BACKGROUND: Postpartum low back pain (PP-LBP) commonly affects women after childbirth due to core muscle weakness, hormonal changes, and altered biomechanics. It significantly impacts daily functioning and quality of life. Core Stability Exercises (CSE) have been widely used in postpartum rehabilitation, yet their overall effectiveness in managing PP-LBP has not been systematically evaluated. This systematic review aimed to evaluate the effectiveness of core stability exercises, either as a standalone approach or combined with otherphysiotherapy interventions in reducing pain, improving function and enhancing quality of life among postpartum women with low back pain.

METHODS: This PRISMA-guided systematic review searched PubMed, Scopus, ScienceDirect, and Google Scholar. Randomized controlled trials and quasi experimental studies published in English between 2004 to 2024 that included postpartum women (≥18 years) with low back pain, accessing CSE interventions with outcomes on pain, functional disability and quality of life. Risk of bias was assessed using the Cochrane ROB-2 tool for RCTs and ROBIN-1 tool for quasi experimental studies.

RESULTS: 950 records identified initially, 18 studies met inclusion criteria, including 13 RCTs and 5 quasi experimental studies with total of 772 postpartum women aged 18 to 45 years were included. Sample size ranged from 16 to 80 participants per study. Most studies showedsignificant reductions in pain and disability following CSE interventions. Protocols ranging from 4 to 8 weeks with 3 sessions/week were most common. A combined approach (e.g.postural correction, pelvic floor exercises, and electrotherapy) showed greater improvementsin all outcomes. Quality of life was not directly assessed in the included studies, making it difficult to evaluate the impact of CSEs on this outcome. Supervised and combined intervention strategies appear to yield better results. Risk of bias was generally moderate; most RCTs were rated as “some concern”, and quasi-experimental studies showed a “serious” risk of bias. Some studies also reported secondary benefits in core strength, pelvic floor function, inter-recti distance and urinary incontinence.

CONCLUSION: CSEs are effective in managing PP-LBP and improving functional statusparticularly when delivered in supervised or combined formats. These findings support the integration of CSE into postpartum rehabilitation. Furthermore, high-quality studies with longer follow-up and direct quality of life assessment are needed to provide more comprehensive evidence for clinical practice.