Simultaneous Effect of Dynamic Neuromuscular Stabilization Exercise and Low-Level Laser Therapy on Depression and Quality of Life in Women with Chronic Low Back Pain
Subject Areas : Exercise Physiology and Performance
Atefeh Rafeieamjad
1
,
Heshmatollah Parsian
2
*
,
Mohammad Ali Azarbayjani
3
,
Shahram Soheili
4
,
Rouhallah Ershadi
5
1 - Department of Physical Education and Sport Sciences, Ki.C., Islamic Azad University, Kish, Iran.
2 - Department of Physical Education and Sport Sciences, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran.
3 - Department of Physical Education and Sport Sciences, CT.C., Islamic Azad University, Tehran, Iran.
4 - Department of Physical Education and Sport Sciences, ShQ.C., Islamic Azad University, Shahr-e Qods, Iran.
5 - Department of Physical Education and sport sciences, Bu.C., Islamic Azad University, Bushehr, Iran
Keywords: DNS exercise, LLLT, depression, quality of life,
Abstract :
Chronic low back pain is a health concern. Evidence indicates that both dynamic neuromuscular stabilization (DNS) exercise and low-level laser therapy (LLLT) can reduce the psychological consequences of this condition and improve quality of life. However, the simultaneous effect of these two interventions on depression and quality of life in women with chronic low back pain was not previously investigated. Therefore, the present study determined the simultaneous effect of DNS exercise combined with LLLT on depression and quality of life in women with non-specific chronic low back pain. In a clinical trial, forty women with non-specific chronic low back pain were selected from among patients referred to the Sarzamin-e Salamat Rehabilitation Center in Isfahan. They were randomly assigned to four groups: DNS exercise combined with LLLT, DNS exercise alone, LLLT alone, and a control group. DNS exercise and LLLT were performed three times per week for eight weeks. Depression, quality of life, and endurance of the lumbar flexor and extensor muscles were measured before and after the intervention. DNS exercise, LLLT, and the combination of both interventions resulted in significant reductions in depression (P=0.001), improvements in quality of life (P=0.001), and increased endurance of the lumbar flexor and extensor muscles (P=0.001). The greatest changes were observed in the group that received combined DNS and LLLT interventions. Based on these findings, it is concluded that the use of both interventions can be considered an effective, non-invasive strategy for reducing the psychological consequences of chronic low back pain and improving quality of life in women with non-specific chronic low back pain.
1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64:2028-37.
2. Alleva J, Hudgins T, Belous J, Origenes AK. Chronic low back pain. Dis Mon. 2016;62:330-3.
3. Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014;17(Suppl 2):3-10.
4. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
5. Hušáková M, Levitová A, Domluvilová D, Dad'ová K, Pavelka K. Depression and anxiety in individuals with axial spondyloarthritis and nonspecific low back pain who are interested in non-pharmacological therapy options: Cross-sectional study. Medicine (Baltimore). 2022;101(39):e30866.
6. Wang LY, Fu TS, Tsia MC, Hung CI. The associations of depression, anxiety, and insomnia at baseline with disability at a five-year follow-up point among outpatients with chronic low back pain: a prospective cohort study. BMC Musculoskelet Disord. 2023;24(1):565.
7. Fernandez M, Colodro-Conde L, Hartvigsen J, Ferreira ML, Refshauge KM, Pinheiro MB, et al. Chronic low back pain and the risk of depression or anxiety symptoms. Insights from a longitudinal twin study. Spine J. 2017;17:905-12.
8. Ge L, Pereira MJ, Yap CW, et al. Chronic low back pain and its impact on physical function, mental health, and health-related quality of life: a cross-sectional study in Singapore. Sci Rep. 2022;12:20040.
9. Sagheer MA, Khan MF, Sharif S. Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre. J Pak Med Assoc. 2013;63(6):688-90.
10. Stoecklein VM, et al. Strong association of depression and anxiety with the presence of back pain while impact of spinal imaging findings is limited: analysis of an MRI cohort study. J Pain. 2025;25:497–507.
11. Huang LT, McMillan SC. Mutual effects of depression on quality of life in patients and family caregivers. Oncol Nurs Forum. 2019;46:208–216.
12. Anselmo A, Pagano M, Cappadona I, Cardile D, Russo F, Laudisio A, et al. A systematic review on the neuropsychological assessment of patients with LBP: the impact of chronic pain on quality of life. J Clin Med. 2024;13(20):6149.
13. Kaka B, Ogwumike OO, Adeniyi AF, Maharaj SS, Ogunlade SO, Bello B. Effectiveness of neck stabilisation and dynamic exercises on pain intensity, depression and anxiety among patients with non-specific neck pain: a randomised controlled trial. Scand J Pain. 2018;18(2):321-331.
14. Rabieezadeh A, Mahdavinejad R, Sedehi M, Adimi M. The effects of an 8-week dynamic neuromuscular stabilization exercise on pain, functional disability, and quality of life in individuals with non-specific chronic low back pain: a randomized clinical trial with a two-month follow-up study. BMC Sports Sci Med Rehabil. 2024;16(1):161.
15. Akodu AK, Akindutire OM. The effect of stabilization exercise on pain-related disability, sleep disturbance, and psychological status of patients with non-specific chronic low back pain. Korean J Pain. 2018;31(3):199-205.
16. Petrelis M, Krekoukias G, Michopoulos I, Nikolaou V, Soultanis K. Predictors for poor outcomes at six months on pain, disability, psychological and health status in Greek patients with chronic low back pain after receiving physiotherapy: a prospective cohort study. Clin Pract. 2025;15(3):63.
17. Petrelis M, Soultanis K, Michopoulos I, Nikolaou V. Efficacy of a conservative physical treatment regimen on psychological status and quality of life in Greek patients with chronic low back pain. Psychiatriki. 2024;35(1):54-65.
18. Molina-Luque R, Yañez AM, Bennasar-Veny M, Romero-Saldaña M, Molina-Recio G, López-González ÁA. A comparison of equation Córdoba for estimation of body fat (ECORE-BF) with other prediction equations. Int J Environ Res Public Health. 2020;17(21):7940.
19. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013;8(1):62.
20. Ip D, Fu NY. Can intractable discogenic back pain be managed by low-level laser therapy without recourse to operative intervention? J Pain Res. 2015;8:253-6.
21. Sangtarash F, Manshadi FD, Sadeghi A. The relationship of thoracic kyphosis to gait performance and quality of life in women with osteoporosis. Osteoporos Int. 2015;26:2203-8.
22. Azhderdor M, Tabatabaei S. Investigating the relationship between musculoskeletal disorders and quality of life in employees of selected hospitals in Golestan province. J Ergonomics. 2018;6(4):30-36.
23. Harris CA, Joyce LD. Psychometric properties of the Beck Depression Inventory-(BDI-II) in individuals with chronic pain. Pain. 2008;137(3):609-622.
24. Rivera CL, Bernal G, Rosselló J. The Children Depression Inventory (CDI) and the Beck Depression Inventory (BDI): their validity as screening measures for major depression in a group of Puerto Rican adolescents. Int J Clin Health Psychol. 2005;5(3):485-498.
25. Adewuya AO, Ola BA, Aloba OO. Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents. Eur Child Adolesc Psychiatry. 2007;16:287-292.
26. Demoulin C, Vanderthommen M, Duysens C, Crielaard JM. Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine. 2006;73(1):43-50.
27. Nejad-Romzi S, Rahnama N, Habibi A, Negahban H. The effect of core stabilization exercises on pain and function in female patients with chronic non-specific low back pain. Res Rehabil Sci. 2012;8(1):57-64.
28. Karartı C, Özsoy İ, Özyurt F, Basat HÇ, Özsoy G, Özüdoğru A. The effects of dynamic neuromuscular stabilization approach on clinical outcomes in older patients with chronic nonspecific low back pain: a randomized, controlled clinical trial. Somatosens Mot Res. 2023;40(3):116-125.
29- Rabieezadeh A, Mahdavinejad R, Sedehi M, Adimi M. Investigating the effect and durability of dynamic neuromuscular stabilization on pain, functional disability, and quality of life in patients with chronic low back pain. BMC Sports Sci Med Rehabil. 2024;16(1):161. 30.
30-Kaushik M, Ahmad I. Bridging Dynamic Neuromuscular Stabilization Synergism with Movement Control Impairment Related Non-Specific Low Back Pain: Scoping Review. J Musculoskelet Neuronal Interact. 2024 Dec 1;24(4):420-432.
31. Madakadze C, Bailey S. Low-Level Laser Treatment for Lower Back Pain: CADTH Horizon Scan [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2023 Apr. Available from: https://www.ncbi.nlm.nih.gov/books/NBK596638/
32. Schiffer F, Johnston AL, Ravichandran C, Polcari A, Teicher MH, Webb RH, et al. Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety. Behav Brain Funct. 2009;5:46.
33. Hosseini H, Rahimi A, Javanshir K, Taghipour M, Daryabor A, Naimi SS. The Effect of 8 Weeks of Dynamic Neuromuscular Stabilization Exercises on Sonographic and Clinical Outcomes in Patients with Non-Specific Low Back Pain. Iran Red Crescent Med J. 2025;10:1-9.
34. Hosseini H, Rahimi A, Javanshir Kh, Taghipour M, Daryabor A, Naimi SS. Effect of Dynamic Neuromuscular Stabilization Exercises on Activity of External Oblique Muscle in Low Back Pain. J Mod Rehabil. 2025;19(1):90-97.
35. Najafi Ghagholestani B, Gandomi F, Assar S, Spears LR. Effects of Dynamic Neuromuscular Stabilization and Aquatic Exercises on the Pain, Disability, Lumbopelvic Control, and Spinal Posture of Patients With Non-specific Low Back Pain. Iran Rehabil J. 2022;20(3):333-344.
36. Babagoltabar-Samakoush H, Aminikhah B, Bahiraei S. Effectiveness of dynamic neuromuscular stabilization training on strength, endurance, and flexibility in adults with intellectual disabilities, a randomized controlled trial. Sci Rep. 2025 Jan 4;15(1):768.
37. Hei P, Zhang Z, Wei J, Lan C, Wang X, Jing X, Chen X, Wu Z. The effect of dynamic neuromuscular stabilization technique combined with Kinesio Taping on neuromuscular function and pain self-efficacy in individuals with chronic nonspecific low back pain: A randomized trial. Medicine (Baltimore). 2025 Jan 24;104(4):e41265.
38. Gocevska M, Nikolikj-Dimitrova E, Gjerakaroska-Savevska C. Effects of High-Intensity Laser in Treatment of Patients with Chronic Low Back Pain. Open Access Maced J Med Sci. 2019 Mar 25;7(6):949-954.
39. Ahmed I, Bandpei MAM, Gilani SA, Ahmad A, Zaidi F. Effectiveness of Low-Level Laser Therapy in Patients with Discogenic Lumbar Radiculopathy: A Double-Blind Randomized Controlled Trial. J Healthc Eng. 2022 Feb 27;2022:6437523.
40. Alayat MS, Atya AM, Ali MM, Shosha TM. Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial. Lasers Med Sci. 2014 May;29(3):1065-73.
41. Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial. Aust J Physiother. 2007;53(3):155-61.