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Effect of Core Stabilization Training On Endurance of Trunk Extensor and Functional Capacity in Subjects With Mechanical Low Back Pain
Effect of Core Stabilization Training On Endurance of Trunk Extensor and Functional Capacity in Subjects With Mechanical Low Back Pain
ABSTRACT
STUDY OBJECTIVES: To determine the effect of Core stabilization training on trunk extensor endurance
and functional capacity in subjects with mechanical low back pain. DESIGN: Experimental study.
SETTING: All the Subjects were taken from Dolphin (PG) Institute Of Biomedical and Natural Science,
Dehradun and the community in and community in and around Dehradun. SUBJECTS: A total of 30 subjects
(M: 14, F: 16) were recruited for the study on the basis of inclusion and exclusion criteria after signing the
informed consent form. METHODS: A total of 30 subjects (M: 14, F: 16) were recruited for the study on the
basis of inclusion and exclusion criteria after signing the informed consent form. The subjects were then
divided into two groups, (Group A= Core Stabilization and Endurance Training & Group B= Endurance
Training). All the subjects were asked to perform 5 min warm-up exercise before the intervention. The total
duration of the protocol was 6 weeks and frequency of exercise performed is 3 times per weeks. OUTCOME
MEASURE: Trunk Extensor Endurance Test was measured using Prone Double Straight-Leg Raise Test, &
Functional Capacity was assessed using Modified Oswestry Disability Index. RESULTS: The result of the
study demonstrates that both the Groups showed significant improvement when comparison is made within
the groups with p=0.001 for both trunk extensor endurance test and functional capacity. However, Group A
shows significant improvement between the groups post intervention p=0.023 & p=.000 respectively.
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CONCLUSION: From the present study it can be concluded that core stabilization training is effective in
increasing trunk extensor endurance and functional capacity in subjects with mechanical low back pain.
KEY WORDS: Core stabilization training, Endurance training, Trunk extensor endurance, Mechanical low
back pain, Trunk Extensor Endurance
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Scientific Research Journal of India ● Volume: 2, Issue: 3, Year: 2013
magnitude of the force generated in each muscle is pain intensity, alleviate functional disability and
measured by the force transducers (signal improve core stability and back extension strength,
producing devices) located in the tendons of the mobility and endurance.17
muscles.15 According to Chok et al. (1999), poor
Therefore, this aspect of the tendons may endurance of the trunk muscles may induce strain
be part of the neural control subsystem. Within the on the passive structures of the lumbar spine,
neutral zone of motion, (that part of the range of eventually leading to low back pain. Evidence
physiological intervertebral motion, measured suggests that muscle endurance is lower for people
from the normal position, within which the spinal with low back pain than for individuals without
motion is produced with a minimal internal low back pain. Due to endurance being less in
resistance - it is the region of high flexibility trunk muscles, fatigue can affect the ability of
around the mid-zone of motion) the restraints and people with low back pain to respond to the
control for bending, rotating and shear force are demands of an unexpected load. Fatigue, after
largely provided by the muscles that surround and repetitive loading, also leads to loss of control and
act on the spinal segment. The neural subsystem precision, which may predispose an individual to
receives information from the various transducers, developing low back pain. Therefore, trunk muscle
determines specific requirements for spinal endurance training has been recommended to
stability and causes the active subsystem to elevate fatigue threshold and improve
achieve the stability goal.16 performance, thus, reducing disability of the
Well-developed core stability allows for lumbar spine.4
improved force output, increased neuromuscular Endurance training of back extensor
efficiency and a decrease in the incidence of muscles, including the multifidus, has long been
overuse injuries.9 The normal function of the recognized as a crucial preventative of recurrent
stabilization system is to provide sufficient low back pain. The function and coordination of
stability to the spine to match instantaneous the muscles that stabilize the lumbar spine,
varying stability demands made by changes in especially the lumbar extensor muscles, are often
spinal posture, static and dynamic load.15 Hicks et impaired in patients with low back pain.13
al, suggest that core stability system has a role in The role of trunk stabilizers is to retain the
ensuring spinal stability and according to van musculature; to control, coordinate and optimize
Dillin et al. (2001), a decrease in spinal stability function. Trunk fatigue, which occurs during
places stress and excessive load on the spinal intense training or matches, produces a loss in
joints and tissues, which eventually results in low synchrony between upper and lower extremities,
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back pain. which may cause a reduction in muscle strength.
Control of back pain and prevention of its This may in turn prevent a proper transfer of force
occurrence can be assisted by enhancing muscle resulting in inappropriate compensation by the
control of the spinal segment through core stability body while performing a particular function.5
exercises. Therefore, exercise programs, which are Dynamic trunk stability training includes
based on active rehabilitation, can reduce low back building muscle strength, endurance and using
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METHODOLOGY
An experimental study was conducted on 30
subjects (14 male and 16 female) who were
recruited from Dolphin (PG) Institute of
Biomedical and Natural Science and the 3. Abdominal crunch
community in and around Dehradun based on the o Sets-2
inclusion and exclusion criteria and they were o Repetition-8
divided into two groups after informed consent o Rest-1minute
was obtained. Group A (Core Stabilization and
Endurance Training) & Group B (Endurance
Training). Pre intervention measurement of Trunk
Extensor Endurance Test was measured using
Prone Double Straight2-Leg Raise Test, &
Functional Capacity was assessed using Modified
Oswestry Disability Index8. For both the groups 5 4. Supine Russian twist
min of warm exercise was given before the o Sets-2
intervention. The total duration of protocol was 6 o Repetition-8
weeks and frequency of exercise was 3 times per o Rest-1minute
week.
Protocol for Group A: All subjects in this
group received Core stabilization training and
Endurance training on a Swiss ball.
1. Lunge
○ Sets-2 Protocol for Group B: All subjects in this group
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Scientific Research Journal of India ● Volume: 2, Issue: 3, Year: 2013
2. Contra-lateral arm and leg lifts t-test was used for data analysis within the group
o Sets-2 A and group B for Extensor muscle endurance test
o Repeatation-8 and Modified Oswestry Low Back Pain Disability
o Rest-1 minute Index. Independent t-test was used for data
o Holding-20sec analysis between the group A and group B for
Modified Oswestry Low Back Pain Disability
Index. The p value was set at (<0.05).
RESULTS
Data was analysed for 30 participants: 15
in each Group A & Group B.
3. Bilateral shoulder lifts with hands
behind the head Table1.1: Comparison of mean value for age
o Sets-2 between group A and B
o Repeatation-8
o Rest-1 minute
o Holding-20sec
4. Bilateral shoulder lifts with arms in Table 1.2: Comparison of Pre and Post EET score
full elevation for group A and group B
o Sets-2
o Repeatation-8
o Rest-1 minute
o Holding-20sec
DATA ANALYSIS
Data was analysed using statistical package of
social sciences SPSS software (version 14.0). Pair
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Table 1.4: Comparison of Pre and Post EET score given Core stabilization training and Endurance
between group A and group B training on a Swiss ball and Group B was given
Endurance training on a Swiss ball. Both groups
received training three times a week for six weeks.
The changes observed in this study were
noteworthy. Within group comparison showed
significant changes with improvement in isometric
Table 1.5: Comparison of Pre and Post MODI hold time and functional capacity in both groups A
score between group A and group B and B. In between groups, statistically significance
difference was found in isometric hold time and
functional capacity.
According to Moffroid, Progression of
loading through postural changes produces
increases in endurance time of the back extensors,
as measured by the Sorensen Test. These postural
progressions increase the load moment on the
Results of the study showed that there is spine and thereby stress the erector spinae
improvement in trunk extensor endurance and muscles, multifidus and others.14
functional capacity after the intervention in both In addition adoptive changes occur in
the groups. This improvement in pressure skeletal muscle during endurance training ie,
threshold was found to be statistically significant. slower rate of glycogenolysis, slower rate of
Group A (Trunk Extensor Endurance & Core lactate production during submaximal exercise
Stabilization) showed more improvement when occurs due to raise in the lactate threshold both in
compared to Group A and this was found to be absolute and relatives terms ie, o2 uptake(VO2)at
statistically significant with p=0.023 & p=.000 LT and vo2 max at LT, increased mitochondrial
respectively. enzyme activity and increase capillary density.7
Therefore, it is reasonable to expect
DISCUSSION increased endurance of trunk extensor muscle in
The present study investigated the effect group B subjects who only underwent endurance
of core stabilization training on endurance of trunk training.
extensor and functional capacity in subjects with Core stabilization training has a theoretical
mechanical low back pain. Endurance of Trunk basis in treatment and prevention of various
extensor and functional capacity was measured 2 musculoskeletal conditions.
times: pre-intervention and post-intervention Core stabilization training is hypothesized
through prone double straight leg raise test and to increase muscle activation by increasing motor
Modified Oswestry Low Back Pain Disability unit recruitment, rate and synchronization of
Index respectively. Subjects were divided into two firing11
groups as Group A and Group B. Group A was
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Scientific Research Journal of India ● Volume: 2, Issue: 3, Year: 2013
Richardson found that individual with low stabilize their form better during performance of
back pain exhibits delayed activation of the prone double leg raise test, thereby resulting in
transversus abdominis muscle when compared longer hold times than subjects who only
with normal individual. Low back pain patient underwent endurance training.18
have an impaired ability to consciously contract So over all core stabilization training
transversus abdominis and this is an important increases muscle activation (transversus
component of abdominal stability training.17 abdominus, lumbar multifidus), alters
Performance of exercises on unstable neuromuscular control and also increases spinal
surfaces like Swiss ball has been shown to increase stability, leading to decreased pain which may
the activity of the rectus abdominis. It also causes have led to the increased isometric hold time and
changes in muscle activity and force output and functional capacity in group A subjects as
may be another way of potentially altering compared to subjects in group B.
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neuromuscular recruitment pattern Limitation of the study are sample size
Spinal instability occurs generally as a was limited and no blinding was done during the
result of delayed recruitment of core muscle/local study. So the further recommendation for future
muscle like transversus abdominus, multifidus and studies need to be done with broader dimensions,
core stabilization training address these core EMG could be used to quantify the activation of
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muscle, thereby increase spinal stability. core muscle and it can also be used to track global
Study by Kimitake Satoand Monique muscle activation during core stability testing.
Mokha has shown that core stabilization training Bio-mechanical marker can be measured.
let to an increase in 5000meter run time
performance. The proposed mechanism was that CONCLUSION
subjects who underwent core stabilization were
From the present study it can be concluded that
conscious of using their core muscle to stabilize
core stabilization training is effective in increasing
their running form. A similar mechanism may
trunk extensor endurance and functional capacity
exist in our study where by subjects who
in subjects with mechanical low back pain.
underwent core stabilization training were able to
REFERENCES
1. Akuthota V. and Nadler, S.F. Core Strengthening. Physical Medicine and Rehabilitation. 2004; 85(1):
86-92.
2. Arab A M, SalawatiMahyar, Mohhammad E. Sensitivity, specificity and predictive value of the
clinical trunk muscle endurance tests in low back pain. Clinical Rehabilitation. 2007;21:640-647
3. Atlas, S.J. and Deyo, R.A. Evaluating and Managing Acute Low Back Pain in the Primary Care
Setting. Journal of General Internal Medicine. 2001; 16(2): 120-131.
4. Chok, B., Raymond. L., Latimer, J. and SeangBeng, T. Endurance Training of the Trunk Extensor
Muscles in People With Sub Acute Low Back Pain. Physical Therapy. 1999; 79(11):1032-1042.
7
ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji
5. Cholewicki, J. and McGills, S.M. Lumbar Posterior Ligament Involvement During Extremely Heavy
Lifts Estimated from Fluroscopeic Measurement. Journal of Biomechanics. 1992; 25:17-28. 8)
6. Dankaerts, W., O’Sullivian, P.B., Straker, L.M, Burnett, A.F. and Skouen, J.S. The Inter- Examiner
Reliability of a Classification Method for non- Specific Chronic Low Back Patients with Motor
Control Impairment. Manual Therapy.2005; 2:1-12.
7. Edward F, Coyle H, Martin, Susan A, Bloomfield, Oliver H, Lowry, John O, Holloszy. Effects of
detraining on response to submaximal exercises. J.Appl. Physiol.1985 59(3): 853-859
8. Fritz JM, Irrgang JJ. A Comparison of a Modified Oswestry Disability Questionnaire and the Quebec
Back Pain Disability Scale. Phys Ther 2001; 81:776-788.
9. Hedrick, A. Training the Trunk for Improved Athletic Performance. Strength and Conditioning
Journal. 2000; 22(3), 50-61.
10. Hubley-Kozey, C.L. and Vezina, M.J. Muscle Activation During Exercise to Improve Trunk Stability
in Men With Low Back Pain. Journal of Physical Medicine and Rehabilitation. 2002; 83(8): 1100-
1108
11. Kisner C, Colby LA. Therapeutic Exercise Foundations and Techniques. 5th ed.Philadelphia: F.A
Davis Company; 2007.
12. Krismer, M. and van Tulder, M. Low Back Pain (non-specific). Journal of Biomechanics. 2007;
21(1): 79-91.
13. Liebenson, C. Spinal Stabilization Training: The Therapeutic Alternative to Weight Training. The
Journal of Body Work and Movement Therapies. 1997; 1 (2): 87-90
14. Moffroid MT, Haugh LD, Haig AJ, et al. Endurance training of trunk extensor muscles. Phys Ther.
1993; 73:10 –17.
15. Panjabi, M.M. The stabilizing system of the spine, Part 1: Neutral zone and instability hypothesis.
Journal of Spinal Disorder. 1992; 5(4) 383 – 389.
16. Panjabi, M.M. The stabilizing system of the spine, Part 2: Neutral zone and instability hypothesis.
Journal of Spinal Disorders. 1992; 5(4): 390 – 397.
17. Richardson C.A. and Jull G.A. Muscle control-pain control. What exercise would you
prescribe?.Manual Therapy. 1995; 1: 2-10.
18. Sato K, Mokha M Does core strength training influence Running kinetics, lower-extremity stability,
And 5000-m performance in runners? Journal of Strength and Conditioning Research. 2009;
23(1):133-140
19. VanDillin, L.R., Sahrmann, S.A., Norton, B.J., Coldwall, C.A., Flemming, D., McDonell, M.K. and
Bloom, N.J. Effect of Active Limb Movements on Symptoms in Patients with Low Back Pain. Journal
of Orthopaedic and Sports Physical Therapy. 2001; 31 (8): 402-4144.
20. http://www.exercise-ball-exercises.com/list-free-exercise-ball-exercises.htm
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