Spinal Stabilization Exercises Research Articles

Comprehensive rehabilitation is superior to surgical intervention for many patients with recurrent lumbar disc herniation

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation (LDH). Methods A total of 124 LDH patients were recruited and randomly divided into an experimental group and a control group, each of 62. The experimental group was given comprehensive rehabilitation consisting of medicine, physical therapy, and spinal stabilization exercises, while the control group received lumbar spine surgery. The patients′ back and leg pain scores and their Oswestry Disability Index (ODI) scores were compared at admission and discharge, as well as 3 and 12 months after discharge. Anxiety and depression were also assessed at admission and 3 months after discharge. Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admission for both groups. There were no significant inter-group differences. In terms of anxiety and depression, however, these had decreased significantly in both groups, but the experimental group′s average rating was significantly better at discharge. Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH. Comprehensive rehabilitation should be considered as the first choice for patients with recurrent LDH, and only supplemented by surgical intervention if it is not effective. Key words: Lumbar discs; Herniation; Rehabilitation; Surgery

Effect of three-dimensional spine stabilization exercise on trunk muscle strength and gait ability in chronic stroke patients: A randomized controlled trial.

Three-dimensional spine stabilization exercise can strengthen the trunk muscles with minimal spine movement. To investigate the effects of the newly developed Spine Balance three-dimensional (3D) system on trunk strength and gait abilities of chronic stroke patients. Twenty-four chronic stroke patients were randomly assigned to an experimental (n = 12) or control group (n = 12). The experimental and control groups performed spine stabilization exercise by using the newly developed Spine Balance 3D system and the well-known Bridge exercise thrice a week for 30 min per day for 7 weeks. Timed up and go (TUG) test, 10-m walking test (10-m WT), trunk muscle strength, and gait ability were evaluated before and after 7 weeks of intervention. The 10-m WT, TUG, walking speed, non-affected side step length, and distance in the experimental group, wherein trunk muscle strength was checked by using the Spine Balance 3D system evaluation program, showed more significant improvement than those in the control group (p < 0.05). We suggest that the newly developed Spine Balance 3D system can be a more useful therapeutic tool for rehabilitation of trunk muscle strength and gait abilities than bridge exercise-based spine stabilization exercise in chronic stroke patients.

Trunk muscle activation levels during eight stabilization exercises used in the functional kinetics concept: A controlled laboratory study.

To ensure accurate implementation of stabilization exercises in rehabilitation, physical therapists need to understand the muscle activation patterns of prescribed exercise. Compare muscle activity during eight trunk and lumbar spine stabilization exercises of the Functional Kinetics concept by Klein-Vogelbach. A controlled laboratory study with a single-group repeated-measures design was utilized to analyze surface electromyographic intensities of 14 female and 6 male young healthy participants performing eight exercises. Data were captured from the rectus abdominis, external/internal oblique and lumbar paraspinalis. The normalized muscle activation levels (maximum voluntary isometric contraction, MVIC) for three repetitions during each exercise and muscle were analyzed. Side bridging (28 ± 20%MVIC) and advanced planking (29 ± 20%MVIC) reached the highest activity in the rectus abdominis. For external and internal oblique muscles, side bridging also showed the greatest activity of 99 ± 36%MVIC and 52 ± 25%MVIC, respectively. Apart from side bridging (52 ± 14%MVIC), the supine roll-out (31 ± 12%MVIC) and prone roll-out (31 ± 9%MVIC) showed the greatest activity for the paraspinalis. The advanced quadruped, seated back extension and flexion on chair/Swiss Ball, prone roll-out and advanced one-leg back bridging only yielded negligible muscle activities for the rectus abdominis (< 5%MVIC). Based on the data obtained, recommendations for selective trunk muscle activation during eight stabilization exercises were established, which will guide physical therapists in the development of exercises tailored to the needs of their patients.

Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis: Erratum

Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis: Erratum

Effects of spinal stabilization exercises in women with benign joint hypermobility syndrome: a randomized controlled trial.

The aim of this study was to investigate the effects of an 8-week lumbar spinal stabilization exercise program on pain, trunk muscle endurance, and postural stability in women with benign joint hypermobility syndrome (BJHS). Women with BJHS were randomly allocated into exercise (n = 20) and control (n = 18) groups. The lumbar spinal stabilization exercise program was carried out 3days a week for 8weeks. BJHS with Brighton criteria, musculoskeletal pain intensity with Visual Analog Scale, trunk muscle endurance with McGill's trunk muscle endurance tests, and postural stability as static and dynamic while eyes open and closed with Biodex Balance System SD were evaluated. Chi-square test, independent sample t test, Mann-Whitney U test, and Wilcoxon test were used for statistical analysis. It was shown that most of the patients with BJHS had low back (exercise group 40.0%; control group 22.2%) and knee pain (exercise group 15.0%; control group 22.2%). After the program, pain intensity, and static and dynamic stability scores (eyes closed) decreased, and trunk muscle endurance scores increased in the exercise group. There was no difference for all parameters in the control group. Pain intensity, trunk muscle endurance, and only dynamic stability (eyes open) improved in the exercise group in comparison to the control group. The lumbar spinal stabilization exercise program improved pain complaints, postural stability, and trunk muscle endurance of women with BJHS. The program can be used for general pain relief, trunk muscle weakness, and postural impairment in women with BJHS.

Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis.

To evaluate the effectiveness of 8 weeks of weekly spinal stabilization exercises compared with 1-time treatment in participants with adolescent idiopathic scoliosis and low back pain at a 6-month follow-up. Thirty-two participants were evaluated at a 6-month follow-up. The supervised group received weekly spinal stabilization exercises. The unsupervised group received a 1-time treatment and home exercise program. Both groups improved in all outcome measures. The supervised group had significantly reduced Numeric Pain Rating Scale and Improved Global Rating of Change scores, but had no differences in the revised Oswestry Back Pain Disability Questionnaire, or Patient-Specific Functional Scale scores in comparison with the unsupervised group.

Commentary on "Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis".

Commentary on "Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis".

An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study

To investigate the effects of an 8-week thoracic stabilization exercise program on back pain, spinal alignment, postural sway, and core endurance in university students. University students were randomly allocated into exercise (n: 28) and control (n: 25) groups. The exercise program was carried out 3 days a week for 8 weeks. Postural pain, spinal alignment, postural sway, and core endurance were assessed via visual analogue scale, Spinal Mouse, Biodex Balance System, and McGill's trunk muscle endurance tests at the baseline and after 8 weeks of training. Differences were observed for postural pain, thoracic and lumbar curvature, dynamic stability index (eyes closed), and core endurance scores in the exercise group between baseline and week 8 (P < 0.05) and all the parameters were significantly different when compared to those of the control group (P < 0.05). The program decreased postural pain, spinal curvatures, and postural sway, and increased core endurance in university students. The program can be effective in postural pain and misalignment of spine problems related to core weakness and balance disorders.

Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain.

[Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilization exercise group as the control group. [Results] There were significant differences in the activities of the rectus abdominis, transverse abdominis, external oblique abdominal, and erector spinae muscles as well as in the Oswestry Disability Index within the experimental group. There were meaningful differences in the activities of the rectus abdominis, external oblique abdominal, and erector spinae muscles and in the Oswestry Disability Index within the control group. In addition, there was a meaningful intergroup difference in transverse abdominis muscle activity alone and in the Oswestry Disability Index. [Conclusion] The breathing exercise effectively increased muscle activity by training gross and fine motor muscles in the trunk. Moreover, it was verified as a very important element for strengthening body stability because it both released and prevented low back pain.

Core muscle Strengthening Effect During Spine Stabilization Exercise

Core spinal muscles are related to trunk stability and assume the main role of stabilizing the spine during daily activities; strengthening of core muscles around the spine can therefore reduce the chance of back pain. The objective of the study was to investigate the effect of core muscle strengthening in the spine during spine stabilization exercise using a whole body tilt device. To achieve this, a validated musculoskeletal (MS) model of the whole body was used to replicate the input motion from the whole body tilting exercise. An inverse dynamics analysis was executed to estimate spine loads and muscle forces depending on the tilting angles of the exercise device. The activation of long and superficial back muscles such as the erector spinae (iliocostalis and longissimus) were mainly affected by the forward direction (-40°) of the tilt, while the front muscles (psoas major, quadratus lumborum, and external and internal obliques) were mainly affected by the backward tilting direction (40°). Deep muscles such as the multifidi and short muscles were activated in most directions of the rotation and tilt. The backward directions of the tilt using this device could be carefully applied for the elderly and for rehabilitation patients who are expected to have less muscle strength. In this study, it was shown that the spine stabilization exercise device can provide considerable muscle exercise effect.

유니버셜 디자인을 적용한 척추 안정화 운동기기의 디자인 개발에 관한 연구

Background : In a modern society, low back pain(LBP) has a lifetime prevalence of 80% of people. In recent years, spinal stabilization movement has been highlighted as a method for the treatment of low back pain and unbalance position. In particular, people are growing more and more interested in a spinal stabilization device with three-dimensional movement. In this study, we identify the problems of a spinal stabilization exercise device from a healthcare design perspective by using the PPP evaluation. In addition, we was developed a device from a universal design view on the basis of problems and solutions for existing products through the PPP results. Methods : For the study, first, we selected the product for improvement. Second, we analyzed the universal design of products through the PPP by user. Third, design modifications were made based on the PPP results, and a prototype was produced. And then, we proceeded to conduct a PPP evaluation of the prototype. Lastly, we conducted a clinical assessment of the prototype. Result : The prototypes with universal designs showed significant improvements to address the problem presented in the existing product. In particular, the entry of aesthetics and quality was significantly improved by about 1.2 points. In addition, the clinical evaluation also showed higher results for the prototype with the universal design when compared with conventional products. Conclusions : A universal design can be improved users’ requirements by product developers in developing products. Also, products with a UD yield higher users’s exercise and rehabilitation effects than conventional products. The results therefore showed the importance of applying a universal design.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain

Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Comparison of deep and superficial abdominal muscle activity between experienced Pilates and resistance exercise instructors and controls during stabilization exercise.

Pilates and resistance exercises are used for lumbar stabilization training. However, it is unclear which exercise is more effective for lumbar stabilization. In our study, we aimed to compare surface muscle activity and deep muscle thickness during relaxation and spinal stabilization exercise in experienced Pilates and resistance exercise instructors. This study is a retrospective case control study set in the Exercise Prescription Laboratory and Sports Medicine Center. The participants included Pilates instructors (mean years of experience, 3.20±1.76; n=10), resistance exercise instructors (mean years of experience, 2.53±0.63; n=10), and controls (n=10). The participants performed 4 different stabilization exercises: abdominal drawing-in maneuver, bridging, roll-up, and one-leg raise. During the stabilization exercises, surface muscle activity was measured with electromyography, whereas deep muscle thickness was measured by ultrasound imaging. During the 4 stabilization exercises, the thickness of the transverse abdominis (TrA) was significantly greater in the Pilates-trained group than the other 2 other groups. The internal oblique (IO) thickness was significantly greater in the Pilates- and resistance-trained group than the control group, during the 4 exercises. However, the surface muscle activities were similar between the groups. Both Pilates and resistance exercise instructors had greater activation of deep muscles, such as the TrA and IO, than the control subjects. Pilates and resistance exercise are both effective for increasing abdominal deep muscle thickness.

Isokinetic Training For Adolescents Low Back Pain Rehabilitation

Nespecifinės kilmės apatinės nugaros dalies skausmas išlieka didele šiuolaikinės visuomenės problema, o jį patiriančiųjų amžius vis jaunėja. Mokslininkai diskutuoja dėl skirtingų metodikų nevienodo efektyvumo skirtingo amžiaus pacientams. Liemens raumenų izokinetinio treniravimo terapinis poveikis esant apatinės nugaros dalies skausmams pradėtas tyrinėti visai neseniai. Mokslinių darbų, kuriuose nagrinėjama ši tematika, publikuota vienetai, o darbuose aprašomi tyrimai buvo atliekami tik suaugusiųjų populiacijose. Dėl to būtina ieškoti naujų veiksmingų nugaros skausmo gydymo metodikų (ypač vaikams), objektyviais tyrimo būdais patikrinti metodų efektyvumą. Tyrimo tikslas: palyginti izokinetinės treniruotės ir stuburo stabilizavimo pratimų efektyvumą gydant paauglių apatinės nugaros dalies skausmus. Tyrimo metodai. Tyrimas atliktas VšĮ VULSK filialo Vaikų ligoninėje, Vaikų fizinės medicinos ir reabilitacijos skyriuje. 2013.01 – 2014.06 mėn. dalyvavo pacientai, atlikę ambulatorinę reabilitaciją II, atitinkantys atrankos kriterijus. Tyrime dalyvavo 75 tiriamieji: 48 (64%) mergaitės ir 27 (36%) berniukai, nugaros skausmą patiriantys 12-17 m. amžiaus paaugliai. Tiriamųjų amžiaus vidurkis buvo 15,1±1,26m. Tiriamieji buvo suskirstyti į dvi grupes taikant atsitiktinės atrankos metodą. Abiejų grupių pacientams 16 dienų buvo taikoma po vieną 30 min. trukmės individualų kineziterapijos užsiėmimą (izokinetinė liemens raumenų treniruotė arba stuburą stabilizuojančių pratimų kompleksas). Kitas reabilitacines priemones grupės gavo vienodai, remiantis Lietuvos respublikos sveikatos apsaugos ministro V-50 įsakymu. Visi tiriamieji buvo vertinami parinktais ištyrimo metodais: matuojamas tiriamųjų ūgis ir svoris, vertinama juosmens raumenų statinė ištvermė pagal McGill metodiką, matuojamas juosmeninės stuburo dalies paslankumas pagal modifikuotą Clarkson metodiką. Izokinetiniu dinamometru „BIODEX 4 PRO“ buvo vertinama pilvo ir nugaros raumenų jėga ir dinaminė ištvermė. Tiriamųjų juntamo skausmo intensyvumas buvo vertinamas vizualinės analogijos skausmo skale. Roland-Morris klausimynas vertinant skausmo sukeltos negalios lygį. Ištyrimas buvo atliekamas prieš reabilitacijos ciklą, po jo. Statistinė duomenų analizė buvo atlikta naudojant specializuotus statistikos paketus. Po reabilitacijos abiejose tiriamųjų grupėse buvo nustatytas statistiškai reikšmingas juosmeninės stuburo dalies paslankumo padidėjimas (p&amp;lt;0,05), liemens raumenų statinės ištvermės padidėjimas (p&amp;lt;0,05), liemens tiesėjų dinaminės ištvermės bei maksimalios jėgos (p&amp;lt;0,05) padidėjimas. Abiejose grupėse buvo nustatytas statistiškai reikšmingas (p&amp;lt;0,05) funkcinio savarankiškumo lygio padidėjimas bei juntamo skausmo intensyvumo sumažėjimas (p&amp;lt;0,05). Lyginant abi grupes tarpusavyje nebuvo nustatyta reikšmingų skirtumų (p&gt;0,05), išskyrus - izokinetinė treniruotė geriau didina liemens statinę ištvermę (p&amp;lt;0,05). Išvados. Po reabilitacijos procedūrų ciklo tiriamųjų funkciniai rodikliai ryškiai pagerėjo, padidėjo savarankiškumo lygis. Nei viena metodika nebuvo efektyvesnė kitos atžvilgiu: vienodai gerai mažina skausmą bei jo sukeltus apribojimus ir negalią, vienodai gerai didina lankstumą bei juosmens paslankumo rodiklius, vienodai gerai didina liemens raumenų jėgą. Izokinetinė treniruotė geriau didina liemens statinę ištvermę.

The effects of backpack loads and spinal stabilization exercises on the dynamic foot pressure of elementary school children with idiopathic scoliosis.

[Purpose] The purpose of this study was to measure and observe the changes in dynamic plantar pressures when school children carried specific bag loads, and to determine whether improved physical balance after an eight-week spinal stabilization exercise program can influences plantar pressures. [Subjects] The subjects were 10 school students with Cobb angles of 10° or greater. [Methods] Gait View Pro 1.0 (Alfoots, Korea) was were based on to measure the pressure of the participants’ feet. Spinal stabilization exercises used TOGU Multi-roll Functional (TOGU, Germany) training. Dynamic plantar pressures were measured with bag loads of 0% no bag and 15% of subjects’ body weight. The independent t test was performed to analyze changes in plantar pressures. [Results] The plantar pressure measurements of bag load of 0% of subjects’ body weight before and after the spinal stabilization exercise program were not significantly different, but those of two foot areas with a 15% load were statistically significant (mt5, 67.32±24.25 and 51.77±25.52 kPa; lat heel, 126.00±20.46 and 102.08±23.87 kPa). [Conclusion] After performance of the spinal stabilization exercises subjects’ overall plantar pressures were reduced, which may suggest that physical balance improved.

Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial.

To compare 8 weeks of weekly supervised spinal stabilization exercises with 1-time treatment in participants with low back pain and adolescent idiopathic scoliosis. Participants were randomly assigned to the supervised or unsupervised group. Seventeen participants in the supervised group received weekly physical therapy, and 17 participants in the unsupervised group received a 1-time treatment followed by home exercises. Significant between-group differences were found in the Numeric Pain Rating Scale and the Patient-Specific Functional Scale scores after 8 weeks (P < .01), indicating the supervised group had significantly more pain reduction and functional improvements than the unsupervised group. However, no between-group differences were found in back muscle endurance, the revised Oswestry Back Pain Disability Questionnaire scores, or the Global Rating of Change scores. Supervised physical therapy may be more effective than 1-time treatment in reducing pain and improving function in patients with adolescent idiopathic scoliosis and low back pain. For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A85.

The effects of trunk stabilization exercise on bone density after menopause.

[Purpose] This study examined the effect of low intensity exercise on bone density by conducting trunk stabilization exercise on females after menopause for 24 weeks. [Subjects and Methods] Thirty three female subjects over 47 years old and under the age of 53 were selected and 16 for experimental group and 17 for control group were randomly selected. Experimental group had performed spinal and pelvic stabilization exercise 30 minutes a day, 5times a week, for 24 weeks. Except for the daily life, control group did not participate in any characteristic movement. Bone density of every member in experimental group was measured using average value of bone density of 1st–4th lumbar through quantitative computer tomography. [Results] There was a meaningful difference in only control group about measured value of bone density within each group, experimental and control group, but there was no meaningful difference in measured value of bone density between two groups, experimental group and control group. [Conclusion] Through this research, we could see the fact that although trunk stability exercise could not change bone density meaningfully, it could maintain bone density. In the future, it is randomly necessary to study things related this because results of researches can show different results according to exercise intensity, exercise period, age, weight, hormone status and mediation period. It is considered that it will help to prevent and treat patients with osteoporosis a lot.

The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients.

[Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain.

Commentary on "Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial".

“How should I apply this information?” In this study, a weekly physical therapy (PT) intervention group experienced significantly greater reduction of pain and an improvement in patient-selected functional outcomes than an unsupervised group. Although the use of technology, such as a DVD, is common for adolescents, using technology to provide intervention may not be an adequate substitute for weekly contact with PT. This study provides support for weekly PT intervention and for the role that spinal stabilization training may play in reducing low back pain in adolescents with adolescent idiopathic scoliosis. A prevention-oriented health care system could use the results of this study to support the development and implementation of PT programs for this patient population. The study provides a beginning point for future research to explore spinal stabilization training for adolescents with low back pain and the use of the Global Rating of Change, Patient Specific Functional Scale, and Revised Oswestry in studies with adolescent subjects. “What should I be mindful about when applying this information?” The majority of the prescribed exercises focused on neuromuscular activation and/or hold of transverse abdominis and lumbar multifidus, but change was not directly assessed for these muscle groups. The Prone Double-leg Test is more specific to multijoint spinal extensors. From a clinical perspective, using the Prone Double-leg Test as a test of muscular endurance should be considered with caution. Lack of improvement may be due to factors other than endurance of the spinal extensors. Structures that may be adversely affected during this test include spinal nerve roots due to compression during closure of the intervertebral foramen; facet joints due to irritation from compression or hypomobility; and the disc due to compression. Selecting an outcome measure for muscle performance requires consideration of several factors, including (1) what one wishes to measure, for example, activation, strength, or endurance; (2) whether the outcome measure is appropriate to assess the focus of training such as strength or endurance; and (3) how the test may affect regional structures. Each factor has the potential to affect outcomes in a positive or negative direction. Melodie Kondratek, PT, DScPT, OMPT Physical Therapy Program Oakland University Rochester, Michigan Dhana Ponners, PT, DPT, OMPT The Training Room Troy, Michigan

Muscle forces and activation patterns in the spine during spine stabilization exercise using a whole body tilt device

The objective of the study was to investigate the effect of 3-D stabilization exercise using a whole body tilt device. A musculoskeletal (MS) model of the whole body was developed, and used to calculate the forces in the spine, assisted by EMG measurement. The inverse dynamics was solved using the MS model of the whole body with the input data of the eight different directions of the tilt: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R), and left (L), replicating the tilting directions of the whole body device. The anterior and posterior directions of tilt mainly induced superficial back and front muscle activations, respectively. However, deep muscles, such as the semispinalis and mulifidi, were activated in all directions of tilt. The joint resultant forces in the right and left direction of tilt were the least; but some higher activations and more diverse recruitments of muscles were demanded. In the present investigation, 3-D stabilization exercise can provide considerable muscle activation and exercise effect, with the minimum perturbation of structure. Therefore, the proposed direction of tilt can be used to strengthen the targeted muscles, depending on the patient’s muscle conditions.