Effects of dynamic neuromuscular stabilization with and without immersive virtual reality on pain, postural, and functional outcomes in women with lumbar hyperlordosis and chronic non-specific low back pain: a randomized controlled trial

Abstract

Lumbar hyperlordosis is a common postural abnormality in women and is often associated with chronic non-specific low back pain (CNLBP). This condition is linked to functional impairments and reduced physical performance. Dynamic Neuromuscular Stabilization (DNS), which emphasizes motor control and core stability, may help address these deficits. Incorporating virtual reality (VR) into rehabilitation may further enhance outcomes by increasing patient engagement and providing real-time visual feedback. This study aimed to compare the effects of DNS, with and without VR, on pain intensity, balance, lumbar proprioception, spinal range of motion (ROM) and lumbar lordosis angle in women with hyperlordosis and CNLBP. This randomized controlled trial used a pretest-posttest design with three parallel groups. Women aged 30–50 years with hyperlordosis and CNLBP were randomly assigned to DNS, DNS + VR, or control groups. The intervention was performed three times per week for six weeks. Pain intensity was measured using the Visual Analogue Scale (VAS), balance using the Biodex Balance System, lumbar proprioception using a goniometer, spinal ROM using the MobeeMed device, and lumbar lordosis angle using a Spinal Mouse. Data were analyzed using mixed-design repeated-measures ANOVA, followed by Bonferroni post hoc tests, with significance set at 0.05. Both intervention groups showed significant within-group improvements in pain intensity, balance, lumbar proprioception, spinal ROM, and lumbar lordosis over time. Compared with the DNS group, the DNS + VR group demonstrated greater improvements in lumbar lordosis angle and dynamic balance. Pain intensity also showed a larger mean reduction in the DNS + VR group, although the between-group difference did not reach statistical significance. In contrast, the DNS-only group showed the greatest improvement in lumbar proprioception. For spinal ROM, both intervention groups improved over time, but no significant pairwise differences were observed between DNS + VR and DNS. Six weeks of DNS exercises, with or without VR, improved pain intensity, lumbar proprioception, spinal ROM, lumbar lordosis, and balance in women with hyperlordosis and CNLBP. The addition of VR resulted in greater improvements in lumbar lordosis and dynamic balance, suggesting that VR may provide added benefits in DNS-based rehabilitation. The trial was registered at Iranian Clinical Trials Registry (IRCT202508010667119N1, registration date: 2025-08-19).

The authors' abstract, as published at the source. Journal of Orthopaedic Surgery and Research, 2026 · DOI ↗