Journal of Isfahan Medical School

Journal of Isfahan Medical School

Effects of DNS and PNF Exercises on Motor Function, Pain, Disability, and Quality of Life in Older Women with Nonspecific Low Back Pain

Document Type : Original Article(s)

Authors
Hamed Safari 1
Vahid Zolaktaf 2
Shahram Lenjannejadian 3
Mojtaba Babaei Khorzoughi 4
1 PhD Student of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Isfahan, Isfahan, Iran
2 Professor, Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Isfahan, Isfahan, Iran
3 Associate Professor of Sports Biomechanics, Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Isfahan, Isfahan, Iran
4 Associate Professor of Sports Injuries and Corrective Exercises, Physical Education Center, Isfahan University of Technology, Isfahan, Iran
10.48305/jims.v44.i873.2052
Abstract
Background: Nonspecific low back pain is one of the common musculoskeletal disorders in older adults and may be associated with reduced motor function and quality of life. This study aimed to determine the effects of eight weeks of Dynamic Neuromuscular Stabilization (DNS) and Proprioceptive Neuromuscular Facilitation (PNF) exercises on motor function, pain, functional disability, and quality of life in older women with nonspecific low back pain.
Methods: In this experimental study, 30 older women aged 60–75 years with nonspecific low back pain were randomly assigned to DNS and PNF groups (15 participants per group). Interventions were performed for eight weeks, with three sessions per week. Outcomes included range of motion, muscular endurance, functional mobility (TUG), pain intensity (VAS), functional disability (ODI), and quality of life (SF-36), assessed at pretest and posttest. Data were analyzed using repeated-measures analysis of variance.
Findings: Both groups showed significant improvements in all variables except the mental component of quality of life (P<0.05). A significant time × group interaction was observed for hip range of motion and lumbar flexion, favoring PNF, and for trunk extensor muscle endurance, favoring DNS. No significant differences in the pattern of change between groups were observed for the other variables.
Conclusion: Both DNS and PNF exercises are effective non-pharmacological interventions for improving clinical and functional outcomes in older women with nonspecific low back pain. Exercise selection may be based on therapeutic goals, with PNF exercises prioritized for improving range of motion and DNS exercises for increasing trunk extensor muscle endurance.

Highlights

Hamed SafariGoogle Scholar, PubMed :

Vahid Zolaktaf: Google Scholar, PubMed:

Shahram Lenjannejadian:Google Scholar, PubMed

Mojtaba Babaei Khorzoughi :Google Scholar, PubMed

Keywords
Exercise Therapy
Low Back Pain
Aged
Pain
Quality of Life
Subjects
1.     Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas 2020; 139: 6-11.
2.     Fathi E. The phenomenon of population aging in Iran. Ijoss Iranian Journal of Official Statistics Studies 2020; 30(2): 387-413.
3.     Chiarotto A, Koes BW. Nonspecific low back pain. N Engl J Med 2022; 386(18): 1732-40.
4.     Traeger AC, Underwood M, Ivers R, Buchbinder R. Low back pain in people aged 60 years and over. BMJ 2022; 376: e066928.
5.     Kaushik M, Ahmad I. Bridging dynamic neuromuscular stabilization synergism with Movement Control Impairment Related Non-specific low back Pain: scoping review. J Musculoskelet Neuronal Interact 2024; 24(4): 420-32.
6.     Tikhile P, Patil DS, Jaiswal PR, Patil Sr DS. An integrated approach to chronic low back pain: Evaluating the impact of consecutive loop theraband training combined with proprioceptive neuromuscular facilitation and conventional physiotherapy. Cureus 2024; 16(4): e58632.
7.     Rum L, Brasiliano P, Vannozzi G, Laudani L, Macaluso A. Non-specific chronic low back pain elicits kinematic and neuromuscular changes in walking and gait termination. Gait Posture 2021; 84: 238-44.
8.     Safari H, Zolaktaf V. Effects of eight weeks of Dynamic Neuromuscular Stabilization exercises on the balance of older men [in Persian]. Sci J Rehabil Med 2023; 11(6): 978-87.
9.     Yin Y, Wang J, Lin Q, Luo Y, Liu Y, Sun J. Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis. PLoS One 2025; 20(1): e0311355.
10.  Gao P, Tang F, Liu W, Mo Y. The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2022; 35(1): 21-33.
11.  Åström M, Thet Lwin ZM, Teni FS, Burström K, Berg J. Use of the visual analogue scale for health state valuation: a scoping review. Qual Life Res 2023; 32(10): 2719-29.
12.  El-Hady AO, El Molla SS, Elwan SI, Ibrahim RA. Evaluation of health related quality of life with the use of Oswestry disability index in degenerative discogenic low back pain. Egypt Rheumatol Rehabil 2023; 50(1): 4.
13.  Járomi M, Szilágyi B, Velényi A, Leidecker E, Raposa BL, Hock M, et al. Assessment of health-related quality of life and patient’s knowledge in chronic non-specific low back pain. BMC Public Health 2021; 21(Suppl 1): 1479.
14.  Kim W-D, Shin D, editors. Effects of pelvic-tilt imbalance on disability, muscle performance, and range of motion in office workers with non-specific low-back pain. Healthcare (Basel) 2023; 11(6): 893.
15.  Segura-Jiménez V, Tsiarleston G, Donoso B, Gil-Gutiérrez YM, Delgado-Fernández M. Association of muscle strength, psychological factors, and central sensitization with Movement-Evoked pain in patients with nonspecific chronic low back pain: the BACKFIT project. Sports Health 2025; 17(2): 342-50.
16.  Sapmaz M, Mujdeci B. The effect of fear of falling on balance and dual task performance in the elderly. Exp Gerontol 2021; 147: 111250.
17.  Rezazadeh F, Aali S, Imani F, Sheikhalizadeh H, Ouergui I, Enoiu R-S, et al. Effects of dynamic neuromuscular stabilization on lower limb muscle activity, pain, and disability in individuals with chronic low back pain: a randomized controlled trial. Medicina (Kaunas) 2025; 61(11): 1961.
18.  Arcanjo FL, Martins JVP, Mote P, Leporace G, de Oliveira DA, de Sousa CS, et al. Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 46: 101505.
19.  Babagoltabar-Samakoush H, Aminikhah B. Effects of dynamic neuromuscular stabilization on balance, gait, and quality of life in older adults: a randomized controlled trial. Scientific Reports. 2026;10(9):221-31
20.  Yucekaya B, Kemer SN, Asan E, Gerdan H, Comuk Balci N, Cakır D, et al. The effect of proprioceptive neuromuscular facilitation techniques on pain, motor functions, fatigue and health related quality of life in individuals with multiple sclerosis: a randomized, single-blind study. Neurol Res 2025; 47(7): 537-49.
21.  Baig AAM, Ansari B. Bilateral asymmetrical limb proprioceptive neuromuscular Facilitation effects on Pain, Multifidus Activity, Range of Motion, and disability in low back Pain: a Randomized Controlled Trial. J Manipulative Physiol Ther 2022; 45(8): 604-13.
22.  Mahdieh L, Zolaktaf V, Karimi MT. Effects of dynamic neuromuscular stabilization (DNS) training on functional movements. Hum Mov Sci 2020; 70: 102568.
23.  Babagoltabar-Samakoush H, Aminikhah B, Bahiraei S. Effectiveness of dynamic neuromuscular stabilization training on strength, endurance, and flexibility in adults with intellectual disabilities, a randomized controlled trial. Sci Rep 2025; 15(1): 768.
24.  Fouda KZ, Dewir IM, Abdelsalam MS. Effects of proprioceptive neuromuscular facilitation techniques in treating chronic nonspecific low back pain patients. Physiother Quart 2021; 29(2): 32-7.
25.  Nosratikia R, Mahdavinejad R, Esmaeili H. Effect of 12 weeks dynamic neuromuscular stabilization training on balance in people with Parkinson's disease [in Persian]. Studies in Sport Medicine 2023; 14(34): 143-68.
Nguyen PT, Chou L-W, Hsieh Y-L. Proprioceptive neuromuscular facilitation-based physical therapy on the improvement of balance and gait in patients with chronic stroke: A systematic review and meta-analysis. Life (Basel) 2022; 12(6): 882.
Journal of Isfahan Medical School
Volume 44, Issue 873
Sports Medicine, Especial Issue
September and October 2026
Pages 2052-2062

  • Receive Date 08 September 2026
  • Accept Date 26 September 2026