Chronic Low Back Pain, Core Stability and Francis Bacon: Implications for Contemporary Physiotherapy – A Narrative Review

Abstract Background: Chronic low back pain (LBP) is the most common cause of disability, hence multiple attempts have been undertaken to develop therapeutic strategies aimed at addressing the issue. The most commonly used strategies include motor control exercises of deep core muscles that stabilize the lower back. However, on the practical side, they require application of special devices, such as ultrasonography or electromyography as well as instructions and support provided by trained personnel. Despite the lack of high-quality empirical evidence, these exercises are extensively used in clinical practice. Narrative Review: The vast body of literature collected suggests that the cause of chronic LBP should be sought in the structural and functional alterations within different levels of the central nervous system. These alterations and maladaptations apply to both the molecular and tissue levels. Nevertheless, successful treatment of these changes is currently possible due to an affordable, cognitive therapeutic approach. It encompasses a number of strategies that aim to restore the normal function of the nervous system using brain plasticity processes. These include graded motor imagery, mirror therapy, graded exposure, pain education, sensory training and pain coping strategies. Conclusions: Lack of clear advantage in the application of the core stability exercises over other, potentially cheaper alternatives, implies a shift-paradigm from the existing biomedical model of chronic LBP treatment towards modern cognitive approaches. As results of numerous studies confirm the validity of the approach aimed at restoring the structure and function of the central nervous system in contrast to the still common concept of treatment of the peripheral tissues of the body, more rigorous systematic reviews and meta-analysis are required. Evidence from this kind of evaluation may contribute to the shift in current beliefs regarding the treatment of chronic LBP.