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Volume 18, Issue 1 (2026)
3 2026, 18(1): 15-19 |
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Received: 2026/05/4 | Accepted: 2026/01/29 | Published: 2026/01/29
Received: 2026/05/4 | Accepted: 2026/01/29 | Published: 2026/01/29
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Kumar K, Kumaresan A, Vishnuram S, Vianni D, Subramanian S, Raj N, et al . Effect of Neurokinetic Therapy on Core Muscle Dysfunction among Subjects with Low Back Pain. 3 2026; 18 (1) :15-19
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Authors
K.T. Kumar1 
, A.K. Kumaresan2 , S. Vishnuram3 , D.D. Vianni *1 , S.S. Subramanian1 , N.B. Raj4 , I. Fatima4 , P. Arjunan5 , V. Thirunavukkarasu5
, A.K. Kumaresan2 , S. Vishnuram3 , D.D. Vianni *1 , S.S. Subramanian1 , N.B. Raj4 , I. Fatima4 , P. Arjunan5 , V. Thirunavukkarasu5
1- SIMATS College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
2- Department of Physiotherapy, Sri Narayani Hospital Research Centre, Vellore, India
3- School of Physiotherapy SBV Chennai, Sri Balaji Vidyapeeth, Pondicherry, India, School of Physiotherapy SBV Chennai, Sri Balaji Vidyapeeth (Deemed-to-be University), Pondicherry, India. (suryavishnuram@gmail.com)
4- School of Rehabilitation Sciences, Faculty of Health Sciences, University Sultan Zainal Abidin (UniSZA), Terengganu Darul Iman, Malaysia
5- Nursing Department, College of Applied Medical Sciences, King Faisal University, Hofuf, Saudi Arabia
2- Department of Physiotherapy, Sri Narayani Hospital Research Centre, Vellore, India
3- School of Physiotherapy SBV Chennai, Sri Balaji Vidyapeeth, Pondicherry, India, School of Physiotherapy SBV Chennai, Sri Balaji Vidyapeeth (Deemed-to-be University), Pondicherry, India. (suryavishnuram@gmail.com)
4- School of Rehabilitation Sciences, Faculty of Health Sciences, University Sultan Zainal Abidin (UniSZA), Terengganu Darul Iman, Malaysia
5- Nursing Department, College of Applied Medical Sciences, King Faisal University, Hofuf, Saudi Arabia
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Introduction
Low back pain (LBP) is a musculoskeletal condition affecting the majority of people at some point in their lives, with a prevalence of 60-80% [1]. The condition is ranked among the leading causes of disability worldwide, significantly affecting quality of life, workplace productivity, and imposing financial burdens on healthcare systems [2]. Among these cases, chronic nonspecific low back pain (NSLBP) accounts for the majority and, being multifactorial, presents a greater challenge for effective treatment. Despite extensive research, effective long-term management strategies remain limited, primarily due to the underlying complexity of neuromuscular dysfunction associated with NSLBP [3].
The term “core” refers to the lumbopelvic-hip complex, which provides the foundation for efficient movement and spinal stability. Dysfunction in this system, marked by delayed activation, poor recruitment patterns, or muscular imbalances, can compromise spinal control and result in pain or recurrent injury [4]. The deep stabilizing muscles, including the transversus abdominis, multifidus, pelvic floor, and diaphragm, work synergistically to maintain spinal integrity. In individuals with NSLBP, altered neuromuscular control leads to a reliance on superficial muscles such as the rectus abdominis and erector spinae, which are not designed to provide segmental stability. This imbalance contributes to excessive spinal loading and compensatory movement patterns, perpetuating pain and functional limitations [5].
Core muscle dysfunction is commonly identified as a contributing factor to low back pain. Weakness or poor endurance of the core muscles, especially the deep stabilizers, compromises spinal stability and postural control, thereby predisposing the individual to recurrent pain episodes. Deep stabilizers often exhibit delayed recruitment, reduced endurance, or inhibition, leading to compensatory overactivation of superficial muscles such as the rectus abdominis and erector spinae [6, 7]. This altered motor control pattern increases spinal loading and contributes to mechanical stress, pain recurrence, and functional impairment. Thus, contemporary rehabilitation emphasizes the need to address not only muscular strength but also neuromuscular coordination and movement efficiency [8]. However, innovations are still needed that not only restore muscle strength but also improve neuromuscular control and reduce compensatory strategies, which are often overlooked.
Conventional rehabilitation strategies often emphasize core strengthening through exercises such as planks, bridges, and dynamic stability routines. While these approaches may offer short-term benefits, they often fail to rectify dysfunctional motor patterns driven by central motor programming. Emerging evidence suggests that interventions targeting neuromuscular re-education and sensorimotor integration may provide superior outcomes by addressing the root cause of compensatory movement patterns rather than focusing solely on muscular conditioning [9, 10]. NeuroKinetic Therapy (NKT) offers a novel intervention that reprograms dysfunctional movement patterns through manual muscle testing and corrective exercises. Based on the principle that the brain may create compensatory recruitment strategies when primary stabilizers are inhibited, NKT identifies these imbalances and facilitates more optimal neuromotor control [11].
Neurokinetic Therapy may represent one of the most promising approaches available. It relies on the concepts of manual muscle testing and theories of motor control to find and correct dysfunctional movement patterns at their neurological roots [12]. By reprogramming these motor control systems, NKT reforms core muscle activation, minimizes compensatory strategies, and enhances functional movement [13]. The therapy is reputed to be effective in treating a range of conditions, from plantar fasciitis to post-stroke recovery [8] to post-stroke recovery [14]. However, this therapy seems less discussed concerning the management of chronic NSLBP.
Recent evidence suggests that interventions targeting movement efficiency and sensorimotor integration may be more effective in managing chronic LBP than isolated strengthening alone. Given the substantial global burden of NSLBP and the limited evidence supporting NKT's effectiveness in addressing core muscle dysfunction, further investigation is warranted. Therefore, the present study aims to evaluate the effects of Neurokinetic Therapy on core muscle endurance, pelvic alignment, pain intensity, and functional disability among individuals with chronic nonspecific low back pain. By examining the outcomes of this innovative neuromuscular approach, the study aims to advance targeted rehabilitation strategies for chronic LBP.
Materials and Methods
The study was a randomized controlled trial designed to evaluate the effect of Neurokinetic Therapy (NKT) on core muscle dysfunction in low back pain. The sample size was calculated using G*Power 3.1 software, with an effect size of 0.65, based on previous studies evaluating core muscle interventions in chronic low back pain. With an alpha level of 0.05 and a statistical power of 0.80, the minimum required sample was 58. To compensate for possible dropouts, 66 participants were recruited.
Sixty-six subjects aged 20-50 years with chronic NSLBP for more than 12 weeks and core muscle dysfunction on clinical examination, such as decreased plank endurance and lateral pelvic tilt, were recruited. Participants with acute low back pain, specific spinal pathologies, or contraindications to physical activity were excluded. Participants were randomly assigned to the Neurokinetic Therapy (NKT) group or the control group using a computer-generated random sequence. The sequencing was monitored by an independent researcher who was not involved in recruitment, analysis, or intervention.
The primary outcome parameters for the study included core muscle endurance, assessed using the plank and side-bridge tests. These tests have been established as reliable and valid core endurance outcome measures, with the inter-rater reliability exceeding 0.9, as cited by various authors [15, 16]. Secondary outcomes included lateral pelvic tilt, assessed using a clinical inclinometer, a device of proven reliability, with mounting evidence supporting its ability to accurately measure pelvic position and tilt [17, 18]. Quadratus lumborum flexibility was assessed using the sit-and-reach test, a commonly used and validated measure of lumbar flexibility that correlates with movement outcomes [19]. For pain intensity, the Visual Analog Scale (VAS) was used, and for functional disability, the Oswestry Disability Index (ODI) was employed. The ODI is a highly reliable and valid instrument, widely used in both clinical practice and research to assess disability related to low back pain [20].
The ethical clearance was obtained from the Institutional Ethics Committee of SIMATS Medical College Hospital. All procedures were conducted in accordance with the ethical standards of the institutional and/or national research committee. The NKT group received treatment for 8 weeks. Manual muscle testing of participants was conducted during this period, along with identifying dysfunctional movement patterns and biweekly neuromotor reprogramming sessions. The neuromotor reprogramming sessions included structured manual testing and corrective exercises guided by NKT principles. These sessions involved identifying muscles that show altered activation patterns due to compensatory dysfunctions and applying manual stimulation or corrective input to restore optimal neuromuscular coordination. Each session focused on targeted muscle testing, inhibition of overactive muscles, and facilitation of underactive muscles to promote balanced movement patterns. This process is based on neurophysiological mechanisms and clinical reasoning, without reliance on promotional or proprietary terminology. Each session involved the following steps:
i) Manual Muscle Testing (MMT) of the muscles related to core stability and postural control (e.g., transversus abdominis, multifidus, gluteus medius) was assessed using manual testing techniques to identify dysfunctional or inhibited muscles;
ii) Compensation Pattern Identification: Dysfunctional muscles were analyzed in the context of compensatory movement patterns, including overactivity of synergists or antagonists;
iii) Corrective Stimulus: Once dysfunctional patterns were identified, manual stimulation (such as light palpation or resisted contraction) was applied to associated neurological structures (e.g., muscle spindle, tendon, or scar tissue) to interrupt maladaptive signaling;
iv) Re-Testing and Reinforcement: After the corrective input, the initially weak or inhibited muscle was retested. If strength returned, the participant was guided through simple reinforcement exercises (e.g., low-load isometric contractions) to integrate the corrected pattern; and
v) Home Exercise Program: Patients were provided with tailored home exercises targeting the reprogrammed motor patterns to reinforce neuromuscular control. Each session lasted approximately 30-40 minutes and was administered twice weekly for eight weeks by a physiotherapist certified in NKT [11-14, 21].
All treatments in both groups were performed by a certified therapist. Meanwhile, the control group performed conventional core-strengthening exercises to develop deep core muscles [22, 23]. The treatment was applied to subjects in both groups for 8 weeks, and at 12 weeks of follow-up. An assessor unaware of the outcome measurements evaluated all outcomes independently.
Data analysis was conducted using SPSS 26 software. Data normality was assessed using the Shapiro-Wilk test, and non-parametric statistical methods were used. Within-group changes were analyzed using the Wilcoxon signed-rank test, while between-group differences were assessed using the Mann-Whitney U test.
Findings
A total of 66 participants were recruited and randomized simply into the Neurokinetic Therapy group (n=33) or the control group (n=33). Ultimately, 62 participants completed the study; Four were considered dropouts due to noncompliance or unrelated health conditions. Both groups were quite similar in baseline characteristics, making them comparable for analysis.
The primary outcome, core muscle endurance, improved significantly in the NKT group. Among the secondary outcomes, the NKT group showed significant reductions in lateral pelvic tilt, with significant improvement, and an effect size. Flexibility of the quadratus lumborum also improved significantly in the NKT group, with sit-and-reach test scores reflecting a large effect.
The Visual Analog Scale (VAS) scores in the NKT group showed a significantly greater reduction than those in the control group (p<0.01). Similarly, with functional disability as measured by the ODI, significant improvement was observed in the NKT group, which was statistically significant (p<0.01; Table 1).
Table 1. Comparing the pre-test and post-test values of neurokinetic therapy
Discussion
The study's results demonstrate the efficacy of neurokinetic therapy in correcting core muscle dysfunction and alleviating symptoms reported by individuals with chronic nonspecific lower-back pain. NKT demonstrated significant gains compared with conventional core strengthening exercises. These findings are corroborated by the literature, which indicates that therapies tackling neuromuscular dysfunctions generally offer better outcomes than a strength-based approach alone [7, 9].
The improvements in core muscle endurance observed in the NKT group are thought to be a consequence of motor control re-education and perhaps in correcting the dysfunctional movement patterns. Thus, endurance provides lumbar stability and has even been correlated with functional limitation and pain intensity in LBP patients [3, 4, 9]. NKT could have improved the neuromuscular coordination of further deep core stabilizers, such as the transversus abdominis and multifidus, leading to greater activation and endurance.
Correction of lateral pelvic tilt and improvement of quadratus lumborum flexibility highlight another aspect of NKT in addressing biomechanical imbalances and functional movement patterns. As pelvic asymmetry is often the cause of mechanical low-back pain, these improvements further reinforce NKT techniques' ability to address this dysfunction [16-18]. Better flexibility of the quadratus lumborum, which is the main lateral stabilizer of the spine, may even have contributed to improved postural alignment and decreased compensatory strain in the lumbar region [22].
There was a dramatic decrease in pain intensity and functional impairment in the NKT group, meditating upon the evidence of NKT's potential to address chronic pain and settle functional outcomes [11-14, 23]. Compared to conventional core strengthening, NKT induces changes in neuro-muscular dysfunctions that maintain pain and compensatory movement patterns. Such an integrated intervention approach may be the causal factor behind the differential reductions in pain and disability observed in this study [24].
Based on the findings, interventional techniques such as NKT should be incorporated into clinical practice for the treatment of chronic low back pain, especially when core dysfunction is involved [11, 12]. The observed improvements in core stability can be attributed to the central mechanism of NKT, which relies on the concept of motor control hierarchy and sensorimotor integration. By challenging the nervous system to correct faulty recruitment patterns, NKT facilitates neuroplastic changes that may restore muscle balance and improve postural control [7-9]. This approach contrasts with traditional strengthening programs, which often focus on isolated muscle activation without addressing the underlying neuromuscular imbalances.
The pain reduction observed in this study is also consistent with prior evidence suggesting that restoring correct motor patterns reduces mechanical loading and abnormal tension in compensatory musculature. Furthermore, activating appropriate stabilizers via targeted neuromuscular feedback may reduce nociceptive drive, contributing to the observed decrease in pain scores. These findings are consistent with previous studies reporting improvements in lumbar function and pain following neuromuscular retraining interventions.
Importantly, the results highlight that addressing core dysfunction is not solely about muscular strength but about coordinated, timely muscle activation. The neuromotor retraining facilitated by NKT may offer a more specific and individualized approach than general core exercises. In this context, NKT serves both a diagnostic and therapeutic role, identifying weak or inhibited muscles and immediately correcting them through brain-based reprogramming.
There are, however, a few limitations that need to be acknowledged. This study is preliminary and was conducted with a small sample size, limiting the generalizability of the findings to broader populations. Larger, multi-centered trials are recommended to confirm the effectiveness of Neurokinetic Therapy (NKT) across diverse demographic and clinical groups. Additionally, while improvements in core muscle function were observed, the absence of objective muscle activity measurements, such as surface or intramuscular electromyography (EMG), limits the ability to accurately assess deep muscle activation and neuromuscular responses [25, 26]. Larger and more heterogeneous populations, coupled with an objective movement analysis system, are needed to strengthen our research.
Conclusion
Neurokinetic therapy demonstrates meaningful improvements in core muscle function, pain, and disability among individuals with chronic low back pain.
Acknowledgments: The authors would like to thank all the participants who took part in this research for their cooperation and valuable time.
Ethical Permissions: Ethical approval for this study was obtained from the Institutional Ethics Committee of SIMATS Medical College Hospital, Chennai, India, prior to commencement of the study. The approval number is 011/11/2023/IEC/SMCH, and the approval was granted on 21st November 2023.
Conflicts of Interests: The authors declare that they have no conflicts of interest related to this study.
Authors' Contribution: Kumar KT (First Author), Introduction Writer/Main Researcher (15%); Kumaresan AK (Second Author), Introduction Writer/Main Researcher (15%); Vishnuram S (Third Author), Methodologist/Discussion Writer (20%); Vianni DD (Fourth Author), Introduction Writer/Assistant Researcher (10%); Subramanian SS (Fifth Author), Introduction Writer/Assistant Researcher (10%); Raj NB (Sixth Author), Introduction Writer/Statistical Analyst (10%); Fatima I (Seventh Author), Introduction Writer/Statistical Analyst (10%); Arjunan P (Eighth Author), Assistant Researcher (5%); Thirunavukkarasu V (Ninth Author), Assistant Researcher (5%)
Funding/Support: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Low back pain (LBP) is a musculoskeletal condition affecting the majority of people at some point in their lives, with a prevalence of 60-80% [1]. The condition is ranked among the leading causes of disability worldwide, significantly affecting quality of life, workplace productivity, and imposing financial burdens on healthcare systems [2]. Among these cases, chronic nonspecific low back pain (NSLBP) accounts for the majority and, being multifactorial, presents a greater challenge for effective treatment. Despite extensive research, effective long-term management strategies remain limited, primarily due to the underlying complexity of neuromuscular dysfunction associated with NSLBP [3].
The term “core” refers to the lumbopelvic-hip complex, which provides the foundation for efficient movement and spinal stability. Dysfunction in this system, marked by delayed activation, poor recruitment patterns, or muscular imbalances, can compromise spinal control and result in pain or recurrent injury [4]. The deep stabilizing muscles, including the transversus abdominis, multifidus, pelvic floor, and diaphragm, work synergistically to maintain spinal integrity. In individuals with NSLBP, altered neuromuscular control leads to a reliance on superficial muscles such as the rectus abdominis and erector spinae, which are not designed to provide segmental stability. This imbalance contributes to excessive spinal loading and compensatory movement patterns, perpetuating pain and functional limitations [5].
Core muscle dysfunction is commonly identified as a contributing factor to low back pain. Weakness or poor endurance of the core muscles, especially the deep stabilizers, compromises spinal stability and postural control, thereby predisposing the individual to recurrent pain episodes. Deep stabilizers often exhibit delayed recruitment, reduced endurance, or inhibition, leading to compensatory overactivation of superficial muscles such as the rectus abdominis and erector spinae [6, 7]. This altered motor control pattern increases spinal loading and contributes to mechanical stress, pain recurrence, and functional impairment. Thus, contemporary rehabilitation emphasizes the need to address not only muscular strength but also neuromuscular coordination and movement efficiency [8]. However, innovations are still needed that not only restore muscle strength but also improve neuromuscular control and reduce compensatory strategies, which are often overlooked.
Conventional rehabilitation strategies often emphasize core strengthening through exercises such as planks, bridges, and dynamic stability routines. While these approaches may offer short-term benefits, they often fail to rectify dysfunctional motor patterns driven by central motor programming. Emerging evidence suggests that interventions targeting neuromuscular re-education and sensorimotor integration may provide superior outcomes by addressing the root cause of compensatory movement patterns rather than focusing solely on muscular conditioning [9, 10]. NeuroKinetic Therapy (NKT) offers a novel intervention that reprograms dysfunctional movement patterns through manual muscle testing and corrective exercises. Based on the principle that the brain may create compensatory recruitment strategies when primary stabilizers are inhibited, NKT identifies these imbalances and facilitates more optimal neuromotor control [11].
Neurokinetic Therapy may represent one of the most promising approaches available. It relies on the concepts of manual muscle testing and theories of motor control to find and correct dysfunctional movement patterns at their neurological roots [12]. By reprogramming these motor control systems, NKT reforms core muscle activation, minimizes compensatory strategies, and enhances functional movement [13]. The therapy is reputed to be effective in treating a range of conditions, from plantar fasciitis to post-stroke recovery [8] to post-stroke recovery [14]. However, this therapy seems less discussed concerning the management of chronic NSLBP.
Recent evidence suggests that interventions targeting movement efficiency and sensorimotor integration may be more effective in managing chronic LBP than isolated strengthening alone. Given the substantial global burden of NSLBP and the limited evidence supporting NKT's effectiveness in addressing core muscle dysfunction, further investigation is warranted. Therefore, the present study aims to evaluate the effects of Neurokinetic Therapy on core muscle endurance, pelvic alignment, pain intensity, and functional disability among individuals with chronic nonspecific low back pain. By examining the outcomes of this innovative neuromuscular approach, the study aims to advance targeted rehabilitation strategies for chronic LBP.
Materials and Methods
The study was a randomized controlled trial designed to evaluate the effect of Neurokinetic Therapy (NKT) on core muscle dysfunction in low back pain. The sample size was calculated using G*Power 3.1 software, with an effect size of 0.65, based on previous studies evaluating core muscle interventions in chronic low back pain. With an alpha level of 0.05 and a statistical power of 0.80, the minimum required sample was 58. To compensate for possible dropouts, 66 participants were recruited.
Sixty-six subjects aged 20-50 years with chronic NSLBP for more than 12 weeks and core muscle dysfunction on clinical examination, such as decreased plank endurance and lateral pelvic tilt, were recruited. Participants with acute low back pain, specific spinal pathologies, or contraindications to physical activity were excluded. Participants were randomly assigned to the Neurokinetic Therapy (NKT) group or the control group using a computer-generated random sequence. The sequencing was monitored by an independent researcher who was not involved in recruitment, analysis, or intervention.
The primary outcome parameters for the study included core muscle endurance, assessed using the plank and side-bridge tests. These tests have been established as reliable and valid core endurance outcome measures, with the inter-rater reliability exceeding 0.9, as cited by various authors [15, 16]. Secondary outcomes included lateral pelvic tilt, assessed using a clinical inclinometer, a device of proven reliability, with mounting evidence supporting its ability to accurately measure pelvic position and tilt [17, 18]. Quadratus lumborum flexibility was assessed using the sit-and-reach test, a commonly used and validated measure of lumbar flexibility that correlates with movement outcomes [19]. For pain intensity, the Visual Analog Scale (VAS) was used, and for functional disability, the Oswestry Disability Index (ODI) was employed. The ODI is a highly reliable and valid instrument, widely used in both clinical practice and research to assess disability related to low back pain [20].
The ethical clearance was obtained from the Institutional Ethics Committee of SIMATS Medical College Hospital. All procedures were conducted in accordance with the ethical standards of the institutional and/or national research committee. The NKT group received treatment for 8 weeks. Manual muscle testing of participants was conducted during this period, along with identifying dysfunctional movement patterns and biweekly neuromotor reprogramming sessions. The neuromotor reprogramming sessions included structured manual testing and corrective exercises guided by NKT principles. These sessions involved identifying muscles that show altered activation patterns due to compensatory dysfunctions and applying manual stimulation or corrective input to restore optimal neuromuscular coordination. Each session focused on targeted muscle testing, inhibition of overactive muscles, and facilitation of underactive muscles to promote balanced movement patterns. This process is based on neurophysiological mechanisms and clinical reasoning, without reliance on promotional or proprietary terminology. Each session involved the following steps:
i) Manual Muscle Testing (MMT) of the muscles related to core stability and postural control (e.g., transversus abdominis, multifidus, gluteus medius) was assessed using manual testing techniques to identify dysfunctional or inhibited muscles;
ii) Compensation Pattern Identification: Dysfunctional muscles were analyzed in the context of compensatory movement patterns, including overactivity of synergists or antagonists;
iii) Corrective Stimulus: Once dysfunctional patterns were identified, manual stimulation (such as light palpation or resisted contraction) was applied to associated neurological structures (e.g., muscle spindle, tendon, or scar tissue) to interrupt maladaptive signaling;
iv) Re-Testing and Reinforcement: After the corrective input, the initially weak or inhibited muscle was retested. If strength returned, the participant was guided through simple reinforcement exercises (e.g., low-load isometric contractions) to integrate the corrected pattern; and
v) Home Exercise Program: Patients were provided with tailored home exercises targeting the reprogrammed motor patterns to reinforce neuromuscular control. Each session lasted approximately 30-40 minutes and was administered twice weekly for eight weeks by a physiotherapist certified in NKT [11-14, 21].
All treatments in both groups were performed by a certified therapist. Meanwhile, the control group performed conventional core-strengthening exercises to develop deep core muscles [22, 23]. The treatment was applied to subjects in both groups for 8 weeks, and at 12 weeks of follow-up. An assessor unaware of the outcome measurements evaluated all outcomes independently.
Data analysis was conducted using SPSS 26 software. Data normality was assessed using the Shapiro-Wilk test, and non-parametric statistical methods were used. Within-group changes were analyzed using the Wilcoxon signed-rank test, while between-group differences were assessed using the Mann-Whitney U test.
Findings
A total of 66 participants were recruited and randomized simply into the Neurokinetic Therapy group (n=33) or the control group (n=33). Ultimately, 62 participants completed the study; Four were considered dropouts due to noncompliance or unrelated health conditions. Both groups were quite similar in baseline characteristics, making them comparable for analysis.
The primary outcome, core muscle endurance, improved significantly in the NKT group. Among the secondary outcomes, the NKT group showed significant reductions in lateral pelvic tilt, with significant improvement, and an effect size. Flexibility of the quadratus lumborum also improved significantly in the NKT group, with sit-and-reach test scores reflecting a large effect.
The Visual Analog Scale (VAS) scores in the NKT group showed a significantly greater reduction than those in the control group (p<0.01). Similarly, with functional disability as measured by the ODI, significant improvement was observed in the NKT group, which was statistically significant (p<0.01; Table 1).
Table 1. Comparing the pre-test and post-test values of neurokinetic therapy
Discussion
The study's results demonstrate the efficacy of neurokinetic therapy in correcting core muscle dysfunction and alleviating symptoms reported by individuals with chronic nonspecific lower-back pain. NKT demonstrated significant gains compared with conventional core strengthening exercises. These findings are corroborated by the literature, which indicates that therapies tackling neuromuscular dysfunctions generally offer better outcomes than a strength-based approach alone [7, 9].
The improvements in core muscle endurance observed in the NKT group are thought to be a consequence of motor control re-education and perhaps in correcting the dysfunctional movement patterns. Thus, endurance provides lumbar stability and has even been correlated with functional limitation and pain intensity in LBP patients [3, 4, 9]. NKT could have improved the neuromuscular coordination of further deep core stabilizers, such as the transversus abdominis and multifidus, leading to greater activation and endurance.
Correction of lateral pelvic tilt and improvement of quadratus lumborum flexibility highlight another aspect of NKT in addressing biomechanical imbalances and functional movement patterns. As pelvic asymmetry is often the cause of mechanical low-back pain, these improvements further reinforce NKT techniques' ability to address this dysfunction [16-18]. Better flexibility of the quadratus lumborum, which is the main lateral stabilizer of the spine, may even have contributed to improved postural alignment and decreased compensatory strain in the lumbar region [22].
There was a dramatic decrease in pain intensity and functional impairment in the NKT group, meditating upon the evidence of NKT's potential to address chronic pain and settle functional outcomes [11-14, 23]. Compared to conventional core strengthening, NKT induces changes in neuro-muscular dysfunctions that maintain pain and compensatory movement patterns. Such an integrated intervention approach may be the causal factor behind the differential reductions in pain and disability observed in this study [24].
Based on the findings, interventional techniques such as NKT should be incorporated into clinical practice for the treatment of chronic low back pain, especially when core dysfunction is involved [11, 12]. The observed improvements in core stability can be attributed to the central mechanism of NKT, which relies on the concept of motor control hierarchy and sensorimotor integration. By challenging the nervous system to correct faulty recruitment patterns, NKT facilitates neuroplastic changes that may restore muscle balance and improve postural control [7-9]. This approach contrasts with traditional strengthening programs, which often focus on isolated muscle activation without addressing the underlying neuromuscular imbalances.
The pain reduction observed in this study is also consistent with prior evidence suggesting that restoring correct motor patterns reduces mechanical loading and abnormal tension in compensatory musculature. Furthermore, activating appropriate stabilizers via targeted neuromuscular feedback may reduce nociceptive drive, contributing to the observed decrease in pain scores. These findings are consistent with previous studies reporting improvements in lumbar function and pain following neuromuscular retraining interventions.
Importantly, the results highlight that addressing core dysfunction is not solely about muscular strength but about coordinated, timely muscle activation. The neuromotor retraining facilitated by NKT may offer a more specific and individualized approach than general core exercises. In this context, NKT serves both a diagnostic and therapeutic role, identifying weak or inhibited muscles and immediately correcting them through brain-based reprogramming.
There are, however, a few limitations that need to be acknowledged. This study is preliminary and was conducted with a small sample size, limiting the generalizability of the findings to broader populations. Larger, multi-centered trials are recommended to confirm the effectiveness of Neurokinetic Therapy (NKT) across diverse demographic and clinical groups. Additionally, while improvements in core muscle function were observed, the absence of objective muscle activity measurements, such as surface or intramuscular electromyography (EMG), limits the ability to accurately assess deep muscle activation and neuromuscular responses [25, 26]. Larger and more heterogeneous populations, coupled with an objective movement analysis system, are needed to strengthen our research.
Conclusion
Neurokinetic therapy demonstrates meaningful improvements in core muscle function, pain, and disability among individuals with chronic low back pain.
Acknowledgments: The authors would like to thank all the participants who took part in this research for their cooperation and valuable time.
Ethical Permissions: Ethical approval for this study was obtained from the Institutional Ethics Committee of SIMATS Medical College Hospital, Chennai, India, prior to commencement of the study. The approval number is 011/11/2023/IEC/SMCH, and the approval was granted on 21st November 2023.
Conflicts of Interests: The authors declare that they have no conflicts of interest related to this study.
Authors' Contribution: Kumar KT (First Author), Introduction Writer/Main Researcher (15%); Kumaresan AK (Second Author), Introduction Writer/Main Researcher (15%); Vishnuram S (Third Author), Methodologist/Discussion Writer (20%); Vianni DD (Fourth Author), Introduction Writer/Assistant Researcher (10%); Subramanian SS (Fifth Author), Introduction Writer/Assistant Researcher (10%); Raj NB (Sixth Author), Introduction Writer/Statistical Analyst (10%); Fatima I (Seventh Author), Introduction Writer/Statistical Analyst (10%); Arjunan P (Eighth Author), Assistant Researcher (5%); Thirunavukkarasu V (Ninth Author), Assistant Researcher (5%)
Funding/Support: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Keywords:
Core Stability [MeSH], Low Back Pain [MeSH], Muscle Weakness [MeSH], Neurokinetic Therapy [MeSH], Health [MeSH]
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