Lumbar Segmental Stabilization Research Articles

Effectiveness of Lumbar Segmental Stabilization Exercises in Managing Disability and Pain Intensity Among Patients with Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Systematic review and meta-analysis. This study aims to assess the effectiveness of lumbar segmental stabilization exercises (LSSE) in managing spondylolysis and spondylolisthesis. Spondylolysis and spondylolisthesis are spinal disorders associated with lumbar segmental instability. LSSE have shown positive effects in treating these conditions; however, systematic reviews and meta-analyses are lacking. A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from the inception of the databases used up to January 2024, was conducted. Disability improvement and pain intensity change were the primary and secondary outcomes, respectively, standardized using Hedges' g. Eligible articles underwent independent scrutiny by two authors, who also performed data extraction and quality assessment. Data pooling was accomplished using a random-effects model. In total, five randomized controlled trials comprising 198 participants were included, revealing a trend effect toward disability improvement in the LSSE group (Hedges' g=-0.598, 95% CI=-1.211 to 0.016, P=0.056, I2=75.447%). When the LSSE was administered as a single treatment, disability improvement became significant (Hedges' g=-1.325, 95% CI=-2.598 to -0.053, P=0.041, I2=80.020%). No significant effect of LSSE on pain reduction was observed (Hedges' g=-0.496, 95% CI=-1.082 to 0.090, P=0.097, I2=73.935%). In summary, our meta-analysis suggests that LSSE can potentially improve disability, especially when used as a single treatment. LSSE appears more beneficial in reducing disability than alleviating pain. Future research on different patient groups is needed to understand comprehensively LSSE's effects on other musculoskeletal disorders.

Unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion for treatment of lumbar foraminal stenosis

BACKGROUND CONTEXTTransforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw fixation (BPSF) is an effective treatment for lumbar foraminal stenosis (LFS). However, the effects of TLIF with unilateral pedicle screw fixation (UPSF) on LFS treatment have not been clearly elucidated. PURPOSEWe conducted this study to compare clinical outcomes and radiographic results of TLIF with UPSF and BPSF 2 years after the surgical treatment. DESIGNProspective randomized study. PATIENT SAMPLEThis study included 23 patients undergoing TLIF with UPSF and 25 patients undergoing TLIF with BPSF. OUTCOME MEASURESClinical outcomes were evaluated by visual analog scale (VAS) for low back pain and leg pain and Oswestry Disability Index (ODI) score. Radiographic outcomes included foraminal height, disc space height, segmental lordosis, and final fusion rates. METHODSThe clinical and radiographic outcomes were compared between the UPSF and BPSF group. The postoperative improvements were evaluated in either group. Intraoperative data such as duration of operation and estimated blood loss were collected. This study was registered at clinicaltrials.gov. RESULTSAnalysis of the VAS and ODI scores showed significant improvements in clinical outcomes within each group. No significant differences between the 2 groups were noted in the improvements of the VAS and ODI scores. The mean operative duration and blood loss were significantly greater in the BPSF group than in the UPSF group. There were significant improvements in the height of the foramen and intervertebral space and segmental lordosis in both groups, while there was no significant difference between the groups in amount of the improvements. No significant difference was found in the final fusion rates. CONCLUSIONSTLIF is an appropriate procedure for LFS treatment. With balanced intervertebral support using a cage, UPSF could achieve similar and satisfactory effects on lumbar segmental stability and fusion compared to BPSF. The unilateral approach appears to be associated with slightly shorter operative time and less blood loss.

Manual Therapy Followed by Dynamic Strengthening Exercise Along With Conventional Physiotherapy Versus Manual Therapy Along With Conventional Physiotherapy on The Improvement of Pain and Functional Disability In Patients With Chronic Non-Specific Low Back Pain: A Randomized-Controlled Pilot Study

Chronic low back pain (LBP), defined as back pain persisting for more than 12 weeks, affects over 50% of the general population.[1] It is the second most common factor for patients in search of primary care services.[2]According to the US National Center for Health Statistics, 14% of new patients admitted to a hospital for treatment had low back pain, representing 13 million people.[3] Also, it is estimated that over 70% of adults have had at least one episode of LBP in their lifetime.[4]In 2007, another study revealed that lower back region pain is caused by disc degeneration, spondylolisthesis, lumbar stenosis, epidural hematoma, and other causes, and 3% of all patients discharged from hospitals have symptomatic low back pain.[5] Because the causes of LBP are variable, different exercise regimens have been used to treat patients, including lumbar flexion, extension, isometric flexion, passive extension, and intensive dynamic back exercise regimens, and many of these exercise regimens have not yielded satisfactory results.[6]Recently, some studies have focused on exercises that aim to maintain or improve lumbar spine stability, such as lumbar stabilization exercises, which are aimed at improving the neuromuscular control, strength, and endurance of the muscles that are fundamental to maintaining spinal and trunk stability through several groups of muscles, particularly transverse abdominis and lumbar multifidi, but also other paraspinal, abdominal, diaphragmatic, and pelvic muscles.[7] Unsubstantiated suggestions that stabilization training may be useful in reducing pain and disability for all patients with nonspecific LBP, have appeared in the literature,[8] but these assertions have not been definitively demonstrated. Weakness of the abdominal muscles among the trunk muscles of low back pain patients is generally prevalent, and the strengthening of the abdominal muscles is essential in the recovery of the spinal neutral position.[9] When imbalance between the abdominal muscles of the trunk and extensor muscles occurs, it triggers slow back pain and reduces stabilization of the lumbar.[10]The ability to actively control the muscles of the hip plays an important part in lumbar segmental stability. If the sacroiliac joint moves excessively, it results in pressure on the joints and disks between the L5–S1 vertebral body, sacroiliac joint, and pubic symphysis, which leads to functional failure of the sacroiliac joint and low back pain. This causes the gluteus maximus muscle to contract, creating a self-locking mechanism, thereby providing stability to the sacroiliac joint.[11]There are various forms of exercise that can be prescribed based on different schools of thought, which include intensive dynamic back extensor exercises (motor control exercises), yoga and aerobic exercises.[12]Graded strengthening exercises are aimed at improving the neuromuscular control, strength, and endurance of the muscles that are central to maintaining dynamic spinal and trunk stability. The effect of graded lumbar stabilization exercises has been studied in subjects with recurrent LBP (8). Dynamic strengthening exercises can strengthen the spinal column and supporting structures.[13] An electromyography study to compare recruitment of the rectus abdominis and erector spinae muscles during dynamic strengthening exercise revealed higher muscle activity in these muscles.[14]Therefore, the aim of this study is to compare the effects of graded lumbar strengthening exercises and lumbar dynamic strengthening exercises on the maximal isometric contraction strength of the lumbar extensors, pain severity, and functional disability in patients with nonspecific chronic LBP. According to many studies, the first step of the physiotherapy treatment pyramid is education of the patient.[15] In another study, researchers explored several research studies that included evidence on conservative treatments,[16] which included manual therapy or conservative physiotherapy, which included exercises, mobilization, McKenzie approach treatment, manipulation, strengthening programs, advice, and other manual therapy techniques, which have strong evidence of effectiveness for chronic low back pain patients.[17] According to a study,[18] rest and exercise are effective for low back pain patients.

Does adding hip strengthening exercises to manual therapy and segmental stabilization improve outcomes in patients with nonspecific low back pain? A randomized controlled trial

BackgroundThe literature is unclear on the need for hip strengthening in persons with low back pain (LBP). ObjectivesTo investigate the effectiveness of hip strengthening exercises when added to manual therapy and lumbar segmental stabilization in patients with chronic nonspecific LBP. MethodsSeventy patients with chronic nonspecific LBP were randomly assigned to either the manual therapy and lumbar segmental stabilization group or the manual therapy and lumbar segmental stabilization plus specific hip strengthening group. A 10 cm visual analogue scale and the Rolland-Morris Questionnaire were the primary clinical outcome measures at baseline, at the end of treatment (posttreatment), and 6- and 12-months posttreatment. Hip strength and kinematics were measured as secondary outcomes . ResultsWhile within-group improvements in pain, disability, and hip extensors strength occurred in both groups, there were no significant between-group differences at posttreatment or follow-ups. Mean difference in changes in pain level between groups at posttreatment and at 6- and 12-month follow-up were 0.5 points (95% confidence interval [CI]: -0.5, 1.5), 0.3 points (95% CI: -0.9, 1.5), and 0.0 points (95% CI: -1.1, 1.1), respectively. The mean differences in changes in disability were 0.8 points (95% CI: -1.3, 2.7), 0.0 points (95% CI: -2.4, 2.4), and 0.4 points (95% CI: -2.0, 2.8), respectively. Finally, we did not observe any between-group differences for any of the other outcomes at any timepoint. ConclusionThe addition of specific hip strengthening does not appear to result in improved clinical outcomes for patients with nonspecific LBP.

Effects of lumbar segmental stabilization exercise and respiratory exercise on the vital capacity in patients with chronic back pain.

Trunk stabilization contributes to the efficient control of body movements in daily life, and it plays an important role in maintaining the proper alignment of the body and preventing low back pain. This study aimed to identify the effectiveness of breathing exercises and lumbar segmental exercises on the vital capacity of lumbar instability patients. Fifty-nine patients suffering from chronic low back pain participated in this study. They were randomly divided into three groups: experiment group 1 performed breathing and segmental stabilization exercises (n= 20), experiment group 2 performed segmental stabilization exercises (n= 20), and the control group performed the modality treatment (n= 19). The measurements were assessed on vital capacity. The difference in the forced vital capacity, maximal expiratory pressure, and maximal inspiratory pressure at pre- and post-intervention was significant in the RE+LSSE and LSSE groups (p< 0.05) and among all groups (p< 0.05). The difference in the forced expiratory volume at one second of each group was significant (p< 0.05) but was not significant among groups (p> 0.05). In conclusion, the lumbar segmental stabilization exercise activates the deep muscle and improves the respiratory function and respiratory pressure, when used for chronic low back pain patients with segmental instability.

Comparison of lumbar segmental stabilization and general exercises on clinical and radiologic criteria in grade‐I spondylolisthesis patients: A double‐blind randomized controlled trial

The effects of different physiotherapy protocols on patients suffering from grade-I spondylolisthesis have been thus far examined in a limited number of clinical trials. Therefore, the main purpose of this study was to compare the effects of lumbar segmental stabilization and general exercises on clinical and radiologic criteria in grade-I spondylolisthesis patients. This study was a double-blind randomized controlled trial (RCT) with a test-retest design and parallel groups. A total of 26 patients with grade-I spondylolisthesis were thus randomly assigned to experimental group (13 patients, lumbar segmental stabilization exercises) and control group (13 patients, general exercises). Subsequently, pain, functional disability, kinesiophobia, translational motion, angular motion and slip percentage of the vertebra were investigated. Of the 120 people recruited in this study, only 26 patients were eligible. According to pre/post-intervention comparison, a statistically significant decrease was observed in the experimental group in terms of pain (p = 0.000), functional disability (p = 0.004), kinesiophobia (p = 0.002), translational motion (p = 0.043) and angular motion (p = 0.011), but not for slip percentage (p = 0.122). Considering the control group, a statistically significant decline was reported for pain (p = 0.043) and functional disability (p = 0.002). However, no significant differences were found for other variables in the control group. With regard to inter-group comparison, there was no statistically significant difference between the two groups regarding the given variables except for kinesiophobia (p = 0.040). Both lumbar segmental stabilization and general exercises led to reduction in pain and functional disability of patients with grade-I spondylolisthesis. Therefore, lumbar segmental stabilization exercises seemed to be better than general ones with reference to improving kinesiophobia and intervertebral movements.

Effect of circular dance compared to lumbar segmental stabilization on nonspecific chronic back pain: randomized controlled trial protocol

Background Circular dance CD has been used to improve flexibility posture strength and muscle resistance thereby reducing pain and tension Lumbar segmental stabilization LSS is a therapeutic approach that aims to improve the neuromuscular control strength and resistance of muscles that provide spinal stability Objective Compare the effect of CD and LSS on pain and functional disability of women with nonspecific chronic low back pain NCLBP Method The nbsp sample nbsp will nbsp consist nbsp of nbsp nbsp women nbsp aged nbsp between nbsp nbsp and nbsp nbsp years nbsp with nbsp nonspecific chronic low back pain and intensity ge points on the Numerical Pain Scale NPS divided into groups CD group participants LSS group participants Sixteen nbsp minutes nbsp sessions nbsp will nbsp be nbsp held nbsp twice nbsp a nbsp week nbsp for nbsp both nbsp groups nbsp The nbsp primary nbsp outcomes will be assessed using the Numerical Pain Scale and Rolland Morris Disability Questionnaire and the secondary outcomes by the Beck Depression Inventory Numerical Anxiety Scale Global Perceived Effect GPE scale Report of Symptoms and Adverse Events or Side Effects and the SF Quality of Life Questionnaire at pre treatment and and weeks post treatment Results It is hoped to obtain results that allow defining the possibility of using CD as a simple alternative to be applied inexpensive viable to be used in the public health system with nbsp results nbsp equivalent nbsp if nbsp compared nbsp to nbsp a nbsp treatment nbsp already nbsp founded nbsp in nbsp the nbsp literature nbsp as nbsp an nbsp effective nbsp treatment nbsp for nbsp chronic nbsp back nbsp pain Statistical nbsp analysis nbsp will nbsp be nbsp conducted nbsp using nbsp Statistical Package for the Social Sciences software SPSS applying descriptive and inferential statistics Discussion This study is expected to broaden the use of CD in the national health system as an effective and efficient therapy which could benefit women with NCLBP to have improved motor functions and emotional aspect of this population as well and ameliorate the quality of life

Efficacy of Lumbar Segmental Stabilization Exercises and Breathing Exercises on Segmental Stabilization in Lumbar Instability Patients

Purpose: The aim of this study was to determine the effectiveness of breathing exercises and lumbar seg-mental exercises on the segmental stability of patients with chronic back pain. Methods: Fifty-nine patients, who suffered from chronic low back pain, were enrolled in this examination. They were divided randomly into three groups: experiment group 1 underwent breathing and segmental stabilization exercises (n=20), experiment group 2 experi-enced segmental stabilization exercises (n=20), and the control group was given the modality treatment (n=19). The measurements were assessed through an Oswestry disability questionnaire (ODQ), as well as a lumbar segmental instability test (LSIT). Results: The ODQ results for experimental groups 1 and 2 were similar (p 0.05). The differences in segmental instability of each of the three groups were similar (p<0.05), and also similar among the three groups (p<0.05). Conclusion: These findings suggest that lumbar segmental stabilization exercises are efficient in increasing the segmental stability and alleviating pain in patients with chronic back pain. Additional studies on this subject will be needed to improve the clinical applications in the future.

Efficacy of Maitland Mobilization and Lumbar Segmental Stabilization Exercises as Compared to Lumbar Segmental Stabilization Exercises in Subjects with Mechanical Low Back Pain: A Randomized Controlled Trial

Efficacy of Maitland Mobilization and Lumbar Segmental Stabilization Exercises as Compared to Lumbar Segmental Stabilization Exercises in Subjects with Mechanical Low Back Pain: A Randomized Controlled Trial

The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain.

[Purpose] This study aimed to examine the effects of self-mobilization techniques for the sciatic nerves on the quality of life in patients with chronic low back pain in the lower limbs accompanied by radiating pain. [Subjects and Methods] The subjects were divided into two groups: a group receiving of lumbar segmental stabilization exercise training including sciatic nerve mobilization techniques, which included 8 males and 7 females, and a group receiving lumbar segmental stabilization exercise training, which included 8 males and 7 females. [Results] There were statistically significant differences in comparison of measurement results between the groups before and after the intervention. [Conclusion] Application of mobilization techniques for the sciatic nerves may promote healing of the soft tissues by stimulating the functions of the nervous system to improve nervous system adaptability and decrease sensitivity, helping to alleviate the symptoms.

Effects of posterior lumbar spinal fusion on the stability of unstable lumbar segment and biomechanical properties of adjacent segments: a finite element study

To explore the effects of posterolateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF) on the stability of postoperative unstable single lumbar segment and the biomechanical alterations of the adjacent segments. A finite element model of L3-S1 segments with a single segmental degeneration at the L4-5 level was established, and the model of L4-5 segmental instability after posterior laminectomy and facetectomy was also established, in which laminar and interior 2/3 area of bilateral facet joints were resected. Physical loads were applied to the models and the changes of the range of motion (ROM) at L4-5 level in different models were recorded at the condition of flexion, extension, lateral bending and rotation. PLF and PLIF were performed on postoperative unstable model respectively, the changes of the ROM at L4-5 level, the ROM and the stress on the adjacent discs in different models were recorded. Compared to the unstable model, the L4-5 segmental stability was restored after PLF or PLIF. The ROMs of L3-4 and L5-S1 levels were similar to the preoperative unstable model. The stress on adjacent discs (L3-4 and L5-S1) was increased significantly, and maximum stress distribution changed and concentrated in the anterior annulus fiber in the two fusion models. There was no significant difference of the maximum stress on adjacent discs between PLF and PLIF models [(1.056 ± 0.061) mPa vs (1.070 ± 0.075) mPa; (1.147 ± 0.055) mPa vs (1.162 ± 0.075)mPa, P>0.05]. Lumbar segmental stability after posterior laminectomy and facetectomy can be recovered by both PLF and PLIF. Both PLF and PLIF may increase the possibility of adjacent segment degeneration because of the augmentation of maximum stress on adjacent discs.

Effects on single segmental lumbar stability after graded facetectomy and laminectomy: a finite element study

To explore the effects on degenerative single segmental lumbar spinal stability after posterior graded laminectomy and facetectomy by a finite element method. A finite element model of L3-S1 segments with a single segmental degeneration at L4-5 level was established. Different models of L4-L5 segmental instability after posterior graded laminectomy and facetectomy were established. And interior 1/3, 1/2, 2/3 of laminar and bilateral facet joints were resected. Physical loads were applied to the models and the changes of range of motion (ROM) at L4-5 level in different models were recorded during flexion, extension, lateral bending and rotation. As compared to preoperative model, after resecting 1/3 bilateral facet joints at L4-5 level, L4-5 segmental ROM increased 18% during flexion, 27% during extension and 45% during torsion. And the increased degree of ROM became more obvious along with a greater resection range of bilateral facet joints. No significant difference existed in L4-5 segmental ROM during lateral bending in all models. Facet joints play vital roles in lumbar segmental stability. And segmental instability may occur when 1/3 bilateral facet joints are resected.

The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.

[Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

Isokinetic performance, functionality, and pain level before and after lumbar and pelvic estabilization exercise in individuals with chronic low back pain

Introduction Chronic low back pain with a mechanical and degenerative origin is among the most common symptoms experienced by people all over the world. Objective To analyze the effects of a protocol for lumbar and pelvic segmental stabilization with regard to isokinetic variables, functionality, and pain in patients with low back pain. Materials and methods The sample consisted of 21 subjects, 8 female and 13 male, with a mean age of 42.6 ± 12.5 years. We used tests for mobility (modified Schober index), flexibility (finger-floor distance), functionality (Roland-Morris questionnaire), pain (Visual Analog Scale of Pain), and the isokinetic variables torque peak, work, flexors/extensors ratio before and after application of a protocol for segmental stabilization in subjects with chronic low back pain with a mechanical and degenerative origin. This protocol was used for two months, being applied twice a week. The data were statistically tested by means of the software Statistica, version 8.0. Results There were significant improvements for the variables flexibility (p = 0.014), functionality (p &lt; 0.001), pain level (p &lt; 0.001), torque peak flexion (p = 0.008), torque peak range (p &lt; 0.001), torque flexion (p = 0.001), torque range (p &lt; 0.001), and flexors/extensors ratio (p = 0.001). Conclusion Even with the improved levels of trunk muscles strength, both flexors and extensors, it was not possible to rebalance the segment according to data available in the literature. It is believed that there is a need for a protocol with a longer application period, maintaining the recruitment of extensor muscles. Regarding mobility of the lumbar segment, the protocol showed no significant differences in post-treatment (p = 0.520). This may be attributed to improved muscle control, providing the increased passive stiffness required to promote stability.

Influence of trunk muscle co-contraction on spinal curvature during sitting

Slumped sitting is known to increase disc pressure and aggravate chronic low back pain. In addition, it has been recognized that co-contraction of the deep spine-stabilizing muscles enhances lumbar segmental stability and the sacro-iliac joint. The purpose of this study was to compare the electromyographic (EMG) activity of the trunk muscles and the muscle thickness of the transverse abdominis (TrA) during slumped sitting with the same parameters during co-contraction and investigate how co-contraction influences spinal curvature. Nine healthy male volunteers participated in the study. EMG signals were recorded during both sitting postures. In order to measure the muscle thickness of the TrA, ultrasound images were captured. While the subjects performed both sitting postures, spinal curvature was measured using a hand-held device. Significantly more activity of the trunk muscles, with the exception of the rectus abdominis muscle, and significantly greater muscle thickness of the TrA were observed during co-contraction of the trunk muscles than during slumped sitting. Co-contraction also resulted in significantly increased lumbar lordosis and a greater sacral angle when compared to slumped sitting. In this study, it was demonstrated that the instructions given to the subjects on co-contraction of the trunk muscles during sitting increased muscle activity with the exception of the rectus abdominis muscle, muscle thickness of the TrA, and lumbar lordosis.

Influence of Stretching and Strengthening of the Iliopsoas Associated with Lumbar Segmental Stabilization Exercises in Patients with Low Back Pain: The pilot study

Low back pain (LBP) is one of the principal causes of incapacity. One treatment approach for this pathology involves segmental stabilization. The iliopsoas muscle is also considered a potential stabilizer of the lumbar spine. Objective: To compare the effects of stretching and strengthening of the iliopsoas muscle associated with segmental stabilization versus stabilization alone, in the treatment for LBP. Methods: Fourteen patients were randomized into three groups. The first group was given only segmental stabilization training (ST); the second was submitted to ST and stretching of the iliopsoas muscle (ST-Stretch), and the third was given ST and strengthening of the iliopsoas (ST-Strength). Results: The group ST (p = 0.006) and ST-Strength (p=0.092) showed significant improvement in the VAS scale. The extension flexibility showed statistically significant improvement in the group ST- strength group (p=0.038). Conclusion: ST alone, or associated with strengthening of the iliopsoas, proved more effective for improving lumbar pain and flexibility compared to ST Stretch.

Co-contractive Activation of the Superficial Multifidus During Volitional Preemptive Abdominal Contraction

To investigate whether the superficial multifidus (MF) muscle at the lower lumbar spine displayed co-contraction during volitional preemptive abdominal contraction (VPAC) through the abdominal drawing-in maneuver (ADIM) or the abdominal bracing maneuver (ABM) in 3 different postural positions. A within-subject cohort design. A clinical laboratory. A healthy convenience sample of 21 women and 13 men; mean age (SD), 25.5 ± 6.5 years. We collected surface electromyographic measurements for the superficial MF at the L5 vertebral level and abdominal wall muscles. Ultrasound imaging was used during screening and testing sessions for confirming transverse abdominis muscle activation while subjects maintained a relaxed state without volitional abdominal contraction (no-VPAC) and performed ADIM and ABM in 3 postural positions: supine, 4-point kneeling, and upright standing. The frequency of superficial MF co-contraction occurrences (percentage of the total number of conditions) was measured during ADIM and ABM in 3 different postural positions. A Cochran Q test for k-related samples (α= 0.05) was used for data analysis. Activation of the abdominal wall by using either VPAC strategy resulted in a significantly greater MF co-contraction occurrence when compared with no-VPAC in each position. The ABM produced a significantly higher MF co-contractive occurrence versus the ADIM in the supine position. Both VPAC strategies produced a co-contractive MF response, which appears to be important for lumbar segmental stabilization and control. Analysis of the results suggests that VPAC strategies are appropriate for coactivating the MF, which can enhance spinal protection and rehabilitation responses.

Core Stabilization Exercise Prescription, Part I

Context:Injury to the low back can cause significant pain and dysfunction, which can affect an athlete’s performance and result in time lost from sport. A common conservative treatment is therapeutic core stabilization exercises, which can address pain and musculoskeletal dysfunction in patients with low back pathology.Evidence Acquisition:MEDLINE and CINAHL were searched (from 1966 to March 2013) to identify relevant research. Keywords and keyword combinations searched included motor control exercise, segmental stabilization, core stabilization, transversus abdominis, multifidi, and low back pain.Results:There are 2 popular rehabilitation strategies to assess core function and promote core stabilization. Each has been developed based on biomechanical models of lumbar segmental stability and observed motor control dysfunction in patients with low back pain.Conclusion:Controversy exists among clinical and research groups as to the optimal strategy for an athlete with low back pain.

Habilidades motoras de cadeirantes influenciadas pelo controle de tronco

O objetivo deste estudo foi analisar a efetividade de um protocolo de treinamento de estabilização segmentar lombar (ESL) no controle de tronco e nas habilidades em cadeira de rodas (CR) em indivíduos paraplégicos. A amostra foi composta por 5 homens (31,2±12,9 anos) com lesão medular abaixo de T6. O deslocamento total (DT) e as amplitudes ântero-posterior (AP) e médio-lateral (ML) do centro de pressão (CP) foram analisados por meio de uma plataforma de força, em duas posições de teste (mãos no joelho e braços cruzados) e as habilidades na cadeira de rodas foram analisadas pelo Wheelchair Skills Test (WST), pré e pós protocolo de treinamento de ESL. A análise estatística foi realizada no software SPSS (15.0), utilizando o teste ANOVA para α ≤ 0,05. Na comparação pré e pós-treino, houve redução significativa do deslocamento total do CP na posição sentada com mãos nos joelhos (P&lt;0,01) e braços cruzados (P&lt;0,01). Não se observou mudança nas habilidades com CR do WST entre as avaliações pré e pós treinamento em nenhum dos níveis estudados. O protocolo de treinamento de ESL proposto foi efetivo para a melhora do controle de tronco, mas não modificou as habilidades no manejo de cadeira de rodas em indivíduos paraplégicos.

Efeitos da Estabilização Segmentar Lombar no Equilíbrio de Tronco em Paraplégicos

Introduction: Paraplegia is an inability of low incidence and high costs, which requires functional changes in the patterns of an individual resulting in trunk imbalance. Objective: To analyze the effect of segmental stabilization on paraplegics’ trunk balance. Material and Methods: This study included five male subjects (31.2  12.93 years) diagnosed with spinal cord injury (T6 to L1). They were submitted to electromyographic evaluation of the lumbar multifidus (LM) and transversus abdominus (TrA) muscles, in addition to TB assessment in two positions (hands on knees and crossed arms), before and after four weeks of lumbar segmental stabilization (LSS) training. The comparisons of the Root Mean Square (RMS) of the EMGs signal and of the displacement of the pressure center (PC) pre- and post-training were conducted on SPSS software (15.0). The Student and Wilcoxon tests were used, with significance level of 5%. Results: There was significant difference in the RMS of the EMGs signal (p=0.043) for the two muscles analyzed (LM and TrA) and in the total displacement of the PC between pre- and post-training, both in the hands on knees position (p=0.014) and in the crossed arms position (p=0.022). Conclusion: The findings showed that the LSS protocol was efficient in improving the balance of the trunk and the activation of the TrA and LM muscles. DESCRIPTORS: Spinal cord. Physiotherapy. Electromyography.