The Effect of Core Stability Exercises with and without the Alexander Technique on Kinesiophobia, Anxiety and Depression in Women with Chronic Nonspecific Low Back Pain

Yalfani, Ali; Azizian, Masoud; Ghasemali, Fatemeh; Bashiri, Mryam

doi:10.48307/FMSJ.2026.30.4.425

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Volume 30, Issue 4 (Bimonthly 2026)

Feyz Med Sci J 2026, 30(4): 425-438

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The Effect of Core Stability Exercises with and without the Alexander Technique on Kinesiophobia, Anxiety and Depression in Women with Chronic Nonspecific Low Back Pain

Ali Yalfani ^*

, Masoud Azizian

, Fatemeh Ghasemali

, Mryam Bashiri

Department of Sport Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran , yalfani@basu.ac.iw

Abstract: (394 Views)

Background and Aim: Kinesiophobia and psychological factors may contribute to the persistence and exacerbation of chronic nonspecific low back pain (CNSLBP). This study aimed to investigate the effects of core stability exercises combined with the Alexander Technique–based ergonomic intervention on kinesiophobia, anxiety, and depression in women with CNSLBP.
Methods: This three-arm randomized controlled trial included 63 women with CNSLBP who were randomly allocated to three groups: core stability exercises combined with Alexander Technique–based ergonomic training (n = 21), core stability exercises alone (n=21), and control (n=21). The combined intervention was performed for 8 weeks, three sessions per week, with each session lasting 60 minutes. Kinesiophobia was assessed using the 17-item Tampa Scale of Kinesiophobia (TSK-17), while anxiety and depression were assessed using the 14-item Hospital Anxiety and Depression Scale (HADS). Repeated-measures analysis of variance (ANOVA) was used to examine differences among the three groups over time.
Results: A significant time × group interaction was observed for kinesiophobia (F(2,60) = 67.55, P<0.001, partial η²=0.692), anxiety (F(2,60)=45.02, P<0.001, partial η²=0.600), and depression (F(2,60) = 131.40, P<0.001, partial η²=0.814). Tukey’s post hoc test showed that the combined intervention group had significantly greater reductions in all three outcomes than both the core stability exercise and control groups (P<0.05).
Conclusion: Combining core stability exercises with Alexander Technique–based ergonomic training was more effective than core stability exercises alone in reducing kinesiophobia, anxiety, and depression in women with CNSLBP. Incorporating this approach into rehabilitation programs may be beneficial for physiotherapists and exercise professionals.

Keywords: Chronic nonspecific low back pain, Alexander Technique, Kinesiophobia, Core stability

Full-Text [PDF 1095 kb] (13 Downloads)

Type of Study: Research | Subject: medicine, paraclinic
Received: 2026/06/26 | Revised: 2026/10/7 | Accepted: 2026/08/19 | Published: 2026/08/23

References

1. Couëpel B, Ducas J, Marchand AA, Bernier M, Abboud J, Descarreaux M. Comparing physical activity practice, pain and psychological characteristics in individuals with fibromyalgia and individuals with low back pain. Chiropr Man Therap. 2026;34(1):1-10. doi:10.1186/s12998-025-00625-9 PMid:41645185 PMCid:PMC12973637

2. Niederer D, Fleckenstein J, Floessel P, Tomschi F, Krempel L, Stoll J, et al. Comparative effectiveness of tailored exercise therapies alone or combined with psychological interventions for chronic, nonspecific low back pain: a systematic review with network meta-analysis. J Orthop Sports Phys Ther. 2026; 56(1):16-27. doi:10.2519/jospt.2025.13281 PMid:41476427

3. Wijnen J, Van Oosterwijck S, Dhondt E, Brandt M, Danneels L, Matheve T, et al. Patterns in anticipatory postural adjustment onset timing across multiple trunk muscles: psychological correlates and participant clustering along the low back pain continuum. Musculoskelet Sci Pract. 2026;103496. doi:10.1016/j.msksp.2026.103496 PMid:41581495

4. Behera D, Venkatesan P, Jensen MP, Gopalakrishna DB, Patil A. The efficacy of hypnosis in chronic low back pain: protocol for a systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med. 2026;102605. doi:10.1016/j.eujim.2025.102605

5. Dupuis F, Tousignant-Laflamme Y, Deschênes PM, Fournier P, Nduwimana I, Ballot O, et al. Combining noninvasive brain stimulation and physiotherapy to improve the management of chronic low back pain in veterans: protocol for a multi-arm randomized controlled trial. JMIR Res Protoc. 2026;15(1):e78952. doi:10.2196/78952 PMid:41587077 PMCid:PMC12887568

6. Yalfani A, Raeisi Z, Koumasian Z. Effects of eight-week water versus mat pilates on female patients with chronic nonspecific low back pain: double-blind randomized clinical trial. J Bodyw Mov Ther. 2020; 24(4):70-5. doi:10.1016/j.jbmt.2020.06.002 PMid:33218568

7. Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25(2):173-83. doi:10.1016/j.berh.2010.01.012 PMid:22094194

8. Aaron RV, Ravyts SG, Carnahan ND, Bhattiprolu K, Harte N, McCaulley CC, et al. Prevalence of depression and anxiety among adults with chronic pain: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268 PMid:40053352 PMCid:PMC11889470

9. Yalfani A, Azizian M, Bashiri M, Azizpour M. Effect of lumbo-pelvic rehabilitation on pain intensity in patients with chronic non-specific low back pain: a systematic review. J Shahid Sadoughi Univ Med Sci. 2025;33(8):e20046. doi:10.18502/ssu.v33i8.20046

10. Arango-Dávila CA, Rincón-Hoyos HG. Depressive disorder, anxiety disorder and chronic pain: multiple manifestations of a common clinical and pathophysiological core. Rev Colomb Psiquiatr (Engl Ed). 2018;47(1):46-55. doi:10.1016/j.rcp.2016.10.007.

11. Higuchi D, Kondo Y, Watanabe Y, Miki T. Sex differences in the mediating effect of kinesiophobia on chronic pain, dysesthesia, and health-related quality of life in Japanese individuals aged 65 years old and older treated with surgery for lumbar spinal stenosis. J Pain Res. 2022;15:1845-54. doi:10.2147/JPR.S366378 PMid:35795101 PMCid:PMC9252318

12. Nguyen T, Behrens M, Broscheid KC, Bielitzki R, Weber S, Libnow S, et al. Associations between gait performance and pain intensity, psychosocial factors, executive functions as well as prefrontal cortex activity in chronic low back pain patients: a cross-sectional fNIRS study. Front Med (Lausanne). 2023;10:1147907. doi:10.3389/fmed.2023.1147907 PMid:37215712 PMCid:PMC10196398

13. Jiang Y, Wang Y, Wang R, Zhang X, Wang X. Differences in pain, disability, and psychological function in low back pain patients with and without anxiety. Front Physiol. 2022;13:906461. doi:10.3389/fphys.2022.906461. PMid:36406992 PMCid:PMC9669742

14. Joyce CT, Chernofsky A, Lodi S, Sherman KJ, Saper RB, Roseen EJ. Do physical therapy and yoga improve pain and disability through psychological mechanisms? A causal mediation analysis of adults with chronic low back pain. J Orthop Sports Phys Ther. 2022;52(7):470-83. doi:10.2519/jospt.2022.10813 PMid:35584010 PMCid:PMC9510936

15. Sakai Y, Watanabe T, Wakao N, Matsui H, Osada N, Sugiura T, et al. Proprioception and geriatric low back pain. Spine Surg Relat Res. 2022;6(5):422-32. doi:10.22603/ssrr.2021-0269 PMid:36348676 PMCid:PMC9605761

16. Zafar T, Zaki S, Alam MF, Sharma S, Babkair RA, Nuhmani S, et al. Effect of whole-body vibration exercise on pain, disability, balance, proprioception, functional performance and quality of life in people with non-specific chronic low back pain: a systematic review and meta-analysis. J Clin Med. 2024;13(6):1639. doi:10.3390/jcm13061639 PMid:38541865 PMCid:PMC10971737

17. Yalfani A, Azizian M, Gholami-Borujeni B. Adding neurofeedback training to neuromuscular training for rehabilitation of chronic ankle instability: a 3-arm randomized controlled trial. Sports Health. 2024;16(5):797-807. doi:10.1177/19417381231219198 PMid:38149335 PMCid:PMC11346238

18. Babaei H, Alizadeh MH, Minoonezhad H, Movahed A. Effectiveness of the Alexander technique on the static and dynamic balance of young men with upper crossed syndrome. Sci J Rehabil Med. 2023;12(1):60-77. doi:10.32598/SJRM.12.1.3

19. Wong GK, Comeau G, Russell D, Huta V. The effect of lessons in the Alexander technique on pianists' posture during performance. Musicae Sci. 2024;28(1):159-73. doi:10.1177/10298649231172928

20. Tissot LP, Evans DW, Kirby E, Liew BX. Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain. Pain Rep. 2023;8(4):e1081. doi:10.1097/PR9.0000000000001081 PMid:37293339 PMCid:PMC10247215

21. Longo UG, Papalia R, De Salvatore S, Marinozzi A, Piergentili I, Lalli A, et al. Establishing the minimum clinically significant difference (MCID) and the patient acceptable symptom score (PASS) for the Hospital Anxiety and Depression Scale (HADS) in patients with rotator cuff disease and shoulder prosthesis. J Clin Med. 2023;12(4):1540. doi:10.3390/jcm12041540 PMid:36836074 PMCid:PMC9967741

22. Grönkvist R, Vixner L, Äng B, Grimby-Ekman A. Measurement error, minimal detectable change, and minimal clinically important difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in patients with chronic pain. J Pain. 2024;25(9):104559. doi:10.1016/j.jpain.2024.104559 PMid:38734041

23. Li Y, Zhao Q, Zhang X, E Y, Su Y. The impact of core training combined with breathing exercises on individuals with chronic non-specific low back pain. Front Public Health. 2025;13:1518612. doi:10.3389/fpubh.2025.1518612 PMid:40061473 PMCid:PMC11885289

24. Shadi N, Khalaghi K, Seyedahmadi M. Comparing the effects of Pilates, corrective exercises, and Alexander's technique on upper cross syndrome among adolescent girls student (ages 13-16): a six-week study. BMC Sports Sci Med Rehabil. 2024;16(1):143. doi:10.1186/s13102-024-00933-2 PMid:38943175 PMCid:PMC11214212

25. Qin D, Qin Y, Wang Y, Xue L, Peng Y. Effects of the Alexander technique on pain and adverse events in chronic non-specific neck pain: a systematic review and meta-analysis. PLoS One. 2024;19(11):e0313526. doi:10.1371/journal.pone.0313526 PMid:39576801 PMCid:PMC11584109

26. Yalfani A, Azizian M, Mohagheghi H, Zoghi Paidar MR, Gholami-Borujeni B. Effect of adding neurofeedback to neuromuscular training on brain waves in athletes with chronic ankle instability: a randomized clinical trial. Sci J Rehabil Med. 2024;13(1):180-93. doi:10.32598/SJRM.13.1.12

27. Yalfani A, Ahmadnezhad L, Gholami Borujeni B, Khoshnamvand Z. The effect of six weeks core stability exercise training on balance, pain and function in women with chronic low back pain. J Health Care. 2017;18(4):336-46.

28. Hafezi M, Rahemi Z, Ajorpaz NM, Izadi FS. The effect of the Alexander technique on pain intensity in patients with chronic low back pain: a randomized controlled trial. J Bodyw Mov Ther. 2022;29:54-9. doi:10.1016/j.jbmt.2021.09.008 PMid:34776188

29. O'Neill MM, Anderson DI, Allen DD, Ross C, Hamel KA. Effects of Alexander technique training experience on gait behavior in older adults. J Bodyw Mov Ther. 2015;19(3):473-81. doi:10.1016/j.jbmt.2014.12.006 PMid:26118520

30. Gleeson M, Sherrington C, Lo S, Keay L. Can the Alexander technique improve balance and mobility in older adults with visual impairments? A randomized controlled trial. Clin Rehabil. 2015;29(3):244-60. doi:10.1177/0269215514542636 PMid:25027444

31. Gorji SM, Mohammadi Nia Samakosh H, Watt P, Henrique Marchetti P, Oliveira R. Pain neuroscience education and motor control exercises versus core stability exercises on pain, disability, and balance in women with chronic low back pain. Int J Environ Res Public Health. 2022;19(5):2694. doi:10.3390/ijerph19052694 PMid:35270384

32. Nipa SI, Sriboonreung T, Paungmali A, Phongnarisorn C. The effects of pelvic floor muscle exercise combined with core stability exercise on women with stress urinary incontinence following the treatment of nonspecific chronic low back pain. Adv Urol. 2022;2022:2051374. doi:10.1155/2022/2051374 PMid:36105867 PMCid:PMC9467742

33. Masroor S, Tanwar T, Aldabbas M, Iram I, Veqar Z. Effect of adding diaphragmatic breathing exercises to core stabilization exercises on pain, muscle activity, disability, and sleep quality in patients with chronic low back pain: a randomized control trial. J Chiropr Med. 2023;22(4):275-83. doi:10.1016/j.jcm.2023.07.001 PMid:38205226 PMCid:PMC10774616

34. Li Y, Yan L, Hou L, Zhang X, Zhao H, Yan C, et al. Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis. Front Public Health. 2023;11:1155225. doi:10.3389/fpubh.2023.1155225 PMid:38035307 PMCid:PMC10687566

35. Wang H, Fan Z, Liu X, Zheng J, Zhang S, Zhang S, et al. Effect of progressive postural control exercise versus core stability exercise in young adults with chronic low back pain: a randomized controlled trial. Pain Ther. 2023;12(1):293-308. doi:10.1007/s40122-022-00458-x PMid:36454387 PMCid:PMC9845492

36. Huang H, Xie H, Zhang G, Xiao W, Ge L, Chen S, et al. Effects of dynamic neuromuscular stabilization training on the core muscle contractility and standing postural control in patients with chronic low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2025;26(1):213. doi:10.1186/s12891-025-08417-1 PMid:40025463 PMCid:PMC11871613

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Yalfani A, Azizian M, Ghasemali F, Bashiri M. The Effect of Core Stability Exercises with and without the Alexander Technique on Kinesiophobia, Anxiety and Depression in Women with Chronic Nonspecific Low Back Pain. Feyz Med Sci J 2026; 30 (4) :425-438
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