This study is designed as a single-blind randomized controlled trial. Male and female patients aged 18-65 years with complaints of non-specific low back pain (NSLBP) lasting longer than 12 weeks will be included in the study. Participants will be randomly assigned into two parallel groups: control and intervention. The control group will perform core stabilization exercises five days a week for three weeks. In the intervention group, core stabilization exercises will be combined with 360-degree breathing exercises. To our knowledge, there is no randomized controlled trial investigating the effect of combining core stabilization with 360-degree breathing in individuals with NSLBP. The aim of this study is to examine the acute effects of combining 360-degree breathing techniques with core stabilization exercises on balance and proprioception in individuals with NSLBP.
Low back pain persisting for at least 3 months
No neurological, rheumatological, or musculoskeletal system problems
Individuals with neurological, vestibular, or serious orthopedic conditions that may cause physical disability
Patients with back-leg or dorsolumbar pain due to lumbar disc protrusion or fracture
Cancer patients
Individuals with acute infections
Parallel
Core Egzercise
Other interventionThe core exercise group will perform core stabilization exercises for a total of 15 sessions, five days a week for three weeks. Exercises will include pelvic tilt, bridge, dead bug, bird dog, mini squats on a balance board, and wall planks. The number of repetitions will be increased from 10 to 20, and plank duration will be increased from 30 seconds to 45 seconds. A 5-minute warm-up and cool-down session will be included.
Core Exercises + Breathing Exercises
Other interventionThis group will perform core stabilization exercises combined with the 360-degree breathing technique, for a total of 15 sessions over three weeks (five days a week). "360-degree breathing" is a novel breathing method targeting deep and controlled inhalations into various regions of the body. Unlike traditional breathing exercises, 360-degree breathing ensures that all directions of the lungs are equally ventilated.
• Proprioception Assessment
Proprioception will be evaluated using an inclinometric method. An inclinometer is usually placed and fixed at the L3-L4 segment of the lumbar spine. The patient will be asked to achieve and then reproduce a target position. The difference between the reference angle and the reproduced angle (position error) will be recorded as a measure of proprioceptive perception.
Y Balance Test (YBT)
The Y Balance Test (YBT) will be used to assess balance. Patients will remove their shoes and place the stance foot on the center footplate of the YBT platform. They will attempt to reach maximally with the opposite leg in three directions (anterior, posteromedial, and posterolateral), maintaining balance on the stance leg. Maximum reach distances will be recorded.
Core Muscle Endurance Assessment:
Core endurance will be assessed using McGill's protocol, including trunk extension, trunk flexion, lateral bridge, and prone bridge tests. 1. Trunk Extension Test: In the prone position, the trunk is extended off the edge of the table to the level of the anterior superior iliac spine. Upper body is supported by arms on a chair, hips and legs are fixed. After removing the support, the individual crosses their arms over the chest. The time the individual can hold this position is recorded in seconds. 2. Trunk Flexion Test: The patient sits on the table with hips and knees at 90° flexion and the trunk at 60° flexion. Feet are secured to the table, arms crossed over the chest. After removing the back support, the individual maintains the position as long as possible. Time is recorded in seconds. 3. Lateral Bridge Test: The patient lies in a side-lying position with the lower arm flexed at 90° and forearm on the table. The upper arm is crossed over the chest. Lower extremities are extended
Visual Analog Scale (VAS)
Pain levels will be evaluated using the Visual Analog Scale (VAS), ranging from 0 to 10. A score of 0 indicates no pain; 1-4 indicates mild pain; 5-6 indicates moderate pain; 7-10 indicates severe pain.
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