Promising technique for managing nonspecific chronic low back pain using multi angular isometric lumbar exercise

Table 1 Multi-angular isometric lumbar exercise technique for lumbopelvic hip complex

Component	Details
Fundamental start position	Four-point kneeling; hands directly under shoulders, knees under hips; arms fully lengthened, avoid locking elbows; chest and shoulders open, neck relaxed, tension-free.
Spinal alignment	Maintain accurate alignment by focusing on: (1) Sacrum: Base of the spine; (2) Thoracic spine: Mid-back between shoulder blades; (3) Back of the head: Neutral, no excessive tilt; and (4) Neutral lumbar spine: Avoid arching or flattening.
Activation and breathing	(1) Steady breathing: Controlled breathing throughout exercises; (2) Abdominal drawing-in maneuver: Gently tighten deep abdominals by drawing umbilicus to spine, engaging transversus abdominis; and (3) Posterior pelvic tilt: Rotate pelvis posteriorly.
Strength component	Isometric hold: Hold activated position (abdominal drawing-in maneuver + posterior pelvic tilt) for 5 seconds; focus on controlled contraction and relaxation.
Power component	Quick squeezes: Perform 10 rapid activations and relaxations of pelvic and abdominal muscles.
Endurance component	Sustained hold: Activate pelvic floor and deep abdominals to 50% of max effort; hold for 20+ seconds to build endurance.
Focus areas	(1) Core stability: Strengthens core and lumbo-pelvic hip complex stability; (2) Spinal alignment: Reduces lumbar strain, reinforces proper posture; (3) Pelvic floor activation: Enhances lumbar and pelvic support; and (4) Mindful breathing: Supports controlled activation and relaxation.
Purpose	Structured progression improves motor control, core stability, and lumbar-pelvic function, addressing chronic low back pain safely and effectively.