The Relationship of Trunk Muscle Activation and Core Stability: A Biomechanical Analysis of Pilates-Based Stabilization Exercise

Pilates is an effective exercise method for rehabilitating musculoskeletal disorders as its principles are based on the activation of local muscles. This study aimed to compare the subjects with and without Pilates experience to find out the effect of the experience on the core muscle activity and muscle co-contraction, and to examine the relationship between the core muscle activation level and the kinematic data. This study involved 32 subjects, including 16 experienced Pilates practitioners and 16 non-experienced subjects. The knee stretch on the reformer was performed in three different positions: flat back with a neutral pelvis, round back with posteriorly tilted pelvis (RPP), and extended back anteriorly tilted pelvis (EAP). The electromyography of the internal oblique (IO), rectus abdominis (RA), multifidus (MU), and iliocostalis lumborum (IL) muscles were measured, as well as kinematic data from a 3D motion analysis system. Compared to the non-experienced subjects, the experienced subjects activated the IO muscles more than the RA muscles, and the most significant difference was seen in the RPP position (p < 0.05). The experienced patients activated the MU muscles more often than the IL muscles, with the most significant difference observed in the RPP position and the least significant in the EAP position (p < 0.05). All kinematic data and muscle activity (IO, IO/RA ratio, MU/IL ratio) showed significant differences between the experienced and non-experienced subjects (p < 0.05). The subjects presented a moderate correlation between muscle activation and core stability. It was confirmed that the experienced Pilates practitioners activated the abdominal and low back core muscles effectively, and the stability of the pelvis and trunk were better than that of the non-experienced participants. In addition, the better the trunk stability was maintained, the larger and more accurate movement of the mobility segment was observed.

Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

Background Therapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP). Methods Thirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m2; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention. Results The CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): − 0.295 (− 0.37 to − 0.2), effect size: 1.38, (p < 0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p < 0.05), and percentage change of muscle thickness of TrA and LM (p < 0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p < 0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program. Conclusion Despite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP. Trial registration Thai Clinical Trial Registry (TCTR20180822001; August 21, 2018).

Title: Effect of Maximum Repetition of Pelvic Floor Stabilization Exercise in Stress Urinary Incontinence.

Background: Stress urinary incontinence (SUI) in females is a common gynecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence. Aim: The aim of the study is to determine if maximum repetition of pelvic stabilization exercise impacts the management of stress urinary incontinence in females. Methodology: One arm quasi-experimental study design was used. 40 patients having SUI and associated musculoskeletal complaints were recruited from the outpatient unit of Physiotherapy department of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. The study was conducted over 4weeks. Outcome measurement was included pelvic floor and abdominal muscle strength, endurance, and incontinence measurement. Result: Pelvic floor muscle and abdominal strength, and endurance had a positive and significant result in maximum repetition (P .001). Pelvic floor strength has been significantly improvement in week 2 (P .001), and week 3 (P .01). Interference in activities (P .003), and ICIQ total (P .001) had improvement but majority of the improvement was noted in weeks 2-3. There was a significant improvement in the frequency of urine leakage in the first week (P .001), and week 3 (P .005) and week 4 (P .001). Conclusion: Pelvic floor exercise with increasing repetition is an effective approach to improve stress urinary incontinence in females. The study had a significant impact on incontinence frequency, amount, and associated quality of life for women with stress urinary incontinence with pelvic floor exercise with maximum repetition. Key Words: Stress Urinary Incontinence, Physiotherapy, exercise, Maximum repetition

Core Stabilization Exercise on the Lumbar Lordosis and Pelvic Inclination Among Chronic Nonspecific Low Back Pain Patients

Introduction: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders and it is documented that >90% of the cases have no defined cause for pain, called nonspecific low back pain (NSLBP). Alteration in the joint position, abnormal posture, and impaired muscle recruitment may result in recurrent CLBP. Lumbar lordosis (LL) provides strength against the compressive forces of gravity and it also protects the posterior spinal ligament and acts as a shock absorber for vertical forces. Increased LL is considered as a reason for radiculopathy, facet pain, and postural pain. Spinal posture and pelvic position were analyzed and documented as altered in CLBP patients. Anatomically, the anterior and posterior tilt of the back and pelvis by the force of different muscles can alter the spinal curvature. Posterior pelvic tilt in a standing position can decrease the LL. The pelvic inclination is related to the lumbar curve, and both are related to the performance and length of the back and abdominal muscles. Therefore, in this study, we aimed to evaluate the effect of core stabilization exercise on pain intensity, functional disability, LL, and pelvic inclination in NSLBP. Methodology: A total of 63 patients aged between 20 and 60 years who met the selection criteria were included. All participants gave their written consent to participate in this study. Demographic data such as age, weight, height, and duration of the back pain were documented. Patients were asked to report their pain using the Visual Analogue Scale (VAS) and Disability in Roland Morris Disability Questionnaire (RMDQ). Exclusion criteria were participants with musculoskeletal disorders (osteoarthritis and rheumatoid arthritis) and a history of previous fractures and systemic diseases. DIERS Formetric 4D spine and posture analyzer were used to assess spinal alignment using the light-optical scanning method on the back of patient in standing position. Angle of LL: the angle formed by the apex of LL and the T12 and L5 spinous processes. Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. Core stabilization exercises were given for 30 min, five days a week, for 12 sessions. Pre- and posttest values were documented and analyzed. Result: In this experimental study, we used Pearson’s correlation coefficient to find the correlation between LL and pelvic inclination angle and found a strong positive correlation (r = 0.76; P = 0.001). The study showed that core stabilization exercise for 12 weeks’ duration had statistically significant reduction in the pain intensity (p < 0.01), functional disability (p < 0.002), LL (p < 0.05), and pelvic inclination angle (p < 0.05) among patients with chronic NSLBP. Conclusion: From this research, we conclude that core stabilization exercises decrease the pain intensity, functional disability, LL, and pelvic inclination angle in patients with chronic NSLBP. Thus, evaluation of the lumbar curvature and pelvic inclination, and designing the appropriate exercise is recommended in the management of NSLBP.

Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial

Background Periarthritis of the shoulder is a common disease leading to dysfunction of the shoulder joint and have a significant impact on patients’ daily life. Evidence shows that there is a close relationship between scapular dyskinesis (SD) and shoulder diseases. Scapular stabilization exercise has been proved to be efficacious in relieving pain and improving function. However, there is no targeted exercise based on the type of scapular dyskinesis. This study will investigate the potential of scapular stabilization exercise based on the type of scapular dyskinesis in treating periarthritis of the shoulder. Methods This study is a prospective, randomized controlled, parallel-group trial, intending to recruit 90 patients diagnosed with periarthritis of the shoulder. Patients will receive scapular stabilization exercise training based on the type of scapular dyskinesis or receive traditional rehabilitation training conducted for 30 min, once a day, for 6 weeks. The primary outcome is Constant-Murley score (CMS), and other outcomes include pain degree, range of motion (ROM), type of scapular dyskinesis, scapula position, and patients’ satisfaction with shoulder function. Assessments will be performed at baseline, 2-, 4- and 6-week treatment, and at the 6-week follow-up after the end of treatment. Discussion This study will be the first study to investigate the clinical efficacy of scapular stabilization exercise based on the type of scapular dyskinesis in patients with periarthritis of the shoulder. The results may provide evidence of the effect of targeted scapular stabilization exercise in improving shoulder function and correcting scapular dyskinesis, and provide valuable information for future research. Trial registration This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2100044332 at March 14, 2021.