Impact of gluteus maximus–focused intervention using Powers’ program on chronic mechanical low back pain: A randomized controlled trial

Chronic mechanical low back pain (CMLBP) is frequently associated with poor neuromuscular control and decreased gluteus maximus (GM) muscle activation. Rather than being caused by direct muscle damage, these deficiencies are frequently the result of disrupted communication between ascending and descending motor pathways, resulting in dysfunctional lumbopelvic stabilizer activation patterns. The purpose of this study was to investigate the effect of GM activation, strengthening, and functional exercise using Powers’ program on pain, disability, GM strength, and hop test performance in subjects with CMLBP. A single-blinded, two parallel groups, randomized controlled clinical trial was conducted. Forty-eight subjects with CMLBP, with a mean age of (32.77 ± 6.10) were randomly allocated to either study or control groups. The study group received eight phases of the Powers’ program plus a conventional intervention of flexibility exercises, hot packs, and transcutaneous electrical stimulation (three sessions per week for four weeks). The active control group received the same conventional intervention only. All subjects were assessed pre- and post-intervention for pain, disability, GM strength, and functional performance using the Visual Analogue Scale, Oswestry Disability Index, Hand-held dynamometer, and one-legged hop tests (single-limb triple hop test for distance and single-limb crossover hop test for distance), respectively. All outcomes showed significant within-group improvements (p < 0.05). The post-treatment between-group MANOVA comparison was not statistically significant (p > 0.05). Post-hoc univariate analysis, however, revealed an improvement in GM strength in the study group (p < 0.05). Nonetheless, this data should be interpreted with caution as the overall MANOVA was not significant, and repeated comparisons may increase the chance of a type I error. The eight-phase Powers program improved GM strength in subjects with CMLBP, demonstrating its effectiveness in targeted muscle strengthening. Non-significant findings, however, in pain, disability, and functional performance indicate that future research should look at lengthier therapies or integration with broader rehabilitation modalities to obtain functional benefits beyond strength improvement. The study was registered on ClinicalTrials.gov: NCT05770986 and the date of registration was March 16th, 2023.