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Core strengthening exercises are extensively used in therapy, however, results may differ depending on postural categorization. This study investigated the effects of core muscle exercises on pain, function, and trunk endurance in patients classified using Saliba\u2019s postural classification system (SPCS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty patients with CMLBP were assigned to one of six postural classification groups (I\u2013VI) of SPCS (10 patients per group) based on photographic analysis and confirmatory clinical tests. For four weeks, abdominal bracing, dynamic stabilization, and advanced core strengthening exercises were performed. Pain intensity, functional disability, and core endurance were assessed using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), standardized endurance tests, respectively. Assessment was performed pre and post-intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A one-way MANOVA and follow up ANOVA tests revealed that there were non-significant differences on reducing pain and functional disability post treatment, F\n                      <jats:sub>(5,54)<\/jats:sub>\n                      \u2009=\u20090.72;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.612; partial \u019e2\u2009=\u20090.06, F\n                      <jats:sub>(5,54)<\/jats:sub>\n                      \u2009=\u20090.67;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.652; partial \u019e2\u2009=\u20090.06 for pain and functional disability, respectively. However, specific postural groups demonstrated statistically significant improvements in trunk muscle endurance, particularly in right and left side plank performance, F\n                      <jats:sub>(5,54)<\/jats:sub>\n                      \u2009=\u20093.34;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011; partial \u019e2\u2009=\u20090.24 and F\n                      <jats:sub>(5,54)<\/jats:sub>\n                      \u2009=\u20093.80;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005; partial \u019e2\u2009=\u20090.26, respectively. A post hoc comparison for plank tests indicated that group I had significantly better right side plank endurance than group V and VI. Also, group I had significantly better left side plank endurance than group II, V and VI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Core muscle strengthening exercises (CMSE) improved trunk muscular endurance in different postural groups, although the reductions in pain and functional impairment were not statistically different. These data indicate that gains in endurance may not directly transfer to similar improvements in pain or function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The study was retrospectively registered at ClinicalTrials.gov (Registration No: NCT06296667) on 5\/3\/2024. Ethical approval was obtained from the Research Ethical Committee of Faculty of Physical Therapy, Cairo University, Egypt prior to study initiation (Approval No: P.T.REC\/012\/003644; Date: 27\/2\/2022).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-025-09693-0","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T16:23:17Z","timestamp":1769098997000},"page":"2924-2933","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of core strengthening on chronic mechanical low back pain: a clinical trial based on Saliba\u2019s postural classification"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8629-211X","authenticated-orcid":false,"given":"Nasr Awad","family":"Abdelkader","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1202-3416","authenticated-orcid":false,"given":"Elsadat Saad","family":"Soliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Omar","family":"Soliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0018-351X","authenticated-orcid":false,"given":"Rania Saleh","family":"Elemam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8664-3602","authenticated-orcid":false,"given":"Mohamed Ahmed","family":"Abdelmegeed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"issue":"4","key":"9693_CR1","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.3390\/jcm12041685","volume":"12","author":"V Nicol","year":"2023","unstructured":"Nicol V, Verdaguer C, Daste C, Bisseriex H, Lapeyre \u00c9, Lef\u00e8vre-Colau MM, Nguyen C (2023) Chronic low back pain: a narrative review of recent international guidelines for diagnosis and Conservative treatment. 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The study was registered on clinical trials.gov [NCT06296667]. All patients received a clear explanation of the study aim and a written informed consent was taken from all patients involved in the study. The study was carried out in accordance with declaration of Helsinki\u2019s ethical criteria and was authorized by the Faculty of Physical Therapy, Cairo University, Egypt\u2019s ethical committee (No P.T.REC\/012\/003644).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent for publication of identifying information (including images, clinical details) was obtained from all patients involved in the study prior to publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"No author has any financial interest or received any financial benefit from this research.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure\u00a0statement"}},{"value":"All data relevant to the study are included in the article or are available as supplementary files.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data sharing statement"}}]}}