The effect of core stabilization exercise on lumbar joint position sense in
patients with subacute non-specific low back pain: a randomized controlled
trial

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Abstract

[Purpose] This study aimed to examine the effect of core stabilization exercise (CSE) on joint position sense, pain intensity, and functional disability in patients with subacute non-specific low back pain (NSLBP). [Participants and Methods] Thirty-eight participants with subacute nonspecific low back pain of 6–12 weeks duration, aged 18–60 years, were included in this study. Participants were randomly divided into two groups: a core stabilization exercise group (n=19) or a control group (n=19). Outcomes measures included lumbar joint repositioning error (LJRE), numeric pain rating scale (11-NRS), and the Roland-Morris disability questionnaires (RMDQ). Measures were taken at baseline, 4 weeks, 7 weeks of intervention, and at 4 weeks after the last intervention. [Results] All outcomes measures were significantly improved in the core stabilization exercise group, compared with the control group. [Conclusion] Core stabilization exercise can improve acuity of joint position sense, reduce pain, and functional disability compared with thermal therapy. The finding demonstrated that core stabilization exercises are more suitable for patients with subacute NSLBP than thermal therapy and this should be useful to clinicians.

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Most cited references 27

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The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement.

Manohar Panjabi (1992)

Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems. The vertebrae, discs, and ligaments constitute the passive subsystem. All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem. The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability. A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities: (a) an immediate response from other subsystems to successfully compensate, (b) a long-term adaptation response of one or more subsystems, and (c) an injury to one or more components of any subsystem. It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain. In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements.

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The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis.

M M Panjabi (1992)

The neutral zone is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. Several studies--in vitro cadaveric, in vivo animal, and mathematical simulations--have shown that the neutral zone is a parameter that correlates well with other parameters indicative of instability of the spinal system. It has been found to increase with injury, and possibly with degeneration, to decrease with muscle force increase across the spanned level, and also to decrease with instrumented spinal fixation. In most of these studies, the change in the neutral zone was found to be more sensitive than the change in the corresponding range of motion. The neutral zone appears to be a clinically important measure of spinal stability function. It may increase with injury to the spinal column or with weakness of the muscles, which in turn may result in spinal instability or a low-back problem. It may decrease, and may be brought within the physiological limits, by osteophyte formation, surgical fixation/fusion, and muscle strengthening. The spinal stabilizing system adjusts so that the neutral zone remains within certain physiological thresholds to avoid clinical instability.

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Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis.

P Hodges, C A Richardson (1996)

The contribution of transversus abdominis to spinal stabilization was evaluated indirectly in people with and without low back pain using an experimental model identifying the coordination of trunk muscles in response to a disturbances to the spine produced by arm movement. To evaluate the temporal sequence of trunk muscle activity associated with arm movement, and to determine if dysfunction of this parameter was present in patients with low back pain. Few studies have evaluated the motor control of trunk muscles or the potential for dysfunction of this system in patients with low back pain. Evaluation of the response of trunk muscles to limb movement provides a suitable model to evaluate this system. Recent evidence indicates that this evaluation should include transversus abdominis. While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the surface electrodes. Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles. The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.

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Author and article information

Journal

Journal ID (nlm-ta): J Phys Ther Sci

Journal ID (iso-abbrev): J Phys Ther Sci

Journal ID (publisher-id): JPTS

Title: Journal of Physical Therapy Science

Publisher: The Society of Physical Therapy Science

ISSN (Print): 0915-5287

ISSN (Electronic): 2187-5626

Publication date (Electronic): 6 November 2018

Publication date (Print): November 2018

Volume: 30

Issue: 11

Pages: 1390-1395

Affiliations

[1) ] School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd, Muang District, Khon Kaen 40002, Thailand

[2) ] Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand

[3) ] Human Movement Sciences, School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand

[4) ] International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Australia

Author notes

[* ]Corresponding author. Rungthip Puntumetakul (E-mail: rungthiprt@ 123456gmail.com )

Article

Publisher ID: jpts-2018-272

DOI: 10.1589/jpts.30.1390

PMC ID: 6220097

SO-VID: cc187317-613c-42a8-b1ce-2d5fad02dec6

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. (CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/ )

The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: a randomized controlled trial

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Most cited references 27

The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement.

The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis.

Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis.

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