Core Stability and Low Back Pain - Annotated Bibliography Example

The Core stability and strengthening has become a well-known fitness and treatment of choice that has started to transcend into the sports medicine world. Popular fitness programs, such as Pilates, yoga, and tai chi follows core stability and strengthening principles. In addition, many institutions offers similar program to these already popular trend.  The core is consist of 29 pair of muscles (ie. rectus abdomilas, tansversus abdominis, quadratus lumborum, multifidi) that help to stabilize the spine, pelvis, and kinetic chain during movements.  Without theses muscles, the spine would become mechanically unstable.  When the system works as it should the result is proper force distribution and maximal force generation with minimal force at the joints.  The core is particularly important in sports because it provides stability and mobility.  It has been suggested and studied that core stability and strengthening exercises are important in maintaining the core, especially in the case of spinal instability.  The gross spinal instability result displacement of vertebrae, which is often associated with neurological deficit and deformity. However, functional or clinical instability is not as easily defined.  Panjabi described clinical instability as, "instability in which the loss of the spines ability to maintain its patterns of displacement under physiologic loads so there is no initial or additional neurologic deficit, no major deformity, and no incapacitating pain." Furthermore, the stability of the spine is not only dependent on muscular strength, but also proper sensory input.  Thus a complete core stabilizing program would consider sensory and motor component s relates to these systems for optimal spinal stabilization. I wanted to look at core stability and strengthening exercises could not only help the clinical instability but also has any preventative effect. Annotated Bibliography Bjerkefors, A., M.M. Ekblom, K. Josefsson, and A. Thorstensson. 201. Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow. Manual Therapy 15, 502-507. The aim of the authors is to evaluate the levels of activation of the TrA and the superficial Rectus Abdominis or RA muscles during five common stabilization exercises performed in supine, bridging and four-point kneeling positions with and without instructions to hollow and as they continuously pull the lower part of the abdomen towards the spine. The authors are experts in the school of sport and health sciences as well as neuroscience, all from Stockholm Karolinska Institutet. The study method was undertaken on nine habitually active women wherein muscle activity was recorded bilaterally from TrA and RA with intramuscular fine-wire electrodes introduced under the guidance of ultrasound. The study is unique for finding out that the participants were able to selectively increase the activation of the TrA, separated from the RA, when instructed to specifically hollow. It found out that side differences in the amplitude of TrA activity, related to the asymmetry of the exercises remained the same even after the instruction to hollow. The exercises performed increase the levels of TrA activation from 4 to 43% during maximal effort and it was suggested to be useful in clinically grading the load of the TrA when designing programs aimed at training that muscle. Stabilization exercises increase the level of TrA activation and could aid training designers in muscle improvement. Level 1. Borghuis, A.J., K. Lemmink, and A.T. Hof. 2011. Core Muscle Response Times and Postural Reactions in Soccer Players and Nonplayers. Medicine Science in Sports & Exercise 43(1), 108-114. The purpose of the authors is to investigate whether soccer players will exhibit shorter average core muscle reflex latencies along with less postural sway in response to a sudden trunk perturbation compared with non-players. Another purpose was to find out whether postural control measures are a valid and more practical alternative for the use of surface EMG in measuring reflexive core neuromuscular control. It is intended for sport medicine, sport education professionals and coaches. The authors are experts in human movement sciences and sports studies, and from the University Medical Center and Hanze University of Applied Sciences in Groningen in the Netherlands. The methodology was undertaken on 10 high-level amateur soccer players and 11 less active nonplayers. It employed sudden trunk loading in the frontal and sagittal plane to find out core muscle reflex latencies using surface EMG of six major trunk muscles. Kinematic response data of a balance seat were taken using gyroscopes measuring seat angular velocity. The study is unique for its findings that soccer players have shorter reflex latencies when compared with nonplayers for the rectus abdominis, erector spinae, and externue obliquus muscles in response to sagittal plane perturbations. It is also simultaneous with greater seat movement in response to sudden trunk loading, with moderate correlations between the two measures. This meant that there is shorter reflex latencies and greater balancing movements for soccer players and suggests that more postural sway maybe an indicator of having less neuromuscular control. To increase reflex latencies for various muscles, increased physical activity may aid. Level 1. Desai, I. and Marshall, P. 2010. Acute effect of labile surfaces during core stability exercises in people with and without low back pain. Journal of Electromyography and Kinesiology 20, 1155-1162. The purpose of the study was to measure trunk muscle activity, whole body balance, and lumbar range or motion during core stability exercises in individuals with and without low back pain on and off a labile surface. The study’s intended audience is for sports medicine professionals, rehabilitation professionals, physical doctors and health professionals. Desai is a fellow in the Department of Sport and Exercise Science at the University of Auckland in New Zealand, while Marshall is a professor in the School of Biomedical and Health Science, University of Western Sydney, NSW, Australia. The authors’ expertise is on sport medicine and exercise providing additional knowledge on core stability in the field of medicine. The method used was the measurement of bilateral trunk muscle activity using surface electromyography or EMG, measurement of whole body balance through quantification of the dispersion of the center of pressure or CoP, and measurement of the lumbar range of motion (LROM) with single-axis inclinometers. It was conducted on ten individuals with chronic but non-specific lower back pain or LBP and 10 matched control subjects. The study is unique for it found that individuals with LBP had adaptive recruitment patterns during the side-bridge and modified push-up exercises. In addition, CoP dispersion and LROM were the same between groups for any exercise. The labile surface have no effect on the groups but increased muscle activity during the side-bridge, increased LROM, increased CoP dispersion during quadruped and CoP dispersion during push-ups, but decreased LROM during squats. The study concluded that individuals with LBP had adaptive trunk muscle activity while maintaining similar levels of balance and lumbar movement to healthy controls. It failed to determine the practicality and safety of labile surfaces for LBP exercise rehabilitation. While the LBP finding on adaptive trunk muscle may be useful, additional research should be undertaken to find out the exercises’ safety among LBP patients. Level 4. Gladwell, V., S. Head, M. Haggar, and R. Beneke. 2006. Does a Progra, of Pilates Improve Chronic Non-Specific Low Back Pain? Journal of Sports Rehabilitation 15, 338-350. The purpose of the authors is to find out the effect of a program of modified Pilates for active individuals with chronic non-specific low back pain. The authors are working with sport and exercise science department, health and human sciences, and department of psychology in various universities in the United Kingdom. The intended audiences are those involved in sport rehabilitation and sport medicine. The methodology used in the study involved 34 individuals with chronic low back pain who were randomly allocated to control and Pilates groups. There were 14 individuals in the control group and 20 in the Pilates group. The Pilates group was given a program of Pilates for six weeks as they and the control group continued with normal daily activity. The outcome was measured through an assessor blinded to group allocation who conducted a functional and questionnaire-based assessment prior to and after the intervention. The study was unique for finding out that there were improvements seen in the Pilates group after the intervention. There was an increase in general health, sports functioning, flexibility, and proprioception, and a decrease in experience of pain. The control group on the other hand showed no significant changes or differences in the measures undertaken prior to and after the intervention. It concluded that Pilates used as a specific core stability exercise incorporated with functional movements can improve non-specific low back pain in an active population as well as improve general health, pain level, sports functioning, flexibility, and proprioception in individuals with chronic low back pain. Pilates is then recommended for development of core stability. Level 3. Harringe, M.L., J.S. Nordgren, I. Arvidson, S. Werner. 2007. Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study. Surgical Sports Traumatology Arthrosc 15, 1264-1271. The purpose of the authors is to evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in 51 young female teamgym gymnasts. The gymnasts perform three events of trampette, tumbling and floor programme and compete even when suffering from back pain. The gymnasts were chosen with or without LBP, 11-16 years old, and belong to three top-level gymnastics team. The study ran for 12 weeks. The gymnasts answered a questionnaire daily regarding LBP. They performed a specific segmental muscle training program after 4 weeks. The study is intended for sport rehabilitation and sport medicine professionals. The authors are experts in molecular medicine and surgery, sport and health sciences, and neurobiology, and care sciences. Their input to the body of knowledge will be invaluable with regards to LBP rehabilitation for young female gymnasts. The study was unique that it gymnasts in the intervention group reported less number of days with lower back pain at completion as compared to baseline when 47% reported presence of LBP. Eight out of 15 gymnasts with LPP also reported the disappearance of pain. The authors concluded that specific segmental muscle control exercises of the lumbar spine may be helpful in the prevention and reduction of LBP among young teamgym gymnasts. Further refinement of the exercises program should be developed to aid gymnasts, and even other athletes. Level 4. Pinto, R.Z., P.H. Ferreira, M.R. Franco, M.L. Ferreira, M.C. Ferreira, L.F. Teixeira-Salmela, and C.G. Maher. Journal of Manipulative and Physiological Therapeutics 34(3), 164. The purpose of the authors is to investigate the effect of 2 different lumbar spine postures, neutral and flexed lumbar postures, on transversus abdominis or TrA muscle function during a voluntary contraction or hollowing and draw-in maneuver in people with and without low back pain. The intended audience is sport rehabilitation and sport medicine professionals. The methodology used was the study on 30 participants with LBP and 30 healthy participants measuring the TrA muscle function after a change in thickness with ultrasound imaging. The participants performed voluntary TrA contraction in supine lying position with the lumbar spine in neutral and flexed postures. The collected data were analyzed with a 2-way analysis of variance for groups and postures. The study is unique for its finding that lumbar posture influenced TrA function during a voluntary contraction in people with and without LBP. It found significant main effect of posture while neutral posture improved participants’ ability to recruit TrA in both group although there was no differences found between healthy subjects and those with LBP. It concluded that subjects performing voluntary TrA contractions had improved ability of the neutral lumbar posture to increase change in TrA thickness. The study, however, failed to establish any significant difference on TrA thickness change between healthy subjects and those with non-specific LBP. TrA contraction must be further explored for rehabilitative purposes for athletes and sport men. Level 4. Oliver, G.D., P.M. Dwelley, N.D. Sarantis, R.A. Helmer and J.A. Bonacci. 2010. Muscle Activation of Different Core Exercises. Journal of Strength and Conditioning Research 24(11), 3069. The purpose of the authors was to examine the muscle activation of the lumbopelvic hip complex during traditional core stability exercises and sports performance movements using the CORE X among 14 healthy college-age men. It collected electromyographic data on dominat gluteus maximus, dominant gluteus medius, rectus abdomonis, external oblique, and multifidis. The intended audiences are sport health care professionals, coaches, trainers, and athletic trainers. The authors are experts in health, kinesiology, recreation and dance from the University of Arkansas. Their findings on core exercises add up to the knowledge on health and sport medicine and care. The study found that a significant difference between 2 different exercise programs for all muscles under study except the external obliques. It also found that there is increased mean muscle activation for the dominant and nondominant multifidus, the dominant gluteus maximus, and medius for movements using CORE X. The traditional core exercises showed greater mean muscle activation for the dominant and nondominant rectus abdominis and external oblique. The authors concluded that there is greater activation of the core musculature when performing movements that mimic sports-related activities with the CORE X. Further study should be undertaken without use of CORE X for sport-related activities’ effect on core musculature. Level 1. Oliver, G.D., A.J. Stone, and H. Plummer. 2010. Electromyographic Examination of Selected Muscle Activation during Isometric Core Exercises. Clinical Journal Sport Medicine 20, 452-457. The purpose of the authors was to quantitatively examine the muscle activations of 3 common isometric core exercises that include abdominal bridge, single-leg abdominal bridge, and superman, together with the newly introduced isometric exercise flying squirrel. It determined if muscle activations differed among the exercises. The study’s intended audience includes physical and sports educators and sport medicine professionals. The authors are fellows at health science department from universities in Arkansas. The methodology used a comparison muscle activation results between thirty healthy college graduate students regardless of sex. It determined the voluntary isometric contraction during each exercise in an athletic training classroom laboratory. The study is unique for finding that multifidi produced the greatest muscle activity in all exercises although the single-leg abdominal bridge exercise produced greater muscle activation than the general abdominal bridge exercise. The study concluded that any of the exercises undertaken may be used as a core stability program. It may be incorporated to supplement current isometric core exercise programs. This study provides an immediate consideration for inclusion on isometric core exercise programs for athletes and non-athletes. Level 4. Richardson, C.A., C.J. Snijders, J.A. Hides, L. Damen, M.S. Pas, and J. Storm. 2002. The Relation Between the Transversus Abdominis Muscles, Sacroiliac Join Mechanics and Low Back Pain. SPINE 27 (4), 399-405. The purpose of the authors was to demonstrate the biomechanical effect of the exercise for the transversus abdominis known to be effective in low back pain. The intended audience for the study are sport medicine, sport rehabilitation, and sport education professionals. The authors are experts in physiotherapy, from the University of Queensland, Australia. Their findings will add to the knowledge and practice for treatment of low back pain. The study was undertaken among 13 healthy individuals who were able to perform test patterns. It recorded the joint laxity values of the participants in the prone position during the two abdominal muscle patterns using the Doppler imaging of vibrations. In addition, simultaneous eletromyographic recordings and ultrasound imaging were used to verify two muscle patterns. The unique finding was that range of sacroiliac joint laxity values decreased significantly in all individuals during both muscle patterns. The independent transversus abdominis contraction lessened the sacroiliac joint laxity or increased sacroiliac joint stiffness to a greater degree tha the general abdominal exercise pattern. The study concluded that contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. It is therefore recommended that contraction of the transversus abdominis be encouraged among LBP patients. Level 1. Steinmetz, A., W. Seidel, and B. Muche. 2010. Impairment Stabilization Systems in Musicians with Playing-related Musculoskeletal Disorders. Journal of Manipulative and Physiological Therapeutics, October. The purpose of the authors is to examine the frequency of PSS disturbance in musicians experiencing playing-related musculoskeletal disorders or PRMDs. The intended audience includes sport medicine and sport rehabilitation practitioners and physicians. The authors are accredited specialists in physical and rehabilitation medicine, consultants of musculoskeletal medicine, and the third is a specialist in internal medicine. Their inputs will add to the knowledge on PRMDs. The method used is analysis of presence of impaired PSS lumbopelvic and scapular stabilizing system dysfunction, and upper cross syndrome among 84 musicians. The study is unique for finding out that dysfunctions of the PSS to be present in 78 musicians, or 93% of participants, 85% had impairments of the scapular, 71% had impairments of lumbopelvic stabilization system, and 57% were found to have upper crossed syndrome. Interestingly, the subgroup of upper strings, lower strings, wind and keyboard instrument palyers were found to have significantly more impairment of the lumbopelvic stabilization system foe upper and lower strings. There were similar rates for disturbances of scapular stabilizers and upper crossed syndrome seen across subgroups. Women had higher frequency of scapular stabilizers and upper crossed syndrome. It concluded that insufficient postural stabilization systems play an important role in the manifestation of musculoskeletal pain and PRMD in musicians. The findings however, lacked PSS data in musicians. Postural stabilization systems should be designed to aid musicians. Level 4. Findings: The various studies indicate a correlation between significant exercise program designs to address core stability and strengthening of muscles not only for athletes but also for regular individuals. This will help non-athletes engage in exercise programs that help sustain their lower back strength and stability. Read More