Effects of Core Stabilization Exercise versus General Trunk-Strengthening Exercise on Balance Performance, Pain Intensity and Trunk Muscle Activity Patterns in Clinical Lumbar Instability Patients: A Single Blind Randomized Trial

Authors

  • Rungthip PUNTUMETAKUL Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
  • Pongsatorn SAIKLANG Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
  • Wantanee YODCHAISARN School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
  • Torkamol HUNSAWONG School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
  • Janyawat RUANGSRI School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand

DOI:

https://doi.org/10.48048/wjst.2021.9054

Keywords:

Clinical lumbar instability, Balance performance, Trunk muscle activity pattern, Core stabilization exercise, Strengthening exercise

Abstract

Postural balance is important for activities of daily living. Patients with chronic low back pain (CLBP) exhibit balance problems, such as difficulty performing daily activities. Specifically, CLBP patients with clinical lumbar instability (CLI) have demonstrated deep trunk muscular dysfunction that induces poor postural control and may result in a high risk of falling. This study aimed to investigate the effect of a 10-week core stabilization exercise (CSE) regimen versus a strengthening trunk exercise (STE) regimen and conduct a 3-month follow-up on balance, pain, and trunk muscle activity patterns in CLI patients. A single-blind randomized controlled trial was used to compare the effects of CSE and STE on balance, pain, and trunk muscle activity patterns in 38 CLBP patients with CLI. The results of the 5-times-sit-to-stand test (FTSST) and pain intensity revealed significant improvements in both groups after ten weeks of exercise and at the 3-month follow-up point. However, the differences in the FTSST scores and pain intensity between the CSE and STE patients were not significant. Moreover, the CSE group presented significantly greater deep abdominal muscle activation than the STE group after ten weeks of exercise. In addition, both groups exhibited a trend of improvement in terms of deep back muscle activation. Therefore, the current study results suggest that both exercise regimens can improve balance performance and pain intensity. Moreover, the CSE group showed more significant improvements in deep abdominal muscle activation than the STE group.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

F Balagué, AF Mannion, F Pellisé and C Cedraschi. Non-specific low back pain. Lancet 2012; 379, 482-91.

M Allegri, S Montella, F Salici, A Valente, M Marchesini, C Compagnone, B Marco, EM Maria and F Guido. Mechanisms of low back pain: A guide for diagnosis and therapy. F1000Research 2016; 5, 1530.

RD Meucci, AG Fassa and NM Faria. Prevalence of chronic low back pain: Systematic review. Rev. Saude. Publica. 2015; 49, 73.

SHV Oostroml, WMM Verschurenl, HCWD Vetl and HSJ Picavetl. Ten year course of low back pain in an adult population-based cohort-The Doetinchem Cohort Study. Eur. J. Pain. 2011; 15, 993-8.

R Puntumetakul, W Siritaratiwat, Y Boonprakob, W Eungpinichpong and M Puntumetakul. Prevalence of musculoskeletal disorders in farmers: Case study in Sila, Muang Khon Kaen, Khon Kaen province. J. Med. Technol. Phys. Ther. 2011; 23, 297-303.

P Taechasubamorn, T Nopkesorn and S Pannarunothai. Prevalence of low back pain among rice farmers in a rural community in Thailand. J. Med. Assoc. Thai. Chotmaihet. Thangphaet. 2011; 94, 616-21.

R Chou. Low back pain (chronic). BMJ Clin. Evid. 2010; 2010, 1116.

C Demoulin, V Distrée, M Tomasella, JM Crielaard and M Vanderthommen. Lumbar functional instability: A critical appraisal of the literature. Ann. Readapt. Med. Phys. 2007; 50, 669-84.

LOP Costa, CG Maher, J Latimer, PW Hodges, RD Herbert, KM Refshauge, JH McAuley and MD Jennings. Motor control exercise for chronic low back pain: A randomized placebo-controlled trial. Phys. Ther. 2009; 89, 1275-86.

MM Panjabi. Clinical spinal instability and low back pain. J. Electromyogr. Kinesiol. Off. J. Int. Soc. Electrophysiol. Kinesiol. 2003; 13, 371-9.

JH Abbott, B McCane, P Herbison, G Moginie, C Chapple and T Hogarty. Lumbar segmental instability: A criterion-related validity study of manual therapy assessment. BMC Musculoskelet. Disord. 2005; 6, 56.

R Puntumetakul, W Yodchaisarn, A Emasithi, P Keawduangdee, U Chatchawan and J Yamauchi. Prevalence and individual risk factors associated with clinical lumbar instability in rice farmers with low back pain. Patient Prefer. Adherence 2015; 9, 1-7.

SP Kumar. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. North Am. J. Med. Sci. 2011; 3, 456-61.

Y Javadian, H Behtash, M Akbari, M Taghipour-Darzi and H Zekavat. The effects of stabilizing exercises on pain and disability of patients with lumbar segmental instability. J. Back Musculoskelet Rehabil. 2012; 25, 149-55.

P Areeudomwong, R Puntumetakul, K Jirarattanaphochai, S Wanpen, J Kanpittaya, U Chatchawan and J Yamauchi. Core stabilization exercise improves pain intensity, functional disability and trunk muscle activity of patients with clinical lumbar instability: A pilot randomized controlled study. J. Phys. Ther. Sci. 2012; 24, 1007-12.

R Puntumetakul, P Areeudomwong, A Emasithi and J Yamauchi. Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability. Patient Prefer. Adherence 2013; 7, 1189-99.

S Davarian, N Maroufi, I Ebrahimi, F Farahmand and M Parnianpour. Trunk muscles strength and endurance in chronic low back pain patients with and without clinical instability. J. Back Musculoskelet 2012; 25, 123-9.

JK Rankin, MH Woollacott, A Shumway-Cook and LA Brown. Cognitive Influence on Postural Stability: A neuromuscular analysis in young and older adults. Comp. Stud. 2000; 55, M112-M119.

Y Ivanenko and VS Gurfinkel. Human postural control. Front. Neurosci. 2018; 12, 171.

C Cook, J-M Brismée and Jr PS Sizer. Subjective and objective descriptors of clinical lumbar spine instability: A Delphi study. Man. Ther. 2006; 11, 11-21.

W Yodchaisarn, R Puntumetakul, A Emasithi, R Boucaut and U Chatchawan. Altered postural sway during quiet standing in women with clinical lumbar instability. J. Phys. Ther. Sci. 2018; 30, 1099-102.

R della Volpe, T Popa, F Ginanneschi, R Spidalieri, R Mazzocchio and A Rossi. Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture 2006; 24, 349-55.

RL Carvalho and GL Almeida. Assessment of postural adjustments in persons with intellectual disability during balance on the seesaw. J. Intellect. Disabil. Res. 2009; 53, 389-95.

SM Henry, JR Hitt, SL Jones and JY Bunn. Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin. Biomech. 2006; 21, 881-92.

S Brumagne, L Janssens, E Janssens and L Goddyn. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture 2008; 28, 657-62.

AB Braga, AC de MA Rodrigues, GVMP de Lima, LR de Melo, AR de Carvalho and GRF Bertolini. Comparison of static postural balance between healthy subjects and those with low back pain. Acta Ortop. Bras. 2012; 20, 210-2.

PW Marshell and BA Murphy. Delayed abdominal muscle onsets and self-report measures of pain and disability in chronic low back pain. J. Electromyogr. Kinesiol. 2010; 20. 833-9.

SP Silfies, R Mehta, SS Smith and AR Karduna. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain. Arch. Phys. Med. Rehabil. 2009; 90, 1159-69.

A Ruhe, R Fejer and B Walker. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: A systematic review of the literature. Eur. Spine. J. 2011; 20. 358-68.

N Karimi, I Ebrahimi, S Kahrizi and G Torkaman. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pak. J. Med. Sci. 2008; 24, 372-7.

M Morris, D Osborne, K Hill, H Kendig, B Lundgren-Lindquist, C Browning and J Reid. Predisposing factors for occasional and multiple falls in older Australians who live at home. Aust. J. Physiother. 2004; 50, 153-9.

SG Leveille, RN Jones, DK Kiely, JM Hausdorff, RH Shmerling, JM Guralnik, DP Kiel, LA Lipsitz and JF Bean. Chronic Musculoskeletal Pain and the Occurrence of falls in an older population. J. Am. Med. Assoc. 2009; 302, 2214-21.

S Muraki, T Akune, H Oka, Y En-yo, M Yoshida, K Nakamura, H Kawaguchi and N Yoshimura. Prevalence of falls and the association with knee osteoarthritis and lumbar spondylosis as well as knee and lower back pain in Japanese men and women. Arthritis Care Res. 2011; 63, 1425-31.

SP Silfies, D Squillante, P Maurer, S Westcott and AR Karduna. Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin. Biomech. 2005; 20. 465-73.

DA MacDonald, G Lorimer Moseley and PW Hodges. The lumbar multifidus: Does the evidence support clinical beliefs? Man. Ther. 2006; 11, 254-63.

S Brumagne, L Janssens, E Janssens and L Goddyn. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture 2008; 28, 657-62.

A Bergmark. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop. Scand. Suppl. 1989; 230, 1-54.

R Izzo, G Guarnieri, G Guglielmi and M Muto. Biomechanics of the spine. Part I: Spinal stability. Eur. J. Radiol. 2013; 82, 118-26.

PB O’Sullivan, A Burnett, AN Floyd, K Gadsdon, J Logiudice, D Miller and H Quirke. Lumbar repositioning deficit in a specific low back pain population. Spine 2003; 28, 1074-9.

JKF Ng, CA Richardson, M Parnianpour and V Kippers. EMG activity of trunk muscles and torque output during isometric axial rotation exertion: A comparison between back pain patients and matched controls. J. Orthop. Res. 2002; 20, 112-21.

A Bjerkefors, MM Ekblom, K Josefsson, A Thorstensson. Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow. Man Ther. 2010; 15, 502-7.

MJ Comeford and SI Mottram. Functional stability re-training: Principles and strategies for managing mechanical dysfunction. Man Ther. 2001; 6, 3-14.

GA Koumantakis, PJ Watson and JA Oldham. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Phys. Ther. 2005; 85, 209-25.

CA Richardson and GA Jull. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995; 1, 2-10.

GA Koumantakis, PJ Watson and JA Oldham. Supplementation of general endurance exercise with stabilisation training versus general exercise only. Physiological and functional outcomes of a randomised controlled trial of patients with recurrent low back pain. Clin. Biomech. Bristol. Avon. 2005; 20, 474-82.

PW Hodges and CA Richardson. Inefficient Muscular Stabilization of the lumbar spine associated with low back pain. Spine. 1996; 21, 2640-50.

SF Andrusaitis, GC Brech, G FallerVitale and JMDA Greve. Trunk stabilization among women with chronic lower back pain: A randomized, controlled, and blinded pilot study. Clinics 2011; 66, 1645-50.

A Kaji, S Sasagawa, T Kubo and H Kanehisa. Transient effect of core stability exercises on postural sway during quiet standing. J. Strength. Cond. Res. Natl. Strength. Cond. Assoc. 2010; 24, 382-8.

A Ruhe, R Fejer and B Walker. Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain? BMC Musculoskelet Disord. 2011; 12, 162.

KC Bliven and BE Anderson. Core stability training for injury prevention. Sports Health 2013; 5, 514-22.

PW Hodges. Core stability exercise in chronic low back pain. Orthop. Clin. North Am. 2003; 34, 245-54.

SL Whitney, DM Wrisley, GF Marchetti, MA Gee, MS Redfern, JM Furman. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand Test. Phys. Ther. 2005; 85, 1034-45.

MJ Simmonds, SL Olson, S Jones, T Hussein, CE Lee, D Novy and H Radwan. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 1998; 23, 2412-21.

A Goldberg, M Chavis, J Watkins and T Wilson. The five-times-sit-to-stand test: Validity, reliability and detectable change in older females. Aging Clin. Exp. Res. 2012; 24, 339-44.

C Benaim, S Blaser, B Léger, P Vuistiner and F Luthi. “Minimal clinically important difference” estimates of 6 commonly-used performance tests in patients with chronic musculoskeletal pain completing a work-related multidisciplinary rehabilitation program. BMC Musculoskelet Disord. 2019; 20, 16.

AF Mannion, F Balagué, F Pellisé and C Cedraschi. Pain measurement in patients with low back pain. Nat. Clin. Pract. Rheumatol. 2007; 3, 610-8.

A Williamson and B Hoggart. Pain: A review of three commonly used pain rating scales. J. Clin. Nurs. 2005; 14, 798-804.

RW Ostelo and HCD Vet. Clinically important outcomes in low back pain. Best Pract. Res. Clin. Rheumatol. 2005; 19, 593-607.

CW Hoppes, AD Sperier, CF Hopkins, BD Griffiths, MF Principe, BL Schnall, JC Bell and SL Koppenhaver. The efficacy of an eight-week core stabilization program on core muscle function and endurance: a randomized trial. Int. J. Sports Phys. Ther. 2016; 11, 507-19.

SJ Atkins, I Bentley, D Brooks, MP Burrows, HT Hurst and JK Sinclair. Electromyographic response of global abdominal stabilizers in response to stable- and unstable-base isometric exercise. J. Strength Cond. Res. 2015; 29, 1609-15.

O Vasseljen and AM Fladmark. Abdominal muscle contraction thickness and function after specific and general exercises: A randomized controlled trial in chronic low back pain patients. Man Ther. 2010; 15, 482-9.

PB O'sullivan, L Twomey and GT Allison. Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J. Orthop. Sports Phys. Ther. 1998; 27, 114-24.

SG Leveille, RN Jones, DK Kiely, JM Hausdorff, RH Shmerling, JM Guralnik, DP Kiel, LA Lipsitz and JF Bean. Chronic musculoskeletal pain and the occurrence of falls in an older population. J. Am. Med. Assoc. 2009; 302, 2214-21.

L Mann, JF Kleinpaul, AR Pereira Moro, CB Mota and FP Carpes. Effect of low back pain on postural stability in younger women: Influence of visual deprivation. J. Bodyw. Mov. Ther. 2010; 14, 361-6.

R Puntumetakul, R Chalermsan, SS Hlaing, W Tapanya, P Saiklang and R Boucaut. The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: A randomized controlled trial. J. Phys. Ther. Sci. 2018; 30, 1390-5.

Downloads

Published

2021-03-23

How to Cite

PUNTUMETAKUL, R. ., SAIKLANG, P. ., YODCHAISARN, W. ., HUNSAWONG, T. ., & RUANGSRI, J. . (2021). Effects of Core Stabilization Exercise versus General Trunk-Strengthening Exercise on Balance Performance, Pain Intensity and Trunk Muscle Activity Patterns in Clinical Lumbar Instability Patients: A Single Blind Randomized Trial. Walailak Journal of Science and Technology (WJST), 18(7), Article 9054 (13 pages). https://doi.org/10.48048/wjst.2021.9054