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This was a mixed method study incorporating a randomized controlled trial (RCf) and focus group interviews to explore the effects of spinal stabilization exercises on sub-clinical chronic low back disorders and participants' perceptions of this type of treatment programme. Eighty four participants (34 males and 50 females) in the RCf were randomly allocated to control (no exercise) or exercise treatment groups in which they carried out stabilization exercises at different frequencies i.e. once weekly, twice weekly or three times weekly. Outcome measures used in the RCT were plasma serotonin concentration measured using an enzyme linked immunoassay technique, multifidus cross sectional area measured with diagnostic ultrasound imaging, pain intensity measured with numeric rating scale, functional disability measured with the Roland- Moris Disability Questionnaire and quality of life measured with Nottingham Health Profile. Data were collected at baseline, after six weeks of intervention and at 18 weeks follow up assessments. The results of the RCf showed that spinal stabilization exercises produced a significant increase in plasma serotonin concentration by 17.8% at all stages of data collection in all the exercise groups. All the participants in the treatment groups experienced significant reduction, by more than SO %, in pain and functional disability and improvement by more than 50% in quality of life scores after six weeks of treatment (P <0.05). The extent of reduction in pain and functional disability scores and improvement in quality oflife showed a clear trend in favour of the three times weekly exercise group at 18 weeks follow up assessments. Significant increase in the size of multifidus cross sectional area was observed only in the three times weekly exercise group (P <0.05). A linear regression analysis showed significant correlation between the changes in plasma serotonin and each of pain, functional disability and quality of life scores. (r values ranged from 0.42 to 0.67, P < 0.05). Following the RCf, nine participants (3 males and 6 females) took part in two focus groups interviews. Open ended questions were used to maximize discussion. Audio recording was used to record participant's opinions during the interview process. Careful checking, reading, and correction of the transcripts was carried out and a thematic analysis was conducted on the data. The main themes that emerged from the data analysis from the focus group interviews were: • Participants' perception of the causes and aggravating factors for their low back disorders. • Physical dimensions of participants' experience of low back disorders. • Emotional and psychological dimensions of participants' experience of low back disorders. • Perceived treatment effects on pain intensity and functional limitation. • Impact of the treatment programme on participants' empowerment and self efficacy. • Impact of information on participants' attitude to treatment. • Relationship with the therapist. • Compliance with the home programme of stabilization exercises. • Suggestion for improvement in future studies involving spinal stabilization exercises. The results of this study have indicated that an increased plasma serotonin concentration gained by the use of stabilization exercises could have a role to play in the outcome of treatment in patients with subclinical chronic LBP. The results generally indicated a better outcome of treatment in the three times weekly exercise group. Participants' explanations for the perceived improvements included major increases in confidence levels and formulation of self help strategies. They also reflected on their ability to exert better control over their own back pain, due to increased empowerment and self efficacy based on better understanding of the spine and how it works.

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Aims: The aim of this study was to investigate Core Stability Exercise (CSE) induced changes in trunk sagittal acceleration as a measure of performance in participants following an acute onset of non-specific low back pain (LBP). Methodology: A Lumbar Motion Monitor (LMM) was used to measure trunk sagittal acceleration. The LMM was demonstrated to be reliable [Intra-Class Correlation (ICC) for average sagittal acceleration (0.96, 95% CI 0.90-0.98) and peak sagittal acceleration (0.89, 95% CI 0.75-0.96) with a 95% limit of agreement for the repeated measure of between -100.64 and +59.84 Deg/s2 ]. Pain was measured using the Visual Analogue Scale (VAS) and disability was measured with the Roland Morris Disability Questionnaire (RMDQ). Results: Differences in mean trunk sagittal acceleration between control and experimental groups at time points were assessed using a regression analysis (ratio of geometric means [95%CI]) and demonstrated to be not statistically significant (3 weeks (20%) 1.2 [0.9 to 1.6], p=0.2; 6 weeks (10%) 1.1 [0.8 to 1.5], p=0.7; 3 months (20%) 1.2 [0.8 to 1.9], p=0.9). Similarly, differences in mean pain score (3 weeks (30%) 1.3 [0.8-2.2], p= 0.3); 6 weeks (20%) 1.2 [0.7-2.0], p=0.6; 3 months (0%) 1.0 [0.5-1.9], p=1.0) and difference in mean disability score (6 weeks (0%) 1.0 [0.7-1.5], p= 1.0, 3 months (30%) 1.3 [0.8-1.9], p= 0.3) between groups were also not statistically significant. Conclusions: This work does not infer that CSE are definitively effective in reducing pain, improving subjective disability and improving trunk performance after an onset acute of non-specific LBP. However, there is a suggestion of clinical importance and a possible mechanism by which they may work. Further investigation into this mechanism may provide future effective management strategies for intervention of acute non-specific low back pain with optimistic cost implications for healthcare delivery in general and Physiotherapy in particular.