The patients were instructed to take a relaxed breath in and out, hold the breath out, and then draw in the lower abdomen without moving the spine. Independent contraction of the transversus abdominis muscle was achieved through the abdominal drawing-in maneuver(ADIM).

• In the supine position, the pressure biofeedback unit was placed beneath the lumbar lordosis, and air was infused into the bulb to establish a baseline pressure of 40 mmHg. pressure increases of 0-2 mmHg g from a baseline of 40 mmHg
• In the prone position, the pressure biofeedback unit was positioned between the navel and the anterior superior iliac spine (ASIS), and air was infused into the bulb to establish a baseline pressure of 70 mmHg. A decrease in pressure ranging from 4 to 10 mmHg during the performance of the active drawing-in maneuverwas considered to indicate a successful execution of the exercise.
• After two weeks, lumbar stabilization exercises were progressively introduced

1. Participants are instructed to walk as normally and flexibly as possible

2. Advise when lifting:

   • Participants are instructed to avoid twisting and bending.
   • When lifting heavy objects, they are instructed to use their thighs while keeping the back vertical.
   • At other times, they are instructed to use the back and flex it appropriately.

3. Participants were instructed to apply heat for 20 minutes, twice daily

4. Avoid sitting or standing for prolonged period and change position every 15 minutes.

5. Sitting: Sit with a back support

6. Driving: Use a back support (lumbar roll) at the curve of your back.

7. Participants were instructed to sleep and lie down on a firm mattress and box spring set that did not sag. If necessary, they were advised to place a board under the mattress or temporarily position the mattress on the floor.

Trunk extensor muscle endurance will be evaluated using the Trunk Extensor Test (TET) from the McGill Core Endurance Test battery. Endurance time will be recorded in seconds, with longer durations reflecting better endurance.

Right lateral trunk muscle endurance will be assessed using the Right Lateral Musculature Test from the McGill Core Endurance Test battery. Endurance time will be recorded in seconds.

Left lateral trunk muscle endurance will be assessed using the Left Lateral Musculature Test from the McGill Core Endurance Test battery. Endurance time will be recorded in seconds.

Abnormal movement patterns will be assessed using the Prone Hip Extension Test. Participants will be classified as positive or negative based on the presence of any of the following:

Lumbar spine rotation

Lateral shift of the lumbar spine

Lumbar spine extension

Pelvic girdle elevation on the side of hip extension

Functional disability will be assessed using the Oswestry Disability Index (ODI). The ODI consists of ten domains including pain intensity, personal care, lifting, work, sitting, standing, sleeping, sexual activity, social life, and traveling. Scores are reported as a percentage, with higher scores indicating greater disability.

Lumbar core muscle strength will be assessed using a Pressure Biofeedback Unit (PBU). Participants will be positioned in crook-lying with the knees flexed between 70° and 90°. The PBU will be placed beneath the lumbar lordosis and inflated to a baseline pressure of 40 mmHg. Participants will be instructed to perform an abdominal drawing-in maneuver and maintain the contraction for 10 seconds. The change in pressure (mmHg) will be recorded as an indicator of lumbar core muscle activation.