{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:59:44Z","timestamp":1781067584656,"version":"3.54.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003819","name":"Natural Science Foundation of Hubei Province","doi-asserted-by":"publisher","award":["2025AFD532"],"award-info":[{"award-number":["2025AFD532"]}],"id":[{"id":"10.13039\/501100003819","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010580","name":"Department of Science and Technology, Hubei Provincial People's Government","doi-asserted-by":"publisher","award":["2023AFD128"],"award-info":[{"award-number":["2023AFD128"]}],"id":[{"id":"10.13039\/501100010580","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005891","name":"State Administration of Traditional Chinese Medicine of the People's Republic of China","doi-asserted-by":"publisher","award":["GZY-KJS-2025-008"],"award-info":[{"award-number":["GZY-KJS-2025-008"]}],"id":[{"id":"10.13039\/501100005891","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic non-specific low back pain (CNLBP) represents a major global public health challenge, with sedentary behavior serving as one of its primary risk factors. Although clinical guidelines recommend core muscle training as a first-line intervention, a treatment dilemma often persists in clinical practice: the efficacy of training is constrained by pre-existing biomechanical, neurophysiological, and psychobehavioral barriers. This study proposes a novel two-stage synergistic model, \u201cPassive Preparation and Active Re-education,\u201d designed to overcome these bottlenecks and evaluate its effectiveness in a sedentary population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a single-center, assessor-blinded randomized controlled trial. A total of 88 sedentary individuals with CNLBP will be randomly allocated (1:1) to either a control group receiving core stability exercise alone or an intervention group receiving manual therapy followed by core stability exercise. The program consists of 12 sessions over 4 weeks. Outcome measures will be assessed at baseline, week 2, and week 4, with additional follow-ups at 1 and 3 months. The primary outcome is the change in pain intensity measured by the Visual Analog Scale (VAS) at week 4. Secondary outcomes include disability assessed by the Roland-Morris Disability Questionnaire (RMDQ), psychological factors via the Fear-Avoidance Beliefs Questionnaire (FABQ), and muscle biomechanical properties measured using MyotonPRO and isokinetic systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The central hypothesis is that the integration of manual therapy and core stability exercise produces a synergistic, non-linear effect rather than a simple additive one. Manual therapy acts as a \u201cpassive preparation\u201d to create a time-sensitive \u201ctherapeutic window\u201d by reducing pain and muscle hypertonicity. By immediately introducing core stability exercise within this window, the model optimizes target muscle recruitment and movement quality. This comprehensive approach aims to achieve a more efficient reversal of the pathological cycle in sedentary populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/itmctr.ccebtcm.org.cn\/mgt\/<\/jats:ext-link>\n                      , identifier ITMCTR2025002406.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1851073","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:29:09Z","timestamp":1781065749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual therapy combined with core muscle training for chronic non-specific low back pain in sedentary individuals: a study protocol for a single-center randomized controlled 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Shizhen Laboratory, Wuhan","place":["Hubei, China"]},{"name":"Hubei Key Laboratory of Theory and Application Research of Liver and Kidney in Traditional Chinese Medicine, Affiliated Hospital of Traditional Chinese Medicine, Wuhan","place":["Hubei, China"]},{"name":"The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan","place":["Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danni","family":"Xiong","sequence":"additional","affiliation":[{"name":"Hubei YJT Intelligent Technology Group Co., Ltd.","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Tuina, Rehabilitation Medicine Center, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan","place":["Hubei, China"]},{"name":"Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan","place":["Hubei, China"]},{"name":"Hubei Shizhen Laboratory, 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