapse is a leading cause of pain, restricted spinal movement and functional disability in adults of working age. Conventional physiotherapy for the condition is built largely around general lumbar stretching and isolated strengthening, with limited structured progression and little emphasis on neuromuscular control. The Augmented Active Control Exercise Programme was developed as a phased, six-week protocol integrating core stabilisation, segmental control, proprioceptive retraining, unstable-surface loading and progressive angular resistance.

Objective. To compare the efficacy of the AACEP with conventional physiotherapy on lumbar spinal mobility, static and dynamic trunk muscle endurance, and functional disability in patients with lumbar disc prolapse.

Methods. This single-centre, two-arm, parallel-group randomised controlled trial was conducted in the Physiotherapy Outpatient Department of a tertiary care teaching hospital. Seventy adults aged 30–50 years with clinically diagnosed lumbar disc prolapse were randomised 1:1 to the AACEP (Group A, n = 35) or conventional physiotherapy (Group B, n = 35). Both groups trained six days per week for six weeks, 45 minutes per session, under direct supervision. Outcomes were active lumbar flexion, extension and bilateral side flexion measured with dual digital inclinometers; static endurance measured by the side bridge test; dynamic endurance measured by sit-up repetitions in 30 seconds; and disability measured by the Oswestry Disability Index. Outcomes were recorded at baseline and at the end of week six and analysed using paired and independent-samples t-tests, with Cohen's dz and 95% confidence intervals.

Results. The groups were comparable at baseline. Within Group A, all outcomes improved significantly (all p < .001): flexion by 14.74°, extension by 9.77°, left side flexion by 10.31°, right side flexion by 8.74°, static endurance by 7.83 s, dynamic endurance by 2.57 repetitions, and ODI by 24.06 percentage points. Group B showed no significant change on any measure except ODI (mean change −2.86 points, p < .001). At six weeks, Group A was superior to Group B on every outcome (all p < .001). Within-group effect sizes in Group A were large for all outcomes (dz = 2.32 to 9.45), whereas Group B effects were small and non-significant except for ODI (dz = −0.74, 95% CI −1.111 to −0.361).

Conclusion. A six-week AACEP produced large, statistically significant and simultaneous improvements in lumbar mobility, trunk muscle endurance and functional disability that were not observed with conventional physiotherapy. The protocol is feasible within routine outpatient practice and merits evaluation in multicentre trials with longer follow-up.