University of North Carolina at Chapel Hill

The Role of Spinal Stabilization Musculature in Treating Lumbar Pathologies and Low Back PainA multitude of muscles may be considered components of the “core” including muscles that attach to the glenohumeral joint or hip; however, this paper will focus on core muscles that attach to the trunk.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 Muscles, such as the transverse abdominus and lumbar multifidus, can be considered local, or deep, muscles in which core stabilization or motor control exercises can be implemented to target these muscles, whereas muscles, such as the erector spinae, rectus abdominus, and internal and external obliques, can be considered global, or superficial, muscles in which general back strengthening exercises may be implemented.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stabilization exercise prescription, part I: current concepts in assessment and intervention.","id":"4907328","page":"504-509","type":"article-journal","volume":"5","issue":"6","author":[{"family":"Brumitt","given":"Jason"},{"family":"Matheson","given":"J W"},{"family":"Meira","given":"Erik P"}],"issued":{"date-parts":[["2013","11"]]},"container-title":"Sports health","container-title-short":"Sports Health","journalAbbreviation":"Sports Health","DOI":"10.1177/1941738113502451","PMID":"24427424","PMCID":"PMC3806181","citation-label":"4907328","Abstract":"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.","CleanAbstract":"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."}]2,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain.","id":"6061433","page":"510-513","type":"article-journal","volume":"5","issue":"6","author":[{"family":"Brumitt","given":"Jason"},{"family":"Matheson","given":"J W"},{"family":"Meira","given":"Erik P"}],"issued":{"date-parts":[["2013","11"]]},"container-title":"Sports health","container-title-short":"Sports Health","journalAbbreviation":"Sports Health","DOI":"10.1177/1941738113502634","PMID":"24427425","PMCID":"PMC3806182","citation-label":"6061433","Abstract":"CONTEXT: Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach. DATA SOURCES: PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain. STUDY SELECTION: Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals. DATA EXTRACTION: Included studies underwent appraisal for exercise intervention and outcomes. RESULTS: Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain. CONCLUSION: Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles.","CleanAbstract":"CONTEXT: Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach.DATA SOURCES: PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain.STUDY SELECTION: Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals.DATA EXTRACTION: Included studies underwent appraisal for exercise intervention and outcomes.RESULTS: Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain.CONCLUSION: Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles."}]3,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability.","id":"6061438","page":"1189-1199","type":"article-journal","volume":"7","author":[{"family":"Puntumetakul","given":"Rungthip"},{"family":"Areeudomwong","given":"Pattanasin"},{"family":"Emasithi","given":"Alongkot"},{"family":"Yamauchi","given":"Junichiro"}],"issued":{"date-parts":[["2013","11","19"]]},"container-title":"Patient preference and adherence","container-title-short":"Patient Prefer. Adherence","journalAbbreviation":"Patient Prefer. Adherence","DOI":"10.2147/PPA.S50436","PMID":"24399870","PMCID":"PMC3875242","citation-label":"6061438","Abstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability. METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks. RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (P< 0.01). Furthermore, CSE enhanced deep abdominal muscle activation better than in the CG (P< 0.001), whereas the CG had deterioration of deep back muscle activation compared with the CSE group (P< 0.01). For within-group comparison, CSE provided significant improvements in all pain-related outcomes over follow-up (P< 0.01), whereas the CG demonstrated reduction in pain intensity during instability catch sign only at 10 weeks (P< 0.01). In addition, CSE showed an improvement in deep abdominal muscle activation (P< 0.01), whereas the CG revealed the deterioration of deep abdominal and back muscle activations (P< 0.05). CONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment.","CleanAbstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability.METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks.RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (PCONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment."}]4 Local muscles are comprised primarily of shorter, slow-twitch fibers and respond to changes in posture and eccentric loads, while global muscles are comprised primarily of longer, fast-twitch fibers and produce large amounts of torque and movement.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 These muscles may provide stability for the spine, but they only comprise one subsystem that provides spinal stability.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 In addition to this active subsystem provided by musculature, a passive subsystem consisting of bones and ligaments and a neuromuscular control subsystem also provide stability.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 While this paper will focus on the active subsystem, the other subsystems undoubtedly play a role in improving core stability. Before discussing interventions related to core musculature, the structure and function of a few core muscles will be briefly overviewed though specific details on attachments and biomechanics are beyond the scope of this paper. Figures depicting the anatomy of the following muscles are provided in Appendix A. The abdominal wall is composed of the transverse abdominis and internal and external obliques that are all involved with trunk flexion due to their attachment to the linea semilunaris, and these muscles help form the rectus sheath.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 The external oblique is the largest and most superficial muscle of the abdominal wall and the internal oblique lies just deep to the external oblique.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Anterior Abdominal Wall, Viscera and Peritoneum","id":"6090073","type":"speech","author":[{"family":"Kernick","given":"Edward"}],"issued":{"date-parts":[["2016"]]},"event-place":"Chapel Hill, NC","event":"Lecture Presentation","citation-label":"6090073","CleanAbstract":"No abstract available"}]6 The external and internal obliques are involved with rotational forces at the torso and lateral bending.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 The rectus abdominis is deep to the internal oblique and is a long, strap-like muscle bisected by the linea alba.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Anterior Abdominal Wall, Viscera and Peritoneum","id":"6090073","type":"speech","author":[{"family":"Kernick","given":"Edward"}],"issued":{"date-parts":[["2016"]]},"event-place":"Chapel Hill, NC","event":"Lecture Presentation","citation-label":"6090073","CleanAbstract":"No abstract available"}]6 It is the strongest trunk flexor.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 The transverse abdominis, which is the deepest abdominal wall muscle, attaches to the abdominal and lumbodorsal fascia and is primarily comprised of horizontal fibers, except for the inferior fibers that are orientated parallel to the internal oblique.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Anterior Abdominal Wall, Viscera and Peritoneum","id":"6090073","type":"speech","author":[{"family":"Kernick","given":"Edward"}],"issued":{"date-parts":[["2016"]]},"event-place":"Chapel Hill, NC","event":"Lecture Presentation","citation-label":"6090073","CleanAbstract":"No abstract available"}]6 The transverse abdominis likewise works with the internal oblique to increase intra-abdominal pressure and stiffen the spine.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 The lumbar multifidi span two to three spinal segments and typically only impact local spinal regions.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 Like the transverse abdominis, the lumbar multifidi stiffen the spine.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 The erector spinae is composed of three vertically oriented muscles that extend the spine: iliocostalis, longissimus, and spinalis.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Muscles of the Back","id":"6090083","type":"speech","author":[{"family":"Edward","given":"Kernick"}],"issued":{"date-parts":[["2016"]]},"event-place":"Chapel Hill, NC","citation-label":"6090083","CleanAbstract":"No abstract available"}]7 The iliocostalis represents the lateral-most column, the longissimus represents the intermediate column, and the spinalis represents the medial column.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Muscles of the Back","id":"6090083","type":"speech","author":[{"family":"Edward","given":"Kernick"}],"issued":{"date-parts":[["2016"]]},"event-place":"Chapel Hill, NC","citation-label":"6090083","CleanAbstract":"No abstract available"}]7 The iliocostalis and longissimus can be divided into thoracic and lumbar sections, and the lumbar component directs force in a posterior and caudal direction which causes a posterior shear and extension moment at the spine.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1An extended period of injury or pain may result in activity avoidance and subsequent core muscle weakness or atrophy and altered spine biomechanics.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8 It may also cause delayed activation of musculature such as the transverse abdominis.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.","id":"5147713","page":"1002-1006","type":"article-journal","volume":"33","issue":"4","author":[{"family":"Akhtar","given":"Muhammad Waseem"},{"family":"Karimi","given":"Hossein"},{"family":"Gilani","given":"Syed Amir"}],"issued":{"date-parts":[["2017","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.334.12664","PMID":"29067082","PMCID":"PMC5648929","citation-label":"5147713","Abstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.","CleanAbstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain.METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment.RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively.CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain."}]9 These stabilizing muscles may control static position and help transfer forces before dynamic movement,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Sports-specific Rehabilitation","id":"6085647","type":"book","publisher":"Elsevier Health Sciences","isbn":"9780443066429","author":[{"family":"Donatelli","given":"Robert"}],"issued":{"date-parts":[["2007"]]},"edition":"illustrated","editor":[{"family":"Donatelli","given":"Robert"}],"citation-label":"6085647","Abstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment.","CleanAbstract":"A comprehensive resource for focusing on returning injured athletes to their optimal performance! This book discusses exercise principles; muscle fatigue, muscle damage, and overtraining concepts; pathophysiology of overuse injuries; core evaluation in sports-specific testing; physiological basis of exercise specific to sport; and special considerations for the athlete. Secial features such as evidence-based clinical application boxes provide the reader with a solid body of research upon which to base their practice. Aligned to the Guide to Physical Therapy Practice to help learn how to work with athletes' injuries and help them make a physical comeback while following best practices. Incorporation of muscle physiology demonstrates it as the basis for athlete's exercise prescription. Coverage of pathophysiology of overuse injuries illustrates the damage to the musculoskeletal system. Inclusion of treatment and training approaches for athletic rehabilitation shows how to restore the musculoskeletal system back to full flexibility, strength, power, and endurance. Evidence-based clinical application boxes found throughout the book cite key studies and provide real-world application to a clinical setting. Extensive photographs show hands-on demonstrations of important rehabilitation techniques, helping the cinician to accurately apply them during treatment."}]1 and likewise may contract before movement of the extremities.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 Core stabilization exercise (CSE) interventions are generally aimed to improve the coordination of trunk musculature and protect the spine from injury.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.","id":"6061371","page":"171-178","type":"article-journal","volume":"32","issue":"3","author":[{"family":"Shamsi","given":"Mohammad Bagher"},{"family":"Rezaei","given":"Mandana"},{"family":"Zamanlou","given":"Mehdi"},{"family":"Sadeghi","given":"Mehdi"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","2","11"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2015.1117550","PMID":"26864057","citation-label":"6061371","Abstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.","CleanAbstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients."}]10 The effects of CSE on various lumbar pathologies, such as lumbar disc herniation, lumbosacral radiculopathy, lumbar spinal stenosis, and non-specific chronic low back pain, will be discussed below. While other conservative and surgical options may often be used for these conditions, CSE will be the primary emphasis of the discussion.Lumbar disc herniation (LDH) is defined as the localized displacement of disc material that is beyond the intervertebral disc space and can often result in low back and radiating leg pain due to spinal nerve root compression.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.","id":"3070568","page":"E93-E113","type":"article-journal","volume":"26","issue":"5","author":[{"family":"Fardon","given":"D F"},{"family":"Milette","given":"P C"},{"family":"Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology"}],"issued":{"date-parts":[["2001","3","1"]]},"container-title":"Spine","container-title-short":"Spine","journalAbbreviation":"Spine","PMID":"11242399","citation-label":"3070568","CleanAbstract":"No abstract available"}]11,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review.","id":"3520035","page":"E488-504","type":"article-journal","volume":"35","issue":"11","author":[{"family":"Hahne","given":"Andrew J"},{"family":"Ford","given":"Jon J"},{"family":"McMeeken","given":"Joan M"}],"issued":{"date-parts":[["2010","5","15"]]},"container-title":"Spine","container-title-short":"Spine","journalAbbreviation":"Spine","DOI":"10.1097/BRS.0b013e3181cc3f56","PMID":"20421859","citation-label":"3520035","Abstract":"STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.","CleanAbstract":"STUDY DESIGN: A systematic review of randomized controlled trials.OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR).SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear.METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment.RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events).CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy."}]13 Symptomatic LDH may be prevalent in about 1-3% of the general population.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Herniated lumbar disc.","id":"6085463","type":"article-journal","volume":"2009","author":[{"family":"Jordan","given":"Jo"},{"family":"Konstantinou","given":"Kika"},{"family":"O'Dowd","given":"John"}],"issued":{"date-parts":[["2009","3","26"]]},"container-title":"Clinical Evidence","container-title-short":"Clin Evid (Online)","journalAbbreviation":"Clin Evid (Online)","PMID":"19445754","PMCID":"PMC2907819","citation-label":"6085463","Abstract":"INTRODUCTION: Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdisectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.","CleanAbstract":"INTRODUCTION: Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc.METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).RESULTS: We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdisectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction."}]14 LDH can decrease lumbar curve and cause sacroiliac joint instability and increase the sacral angle of inclination.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.","id":"5857146","page":"2121-2125","type":"article-journal","volume":"29","issue":"12","author":[{"family":"Jeong","given":"Dae-Keun"},{"family":"Choi","given":"Hyun-Ho"},{"family":"Kang","given":"Jeong-Il"},{"family":"Choi","given":"Hyun"}],"issued":{"date-parts":[["2017","12","7"]]},"container-title":"Journal of physical therapy science","container-title-short":"J. Phys. Ther. Sci.","journalAbbreviation":"J. Phys. Ther. Sci.","DOI":"10.1589/jpts.29.2121","PMID":"29643588","PMCID":"PMC5890214","citation-label":"5857146","Abstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.","CleanAbstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery."}]15 Diagnosis of LDH can be confirmed by imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI).ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review.","id":"3520035","page":"E488-504","type":"article-journal","volume":"35","issue":"11","author":[{"family":"Hahne","given":"Andrew J"},{"family":"Ford","given":"Jon J"},{"family":"McMeeken","given":"Joan M"}],"issued":{"date-parts":[["2010","5","15"]]},"container-title":"Spine","container-title-short":"Spine","journalAbbreviation":"Spine","DOI":"10.1097/BRS.0b013e3181cc3f56","PMID":"20421859","citation-label":"3520035","Abstract":"STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.","CleanAbstract":"STUDY DESIGN: A systematic review of randomized controlled trials.OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR).SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear.METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment.RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events).CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy."}]13 Bayraktar et al. compared the effects of land-based and water-based CSE interventions on outcomes in individuals with LDH.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 Both interventions were 8 weeks with 60-minute sessions performed 3 times per week.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 The sessions emphasized isolated activation of the transverse abdominus.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 Both interventions were progressed by changing positions or base of support and increasing resistance.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 Both interventions resulted in significant improvements in pain, trunk muscle endurance, perceived disability, and health-related quality of life, although no significant differences were found between the groups.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 Therefore, land- and water-based core exercises may be similarly effective in improving outcomes. Aquatic therapy may be a particularly intriguing option for patients with back pain. The authors note that many patients with back pain may have kinesiophobia, but aquatic therapy may be a safe method that can alleviate pain and could possibly be more amenable or interesting to some patients.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.","id":"4270016","page":"1163-1171","type":"article-journal","volume":"38","issue":"12","author":[{"family":"Bayraktar","given":"Deniz"},{"family":"Guclu-Gunduz","given":"Arzu"},{"family":"Lambeck","given":"Johan"},{"family":"Yazici","given":"Gokhan"},{"family":"Aykol","given":"Sukru"},{"family":"Demirci","given":"Harun"}],"issued":{"date-parts":[["2016"]]},"container-title":"Disability and rehabilitation","container-title-short":"Disabil. Rehabil.","journalAbbreviation":"Disabil. Rehabil.","DOI":"10.3109/09638288.2015.1075608","PMID":"26328542","citation-label":"4270016","Abstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.","CleanAbstract":"PURPOSE: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients.METHOD: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life.RESULTS: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05).CONCLUSION: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.IMPLICATIONS FOR REHABILITATION: An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment."}]12 Jeong et al. reported that both a balance center stabilization resistance intervention and a three-dimensional stabilization intervention significantly improved disc herniation index and Korean Oswestry Disability Index, which is related to disability and functional performance, in subjects with LDH.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.","id":"5857146","page":"2121-2125","type":"article-journal","volume":"29","issue":"12","author":[{"family":"Jeong","given":"Dae-Keun"},{"family":"Choi","given":"Hyun-Ho"},{"family":"Kang","given":"Jeong-Il"},{"family":"Choi","given":"Hyun"}],"issued":{"date-parts":[["2017","12","7"]]},"container-title":"Journal of physical therapy science","container-title-short":"J. Phys. Ther. Sci.","journalAbbreviation":"J. Phys. Ther. Sci.","DOI":"10.1589/jpts.29.2121","PMID":"29643588","PMCID":"PMC5890214","citation-label":"5857146","Abstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.","CleanAbstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery."}]15 The balance center stabilization intervention also decreased sacral angle.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.","id":"5857146","page":"2121-2125","type":"article-journal","volume":"29","issue":"12","author":[{"family":"Jeong","given":"Dae-Keun"},{"family":"Choi","given":"Hyun-Ho"},{"family":"Kang","given":"Jeong-Il"},{"family":"Choi","given":"Hyun"}],"issued":{"date-parts":[["2017","12","7"]]},"container-title":"Journal of physical therapy science","container-title-short":"J. Phys. Ther. Sci.","journalAbbreviation":"J. Phys. Ther. Sci.","DOI":"10.1589/jpts.29.2121","PMID":"29643588","PMCID":"PMC5890214","citation-label":"5857146","Abstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.","CleanAbstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery."}]15 Both interventions comprised of 30-minute sessions performed 3 times per week for 4 weeks and required the use of specialized equipment that induced pelvic movements.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.","id":"5857146","page":"2121-2125","type":"article-journal","volume":"29","issue":"12","author":[{"family":"Jeong","given":"Dae-Keun"},{"family":"Choi","given":"Hyun-Ho"},{"family":"Kang","given":"Jeong-Il"},{"family":"Choi","given":"Hyun"}],"issued":{"date-parts":[["2017","12","7"]]},"container-title":"Journal of physical therapy science","container-title-short":"J. Phys. Ther. Sci.","journalAbbreviation":"J. Phys. Ther. Sci.","DOI":"10.1589/jpts.29.2121","PMID":"29643588","PMCID":"PMC5890214","citation-label":"5857146","Abstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.","CleanAbstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery."}]15 Interestingly, the use of pelvic movements appeared to aid in improving lumbar symptoms.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.","id":"5857146","page":"2121-2125","type":"article-journal","volume":"29","issue":"12","author":[{"family":"Jeong","given":"Dae-Keun"},{"family":"Choi","given":"Hyun-Ho"},{"family":"Kang","given":"Jeong-Il"},{"family":"Choi","given":"Hyun"}],"issued":{"date-parts":[["2017","12","7"]]},"container-title":"Journal of physical therapy science","container-title-short":"J. Phys. Ther. Sci.","journalAbbreviation":"J. Phys. Ther. Sci.","DOI":"10.1589/jpts.29.2121","PMID":"29643588","PMCID":"PMC5890214","citation-label":"5857146","Abstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.","CleanAbstract":"[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery."}]15 Due to the use of specialized equipment, this intervention may not be financially or spatially feasible to directly perform in many clinic environments, but the results suggest that lumbopelvic stabilization exercises may improve outcomes in patients with LDH.LDH may be considered the most common cause of lumbosacral radiculopathy.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review.","id":"3520035","page":"E488-504","type":"article-journal","volume":"35","issue":"11","author":[{"family":"Hahne","given":"Andrew J"},{"family":"Ford","given":"Jon J"},{"family":"McMeeken","given":"Joan M"}],"issued":{"date-parts":[["2010","5","15"]]},"container-title":"Spine","container-title-short":"Spine","journalAbbreviation":"Spine","DOI":"10.1097/BRS.0b013e3181cc3f56","PMID":"20421859","citation-label":"3520035","Abstract":"STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.","CleanAbstract":"STUDY DESIGN: A systematic review of randomized controlled trials.OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR).SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear.METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment.RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events).CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy."}]13 Direct trauma or chemical irritation can likewise cause radiculopathy.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8 The prevalence of lumbosacral radiculopathy in the general population may range from 9.9% to 25%.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"11. Lumbosacral radicular pain.","id":"247271","page":"339-358","type":"article-journal","volume":"10","issue":"4","author":[{"family":"Van Boxem","given":"Koen"},{"family":"Cheng","given":"Jianguo"},{"family":"Patijn","given":"Jacob"},{"family":"van Kleef","given":"Maarten"},{"family":"Lataster","given":"Arno"},{"family":"Mekhail","given":"Nagy"},{"family":"Van Zundert","given":"Jan"}],"issued":{"date-parts":[["2010","8"]]},"container-title":"Pain Practice","container-title-short":"Pain Pract.","journalAbbreviation":"Pain Pract.","DOI":"10.1111/j.1533-2500.2010.00370.x","PMID":"20492580","citation-label":"247271","Abstract":"Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral radicular pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral radicular pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral radicular pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.","CleanAbstract":"Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral radicular pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral radicular pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral radicular pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers."}]16 Lumbosacral radiculopathy can result in pain, sensory impairment, or weakness along the affected nerve root distribution.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8 LDH or radiculopathy may also cause changes in the size or distribution of type I and II lumbar multifidus muscle fibers.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis.","id":"5854040","page":"351","type":"article-journal","volume":"19","issue":"1","author":[{"family":"Cooley","given":"Jeffrey R"},{"family":"Walker","given":"Bruce F"},{"family":"M Ardakani","given":"Emad"},{"family":"Kjaer","given":"Per"},{"family":"Jensen","given":"Tue S"},{"family":"Hebert","given":"Jeffrey J"}],"issued":{"date-parts":[["2018","9","27"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/s12891-018-2266-5","PMID":"30261870","PMCID":"PMC6161433","citation-label":"5854040","Abstract":"BACKGROUND: Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology. METHODS: Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained. RESULTS: Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis. CONCLUSIONS: Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies. TRIAL REGISTRATION: PROSPERO 2015: CRD42015012985.","CleanAbstract":"BACKGROUND: Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology.METHODS: Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained.RESULTS: Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis.CONCLUSIONS: Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies.TRIAL REGISTRATION: PROSPERO 2015: CRD42015012985."}]17 A CSE intervention addressing radiculopathy can include exercises such as “abdominal hollowing” that activate the transverse abdominus, and can be supplemented by biofeedback and cueing.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8 Gradually, the exercises can be progressed to more functional positions and activities.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8 Exercises involving lumbar flexion should be avoided as lumbar flexion can increase radicular symptoms through greater posterior pressure on the disc, so exercises in a neutral or slightly extended position should be implemented.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The role of core stabilization in lumbosacral radiculopathy.","id":"6061245","page":"91-103","type":"article-journal","volume":"22","issue":"1","author":[{"family":"Kennedy","given":"David J"},{"family":"Noh","given":"Maureen Y"}],"issued":{"date-parts":[["2011","2"]]},"container-title":"Physical medicine and rehabilitation clinics of North America","container-title-short":"Phys. Med. Rehabil. Clin. N. Am.","journalAbbreviation":"Phys. Med. Rehabil. Clin. N. Am.","DOI":"10.1016/j.pmr.2010.12.002","PMID":"21292147","citation-label":"6061245","Abstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy. Copyright ? 2011 Elsevier Inc. All rights reserved.","CleanAbstract":"Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.Copyright ? 2011 Elsevier Inc. All rights reserved."}]8Hahne et al. conducted a systematic review of conservative treatments implemented on subjects with LDH and radiculopathy and identified a randomized controlled trial (RCT) that they considered high-quality which found that a lumbar stabilization exercise intervention significantly improved pain, trunk flexion range of motion, painless straight leg raise range, and physical functioning.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review.","id":"3520035","page":"E488-504","type":"article-journal","volume":"35","issue":"11","author":[{"family":"Hahne","given":"Andrew J"},{"family":"Ford","given":"Jon J"},{"family":"McMeeken","given":"Joan M"}],"issued":{"date-parts":[["2010","5","15"]]},"container-title":"Spine","container-title-short":"Spine","journalAbbreviation":"Spine","DOI":"10.1097/BRS.0b013e3181cc3f56","PMID":"20421859","citation-label":"3520035","Abstract":"STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.","CleanAbstract":"STUDY DESIGN: A systematic review of randomized controlled trials.OBJECTIVE: To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR).SUMMARY OF BACKGROUND DATA: Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear.METHODS: We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment.RESULTS: Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events).CONCLUSION: Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy."}]13,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation","id":"6088130","page":"55-60","type":"article-journal","volume":"18","issue":"3-4","author":[{"family":"Bakhtiary","given":"Amir Hoshang"},{"family":"Safavi-Farokhi","given":"Ziaeddin"},{"family":"Rezasoltani","given":"Asghar"}],"issued":{"date-parts":[["2005","9","12"]]},"container-title":"Business and Management Research","container-title-short":"BMR","journalAbbreviation":"BMR","DOI":"10.3233/BMR-2005-183-401","citation-label":"6088130","CleanAbstract":"No abstract available"}]18 The exercises in this intervention were progressed by changing positions and adding extremity movements or an exercise ball.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation","id":"6088130","page":"55-60","type":"article-journal","volume":"18","issue":"3-4","author":[{"family":"Bakhtiary","given":"Amir Hoshang"},{"family":"Safavi-Farokhi","given":"Ziaeddin"},{"family":"Rezasoltani","given":"Asghar"}],"issued":{"date-parts":[["2005","9","12"]]},"container-title":"Business and Management Research","container-title-short":"BMR","journalAbbreviation":"BMR","DOI":"10.3233/BMR-2005-183-401","citation-label":"6088130","CleanAbstract":"No abstract available"}]18 While there is limited evidence overall, CSE may improve outcomes in patients with lumbosacral radiculopathy. Lumbar spinal stenosis (LSS), or narrowing of the spinal canal, is often diagnosed through MRI or CT, but there is no established objective definition for LSS.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Spinal stenosis prevalence and association with symptoms: the Framingham Study.","id":"6066587","page":"545-550","type":"article-journal","volume":"9","issue":"7","author":[{"family":"Kalichman","given":"Leonid"},{"family":"Cole","given":"Robert"},{"family":"Kim","given":"David H"},{"family":"Li","given":"Ling"},{"family":"Suri","given":"Pradeep"},{"family":"Guermazi","given":"Ali"},{"family":"Hunter","given":"David J"}],"issued":{"date-parts":[["2009","7"]]},"container-title":"The Spine Journal","container-title-short":"Spine J.","journalAbbreviation":"Spine J.","DOI":"10.1016/j.spinee.2009.03.005","PMID":"19398386","PMCID":"PMC3775665","citation-label":"6066587","Abstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS. METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53). CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.","CleanAbstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear.PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP.STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study.PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study.OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS.METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index.RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53).CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP."}]19 Kalichman et al. incorporated a commonly used cutoff of <12 mm canal diameter to represent “relative” stenosis and <10 mm to represent “absolute” stenosis.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Spinal stenosis prevalence and association with symptoms: the Framingham Study.","id":"6066587","page":"545-550","type":"article-journal","volume":"9","issue":"7","author":[{"family":"Kalichman","given":"Leonid"},{"family":"Cole","given":"Robert"},{"family":"Kim","given":"David H"},{"family":"Li","given":"Ling"},{"family":"Suri","given":"Pradeep"},{"family":"Guermazi","given":"Ali"},{"family":"Hunter","given":"David J"}],"issued":{"date-parts":[["2009","7"]]},"container-title":"The Spine Journal","container-title-short":"Spine J.","journalAbbreviation":"Spine J.","DOI":"10.1016/j.spinee.2009.03.005","PMID":"19398386","PMCID":"PMC3775665","citation-label":"6066587","Abstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS. METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53). CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.","CleanAbstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear.PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP.STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study.PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study.OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS.METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index.RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53).CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP."}]19 Using data from the large Framingham Heart Study, the investigators observed that the prevalence of relative acquired, or developmental, LSS was 22.5% and of absolute acquired LSS was 7.3%.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Spinal stenosis prevalence and association with symptoms: the Framingham Study.","id":"6066587","page":"545-550","type":"article-journal","volume":"9","issue":"7","author":[{"family":"Kalichman","given":"Leonid"},{"family":"Cole","given":"Robert"},{"family":"Kim","given":"David H"},{"family":"Li","given":"Ling"},{"family":"Suri","given":"Pradeep"},{"family":"Guermazi","given":"Ali"},{"family":"Hunter","given":"David J"}],"issued":{"date-parts":[["2009","7"]]},"container-title":"The Spine Journal","container-title-short":"Spine J.","journalAbbreviation":"Spine J.","DOI":"10.1016/j.spinee.2009.03.005","PMID":"19398386","PMCID":"PMC3775665","citation-label":"6066587","Abstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS. METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53). CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.","CleanAbstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear.PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP.STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study.PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study.OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS.METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index.RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53).CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP."}]19 Prevalence increased with increasing age, and absolute, though not relative, LSS was associated with the presence of low back pain.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Spinal stenosis prevalence and association with symptoms: the Framingham Study.","id":"6066587","page":"545-550","type":"article-journal","volume":"9","issue":"7","author":[{"family":"Kalichman","given":"Leonid"},{"family":"Cole","given":"Robert"},{"family":"Kim","given":"David H"},{"family":"Li","given":"Ling"},{"family":"Suri","given":"Pradeep"},{"family":"Guermazi","given":"Ali"},{"family":"Hunter","given":"David J"}],"issued":{"date-parts":[["2009","7"]]},"container-title":"The Spine Journal","container-title-short":"Spine J.","journalAbbreviation":"Spine J.","DOI":"10.1016/j.spinee.2009.03.005","PMID":"19398386","PMCID":"PMC3775665","citation-label":"6066587","Abstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP. STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study. OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS. METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index. RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53). CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.","CleanAbstract":"BACKGROUND CONTEXT: The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear.PURPOSE: To evaluate the prevalence of congenital and acquired LSS observed on computed tomography in a community-based sample; and to evaluate the association between LSS and LBP.STUDY DESIGN/SETTING: Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study.PATIENT SAMPLE: A total of 3,529 participants underwent multidetector computed tomography; 191 were enrolled in this study.OUTCOME MEASURES: Self-report measures: LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic measures: LSS (congenital and acquired) was characterized using two cut-points: 12mm for relative LSS and 10mm for absolute LSS.METHODS: Using multiple logistic regression, we examined the association between LSS and LBP, adjusting for sex, age, and body mass index.RESULTS: In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age less than 40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively, and in those 60 to 69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% confidence interval [CI]: 1.05-9.53).CONCLUSIONS: The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP."}]19 Overall, although LSS is not clearly defined, it appears present in a fairly large proportion of the population and may be commonly associated with back pain. Like the two above conditions, there appears to be few articles examining CSE and lumbar spinal stenosis. One study implemented a CSE intervention that included exercises such as planks, bridges, and straight leg raises that were performed daily for six weeks.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?","id":"5857153","page":"631-634","type":"article-journal","volume":"33","issue":"3","author":[{"family":"Chen","given":"Chaxiang"},{"family":"Lin","given":"Zhichao"},{"family":"Zhang","given":"Yingjie"},{"family":"Chen","given":"Zemin"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2017","6"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.333.12123","PMID":"28811784","PMCID":"PMC5510116","citation-label":"5857153","Abstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis. METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed. RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p< 0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05). CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.","CleanAbstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed.RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p0.05) or self-reported walking distance (p>0.05).CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis."}]20 This intervention was shown to significantly improve self-reported walking distance and Japanese Orthopedic Association (JOA) score, which assesses subjective symptoms and functional impairments in subjects with LSS.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?","id":"5857153","page":"631-634","type":"article-journal","volume":"33","issue":"3","author":[{"family":"Chen","given":"Chaxiang"},{"family":"Lin","given":"Zhichao"},{"family":"Zhang","given":"Yingjie"},{"family":"Chen","given":"Zemin"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2017","6"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.333.12123","PMID":"28811784","PMCID":"PMC5510116","citation-label":"5857153","Abstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis. METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed. RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p< 0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05). CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.","CleanAbstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed.RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p0.05) or self-reported walking distance (p>0.05).CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis."}]20 Mu et al. implemented a very similar CSE intervention that was continued for four weeks but was compared to a general exercise intervention.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Comparison of two types of exercises in the treatment of lumbar spinal stenosis.","id":"5857152","page":"897-900","type":"article-journal","volume":"34","issue":"4","author":[{"family":"Mu","given":"Wenzhi"},{"family":"Shang","given":"Yong"},{"family":"Mo","given":"Zhuomao"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2018","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.344.15296","PMID":"30190749","PMCID":"PMC6115584","citation-label":"5857152","Abstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis. Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment. Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p< 0.05) and self-reported walking capacity (p< 0.05) increased significantly in each group when compared with baseline. The self-reported walking capacity and JOA scores in the group of core stability exercise were significantly higher than those in the conventional exercise group (p< 0.05). However, both the intragroup and intergroup comparison of lumbar lordosis presented with no significance (p>0.05). Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis.","CleanAbstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis.Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment.Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p0.05).Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis."}]21 All of the subjects in both groups received middle frequency electrotherapy prior to the interventions, which may influence the results.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Comparison of two types of exercises in the treatment of lumbar spinal stenosis.","id":"5857152","page":"897-900","type":"article-journal","volume":"34","issue":"4","author":[{"family":"Mu","given":"Wenzhi"},{"family":"Shang","given":"Yong"},{"family":"Mo","given":"Zhuomao"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2018","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.344.15296","PMID":"30190749","PMCID":"PMC6115584","citation-label":"5857152","Abstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis. Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment. Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p< 0.05) and self-reported walking capacity (p< 0.05) increased significantly in each group when compared with baseline. The self-reported walking capacity and JOA scores in the group of core stability exercise were significantly higher than those in the conventional exercise group (p< 0.05). However, both the intragroup and intergroup comparison of lumbar lordosis presented with no significance (p>0.05). Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis.","CleanAbstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis.Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment.Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p0.05).Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis."}]21 Both groups significantly improved in JOA score and self-reported walking capacity, but the CSE group had a significantly larger increase in the outcomes than the general exercise group.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Comparison of two types of exercises in the treatment of lumbar spinal stenosis.","id":"5857152","page":"897-900","type":"article-journal","volume":"34","issue":"4","author":[{"family":"Mu","given":"Wenzhi"},{"family":"Shang","given":"Yong"},{"family":"Mo","given":"Zhuomao"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2018","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.344.15296","PMID":"30190749","PMCID":"PMC6115584","citation-label":"5857152","Abstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis. Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment. Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p< 0.05) and self-reported walking capacity (p< 0.05) increased significantly in each group when compared with baseline. The self-reported walking capacity and JOA scores in the group of core stability exercise were significantly higher than those in the conventional exercise group (p< 0.05). However, both the intragroup and intergroup comparison of lumbar lordosis presented with no significance (p>0.05). Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis.","CleanAbstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis.Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment.Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p0.05).Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis."}]21 Lumbar lordosis angle measured through radiograph did not significantly change in either group.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Comparison of two types of exercises in the treatment of lumbar spinal stenosis.","id":"5857152","page":"897-900","type":"article-journal","volume":"34","issue":"4","author":[{"family":"Mu","given":"Wenzhi"},{"family":"Shang","given":"Yong"},{"family":"Mo","given":"Zhuomao"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2018","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.344.15296","PMID":"30190749","PMCID":"PMC6115584","citation-label":"5857152","Abstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis. Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment. Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p< 0.05) and self-reported walking capacity (p< 0.05) increased significantly in each group when compared with baseline. The self-reported walking capacity and JOA scores in the group of core stability exercise were significantly higher than those in the conventional exercise group (p< 0.05). However, both the intragroup and intergroup comparison of lumbar lordosis presented with no significance (p>0.05). Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis.","CleanAbstract":"Objective: To evaluate the efficacy of core stability exercise versus conventional exercise in the treatment of lumbar spinal stenosis.Methods: Between January 2014 and May 2017, patients with lumbar spinal stenosis were recruited and divided into group of core stability exercise or conventional exercise randomly. All the patients were treated using middle frequency electrotherapy, in addition to that, the patients in group of core stability exercise were treated using core stability exercise. The patients in group of conventional exercise were treated using conventional exercise. The outcome was evaluated using Japanese Orthopedic Association (JOA) score, self-reported walking capacity and lumbar lordosis angle at baseline and after treatment.Results: In the current study, sixty-two patients with lumbar spinal stenosis met the inclusion and exclusion criteria, in which 33 patients were included in group of core stability exercise and 29 in group of conventional exercise. After treatment, both Japanese Orthopedic Association scores (p0.05).Conclusion: Core stability exercise presents with better efficacy than conventional exercise in the treatment of lumbar spinal stenosis."}]21 Chen et al. also measured the degree of spinal stenosis in the subjects through MRI but did not find a significant correlation between the degree of spinal stenosis and JOA score or walking distance.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?","id":"5857153","page":"631-634","type":"article-journal","volume":"33","issue":"3","author":[{"family":"Chen","given":"Chaxiang"},{"family":"Lin","given":"Zhichao"},{"family":"Zhang","given":"Yingjie"},{"family":"Chen","given":"Zemin"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2017","6"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.333.12123","PMID":"28811784","PMCID":"PMC5510116","citation-label":"5857153","Abstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis. METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed. RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p< 0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05). CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.","CleanAbstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed.RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p0.05) or self-reported walking distance (p>0.05).CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis."}]20 This suggests that symptoms or function do not reliably correlate with the severity of canal narrowing.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?","id":"5857153","page":"631-634","type":"article-journal","volume":"33","issue":"3","author":[{"family":"Chen","given":"Chaxiang"},{"family":"Lin","given":"Zhichao"},{"family":"Zhang","given":"Yingjie"},{"family":"Chen","given":"Zemin"},{"family":"Tang","given":"Shujie"}],"issued":{"date-parts":[["2017","6"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.333.12123","PMID":"28811784","PMCID":"PMC5510116","citation-label":"5857153","Abstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis. METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed. RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p< 0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05). CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.","CleanAbstract":"OBJECTIVE: To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.METHODS: Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed.RESULTS: The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p0.05) or self-reported walking distance (p>0.05).CONCLUSION: There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis."}]20 Nevertheless, physical therapists would likely focus on the symptoms more than the canal diameter, and CSE may improve symptoms and function in patients with LSS. Unlike in the above conditions, there seems to be a far larger number of studies examining CSE interventions and non-specific chronic low back pain (CLBP). 70-85% of individuals may suffer from back pain during some portion of their lives and recurrence rates can be very high.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Epidemiological features of chronic low-back pain.","id":"881027","page":"581-585","type":"article-journal","volume":"354","issue":"9178","author":[{"family":"Andersson","given":"G B"}],"issued":{"date-parts":[["1999","8","14"]]},"container-title":"The Lancet","container-title-short":"Lancet","journalAbbreviation":"Lancet","DOI":"10.1016/S0140-6736(99)01312-4","PMID":"10470716","citation-label":"881027","Abstract":"Although the literature is filled with information about the prevalence and incidence of back pain in general, there is less information about chronic back pain, partly because of a lack of agreement about definition. Chronic back pain is sometimes defined as back pain that lasts for longer than 7-12 weeks. Others define it as pain that lasts beyond the expected period of healing, and acknowledge that chronic pain may not have well-defined underlying pathological causes. Others classify frequently recurring back pain as chronic pain since it intermittently affects an individual over a long period. Most national insurance and industrial sources of data include only those individuals in whom symptoms result in loss of days at work or other disability. Thus, even less is known about the epidemiology of chronic low-back pain with no associated work disability or compensation. Chronic low-back pain has also become a diagnosis of convenience for many people who are actually disabled for socioeconomic, work-related, or psychological reasons. In fact, some people argue that chronic disability in back pain is primarily related to a psychosocial dysfunction. Because the validity and reliability of some of the existing data are uncertain, caution is needed in an assessment of the information on this type of pain.","CleanAbstract":"Although the literature is filled with information about the prevalence and incidence of back pain in general, there is less information about chronic back pain, partly because of a lack of agreement about definition. Chronic back pain is sometimes defined as back pain that lasts for longer than 7-12 weeks. Others define it as pain that lasts beyond the expected period of healing, and acknowledge that chronic pain may not have well-defined underlying pathological causes. Others classify frequently recurring back pain as chronic pain since it intermittently affects an individual over a long period. Most national insurance and industrial sources of data include only those individuals in whom symptoms result in loss of days at work or other disability. Thus, even less is known about the epidemiology of chronic low-back pain with no associated work disability or compensation. Chronic low-back pain has also become a diagnosis of convenience for many people who are actually disabled for socioeconomic, work-related, or psychological reasons. In fact, some people argue that chronic disability in back pain is primarily related to a psychosocial dysfunction. Because the validity and reliability of some of the existing data are uncertain, caution is needed in an assessment of the information on this type of pain."}]22 About 90% of CLBP may be of a non-specific origin.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis.","id":"5854040","page":"351","type":"article-journal","volume":"19","issue":"1","author":[{"family":"Cooley","given":"Jeffrey R"},{"family":"Walker","given":"Bruce F"},{"family":"M Ardakani","given":"Emad"},{"family":"Kjaer","given":"Per"},{"family":"Jensen","given":"Tue S"},{"family":"Hebert","given":"Jeffrey J"}],"issued":{"date-parts":[["2018","9","27"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/s12891-018-2266-5","PMID":"30261870","PMCID":"PMC6161433","citation-label":"5854040","Abstract":"BACKGROUND: Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology. METHODS: Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained. RESULTS: Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis. CONCLUSIONS: Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies. TRIAL REGISTRATION: PROSPERO 2015: CRD42015012985.","CleanAbstract":"BACKGROUND: Individual study results have demonstrated unclear relationships between neurocompressive disorders and paraspinal muscle morphology. This systematic review aimed to synthesize current evidence regarding the relationship lumbar neurocompressive disorders may have with lumbar paraspinal muscle morphology.METHODS: Searches were conducted in seven databases from inception through October 2017. Observational studies with control or comparison groups comparing herniations, facet degeneration, or canal stenosis to changes in imaging or biopsy-identified lumbar paraspinal muscle morphology were included. Data extraction and risk of bias assessment were performed by review author pairs independent of one another. Morphological differences between individuals with and without neurocompressive disorders were compared qualitatively, and where possible, standardised mean differences were obtained.RESULTS: Twenty-eight studies were included. Lumbar multifidus fiber diameter was smaller on the side of and below herniation for type I [SMD: -0.40 (95% CI = -0.70, -0.09) and type II fibers [SMD: -0.38 (95% CI = -0.69, -0.06)] compared to the unaffected side. The distribution of type I fibers was greater on the herniation side [SMD: 0.43 (95% CI = 0.03, 0.82)]. Qualitatively, two studies assessing small angular fiber frequency and fiber type groupings demonstrated increases in these parameters below the herniation level. For diagnostic imaging meta-analyses, there were no consistent differences across the various assessment types for any paraspinal muscle groups when patients with herniation served as their own control. However, qualitative synthesis of between-group comparisons reported greater multifidus and erector spinae muscle atrophy or fat infiltration among patients with disc herniation and radiculopathy in four of six studies, and increased fatty infiltration in paraspinal muscles with higher grades of facet joint degeneration in four of five studies. Conflicting outcomes and variations in study methodology precluded a clear conclusion for canal stenosis.CONCLUSIONS: Based on mixed levels of risk of bias data, in patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level. As the variability of study quality and heterogeneous approaches utilized to assess muscle morphology challenged comparison across studies, we provide recommendations to promote uniform measurement techniques for future studies.TRIAL REGISTRATION: PROSPERO 2015: CRD42015012985."}]17 Wang et al. conducted a systematic review and meta-analysis of 5 RCTs comparing CSE and general exercise interventions in individuals with non-specific CLBP and found that CSE interventions significantly improved pain and functional status at short term follow-up; however, no significant differences were found between the interventions at 6 or 12 month follow-up.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A meta-analysis of core stability exercise versus general exercise for chronic low back pain.","id":"27489","page":"e52082","type":"article-journal","volume":"7","issue":"12","author":[{"family":"Wang","given":"Xue-Qiang"},{"family":"Zheng","given":"Jie-Jiao"},{"family":"Yu","given":"Zhuo-Wei"},{"family":"Bi","given":"Xia"},{"family":"Lou","given":"Shu-Jie"},{"family":"Liu","given":"Jing"},{"family":"Cai","given":"Bin"},{"family":"Hua","given":"Ying-Hui"},{"family":"Wu","given":"Mark"},{"family":"Wei","given":"Mao-Ling"},{"family":"Shen","given":"Hai-Min"},{"family":"Chen","given":"Yi"},{"family":"Pan","given":"Yu-Jian"},{"family":"Xu","given":"Guo-Hui"},{"family":"Chen","given":"Pei-Jie"}],"issued":{"date-parts":[["2012","12","17"]]},"container-title":"Plos One","container-title-short":"PLoS ONE","journalAbbreviation":"PLoS ONE","DOI":"10.1371/journal.pone.0052082","PMID":"23284879","PMCID":"PMC3524111","citation-label":"27489","Abstract":"OBJECTIVE: To review the effects of core stability exercise or general exercise for patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Exercise therapy appears to be effective at decreasing pain and improving function for patients with chronic LBP in practice guidelines. Core stability exercise is becoming increasingly popular for LBP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with chronic LBP. METHODS: Published articles from 1970 to October 2011 were identified using electronic searches. For this meta-analysis, two reviewers independently selected relevant randomized controlled trials (RCTs) investigating core stability exercise versus general exercise for the treatment of patients with chronic LBP. Data were extracted independently by the same two individuals who selected the studies. RESULTS: From the 28 potentially relevant trials, a total of 5 trials involving 414 participants were included in the current analysis. The pooling revealed that core stability exercise was better than general exercise for reducing pain [mean difference (-1.29); 95% confidence interval (-2.47, -0.11); P?=?0.003] and disability [mean difference (-7.14); 95% confidence interval (-11.64, -2.65); P?=?0.002] at the time of the short-term follow-up. However, no significant differences were observed between core stability exercise and general exercise in reducing pain at 6 months [mean difference (-0.50); 95% confidence interval (-1.36, 0.36); P?=?0.26] and 12 months [mean difference (-0.32); 95% confidence interval (-0.87, 0.23); P?=?0.25]. CONCLUSIONS: Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42011001717.","CleanAbstract":"OBJECTIVE: To review the effects of core stability exercise or general exercise for patients with chronic low back pain (LBP).SUMMARY OF BACKGROUND DATA: Exercise therapy appears to be effective at decreasing pain and improving function for patients with chronic LBP in practice guidelines. Core stability exercise is becoming increasingly popular for LBP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with chronic LBP.METHODS: Published articles from 1970 to October 2011 were identified using electronic searches. For this meta-analysis, two reviewers independently selected relevant randomized controlled trials (RCTs) investigating core stability exercise versus general exercise for the treatment of patients with chronic LBP. Data were extracted independently by the same two individuals who selected the studies.RESULTS: From the 28 potentially relevant trials, a total of 5 trials involving 414 participants were included in the current analysis. The pooling revealed that core stability exercise was better than general exercise for reducing pain [mean difference (-1.29); 95% confidence interval (-2.47, -0.11); P?=?0.003] and disability [mean difference (-7.14); 95% confidence interval (-11.64, -2.65); P?=?0.002] at the time of the short-term follow-up. However, no significant differences were observed between core stability exercise and general exercise in reducing pain at 6 months [mean difference (-0.50); 95% confidence interval (-1.36, 0.36); P?=?0.26] and 12 months [mean difference (-0.32); 95% confidence interval (-0.87, 0.23); P?=?0.25].CONCLUSIONS: Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise.SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42011001717."}]23 CSE interventions may therefore have at least a short-term advantage over general exercise. The studies were considered to have a high risk of bias, which may limit the conclusions drawn from the review, although no adverse events were reported in the studies.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"A meta-analysis of core stability exercise versus general exercise for chronic low back pain.","id":"27489","page":"e52082","type":"article-journal","volume":"7","issue":"12","author":[{"family":"Wang","given":"Xue-Qiang"},{"family":"Zheng","given":"Jie-Jiao"},{"family":"Yu","given":"Zhuo-Wei"},{"family":"Bi","given":"Xia"},{"family":"Lou","given":"Shu-Jie"},{"family":"Liu","given":"Jing"},{"family":"Cai","given":"Bin"},{"family":"Hua","given":"Ying-Hui"},{"family":"Wu","given":"Mark"},{"family":"Wei","given":"Mao-Ling"},{"family":"Shen","given":"Hai-Min"},{"family":"Chen","given":"Yi"},{"family":"Pan","given":"Yu-Jian"},{"family":"Xu","given":"Guo-Hui"},{"family":"Chen","given":"Pei-Jie"}],"issued":{"date-parts":[["2012","12","17"]]},"container-title":"Plos One","container-title-short":"PLoS ONE","journalAbbreviation":"PLoS ONE","DOI":"10.1371/journal.pone.0052082","PMID":"23284879","PMCID":"PMC3524111","citation-label":"27489","Abstract":"OBJECTIVE: To review the effects of core stability exercise or general exercise for patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Exercise therapy appears to be effective at decreasing pain and improving function for patients with chronic LBP in practice guidelines. Core stability exercise is becoming increasingly popular for LBP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with chronic LBP. METHODS: Published articles from 1970 to October 2011 were identified using electronic searches. For this meta-analysis, two reviewers independently selected relevant randomized controlled trials (RCTs) investigating core stability exercise versus general exercise for the treatment of patients with chronic LBP. Data were extracted independently by the same two individuals who selected the studies. RESULTS: From the 28 potentially relevant trials, a total of 5 trials involving 414 participants were included in the current analysis. The pooling revealed that core stability exercise was better than general exercise for reducing pain [mean difference (-1.29); 95% confidence interval (-2.47, -0.11); P?=?0.003] and disability [mean difference (-7.14); 95% confidence interval (-11.64, -2.65); P?=?0.002] at the time of the short-term follow-up. However, no significant differences were observed between core stability exercise and general exercise in reducing pain at 6 months [mean difference (-0.50); 95% confidence interval (-1.36, 0.36); P?=?0.26] and 12 months [mean difference (-0.32); 95% confidence interval (-0.87, 0.23); P?=?0.25]. CONCLUSIONS: Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42011001717.","CleanAbstract":"OBJECTIVE: To review the effects of core stability exercise or general exercise for patients with chronic low back pain (LBP).SUMMARY OF BACKGROUND DATA: Exercise therapy appears to be effective at decreasing pain and improving function for patients with chronic LBP in practice guidelines. Core stability exercise is becoming increasingly popular for LBP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with chronic LBP.METHODS: Published articles from 1970 to October 2011 were identified using electronic searches. For this meta-analysis, two reviewers independently selected relevant randomized controlled trials (RCTs) investigating core stability exercise versus general exercise for the treatment of patients with chronic LBP. Data were extracted independently by the same two individuals who selected the studies.RESULTS: From the 28 potentially relevant trials, a total of 5 trials involving 414 participants were included in the current analysis. The pooling revealed that core stability exercise was better than general exercise for reducing pain [mean difference (-1.29); 95% confidence interval (-2.47, -0.11); P?=?0.003] and disability [mean difference (-7.14); 95% confidence interval (-11.64, -2.65); P?=?0.002] at the time of the short-term follow-up. However, no significant differences were observed between core stability exercise and general exercise in reducing pain at 6 months [mean difference (-0.50); 95% confidence interval (-1.36, 0.36); P?=?0.26] and 12 months [mean difference (-0.32); 95% confidence interval (-0.87, 0.23); P?=?0.25].CONCLUSIONS: Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise.SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42011001717."}]23 A systematic review and meta-analysis of 29 studies conducted a few years later observed more mixed results. Smith et al. found that CSE interventions led to statistically significant improvements in pain and function compared to alternative forms of treatment or control in short and long term follow-up periods among subjects with low back pain; however, these differences were not clinically significant based on minimal clinically important differences (MCID) at any time period.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.","id":"3516336","page":"416","type":"article-journal","volume":"15","author":[{"family":"Smith","given":"Benjamin E"},{"family":"Littlewood","given":"Chris"},{"family":"May","given":"Stephen"}],"issued":{"date-parts":[["2014","12","9"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/1471-2474-15-416","PMID":"25488399","PMCID":"PMC4295260","citation-label":"3516336","Abstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.","CleanAbstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise.METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate.RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33).CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion."}]24 Compared to only other forms of exercise, CSE also did not demonstrate clinically significant differences in pain and function at any time period and only statistically significant differences at short and medium term follow-up.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.","id":"3516336","page":"416","type":"article-journal","volume":"15","author":[{"family":"Smith","given":"Benjamin E"},{"family":"Littlewood","given":"Chris"},{"family":"May","given":"Stephen"}],"issued":{"date-parts":[["2014","12","9"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/1471-2474-15-416","PMID":"25488399","PMCID":"PMC4295260","citation-label":"3516336","Abstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.","CleanAbstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise.METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate.RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33).CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion."}]24 Many of the studies were considered to be of high quality with a lower risk of bias.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.","id":"3516336","page":"416","type":"article-journal","volume":"15","author":[{"family":"Smith","given":"Benjamin E"},{"family":"Littlewood","given":"Chris"},{"family":"May","given":"Stephen"}],"issued":{"date-parts":[["2014","12","9"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/1471-2474-15-416","PMID":"25488399","PMCID":"PMC4295260","citation-label":"3516336","Abstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.","CleanAbstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise.METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate.RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33).CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion."}]24 The authors offer a strong conclusion that CSE interventions can produce beneficial results but not better than any other forms of exercise.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.","id":"3516336","page":"416","type":"article-journal","volume":"15","author":[{"family":"Smith","given":"Benjamin E"},{"family":"Littlewood","given":"Chris"},{"family":"May","given":"Stephen"}],"issued":{"date-parts":[["2014","12","9"]]},"container-title":"BMC Musculoskeletal Disorders","container-title-short":"BMC Musculoskelet. Disord.","journalAbbreviation":"BMC Musculoskelet. Disord.","DOI":"10.1186/1471-2474-15-416","PMID":"25488399","PMCID":"PMC4295260","citation-label":"3516336","Abstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.","CleanAbstract":"BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise.METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate.RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33).CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion."}]24 Clinical significance is a crucial concept to consider and was not discussed in most of the above studies in this paper. As a result, the authors’ conclusions are based on a higher but likely more meaningful threshold from the MCID than the other studies. Examining only statistical significance, this review similarly shows that CSE only seem to consistently produce short term benefits in pain and function better than general exercise. Either way, the results from this review certainly highlight the value of exploring clinical significance. Nevertheless, a few more recent studies have produced some positive results. A RCT of female nurses with CLBP depicted that an 8-week multi-step CSE intervention led to a significant improvement in pain, functional ability, quality of life, and muscle diameter of the external oblique, internal oblique, and transverse abdominis during an abdominal drawing-in maneuver (ADIM) compared to a wait-list control group.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial.","id":"5808266","page":"490-502","type":"article-journal","volume":"12","issue":"3","author":[{"family":"Noormohammadpour","given":"Pardis"},{"family":"Kordi","given":"Mahla"},{"family":"Mansournia","given":"Mohammad Ali"},{"family":"Akbari-Fakhrabadi","given":"Maryam"},{"family":"Kordi","given":"Ramin"}],"issued":{"date-parts":[["2018","6","4"]]},"container-title":"Asian spine journal","container-title-short":"Asian Spine J.","journalAbbreviation":"Asian Spine J.","DOI":"10.4184/asj.2018.12.3.490","PMID":"29879777","PMCID":"PMC6002169","citation-label":"5808266","Abstract":"STUDY DESIGN: Single-blinded randomized controlled trial. PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP. METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups. RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p < 0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p < 0.05). CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP.","CleanAbstract":"STUDY DESIGN: Single-blinded randomized controlled trial.PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP).OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP.METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups.RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP."}]25 The intervention included the ADIM and exercises utilizing a Swiss ball, with progressions in various positions and dynamic movements.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial.","id":"5808266","page":"490-502","type":"article-journal","volume":"12","issue":"3","author":[{"family":"Noormohammadpour","given":"Pardis"},{"family":"Kordi","given":"Mahla"},{"family":"Mansournia","given":"Mohammad Ali"},{"family":"Akbari-Fakhrabadi","given":"Maryam"},{"family":"Kordi","given":"Ramin"}],"issued":{"date-parts":[["2018","6","4"]]},"container-title":"Asian spine journal","container-title-short":"Asian Spine J.","journalAbbreviation":"Asian Spine J.","DOI":"10.4184/asj.2018.12.3.490","PMID":"29879777","PMCID":"PMC6002169","citation-label":"5808266","Abstract":"STUDY DESIGN: Single-blinded randomized controlled trial. PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP. METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups. RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p < 0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p < 0.05). CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP.","CleanAbstract":"STUDY DESIGN: Single-blinded randomized controlled trial.PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP).OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP.METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups.RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP."}]25 A large limitation of the study is that 16 of the 36 total subjects dropped out, which could influence the results.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial.","id":"5808266","page":"490-502","type":"article-journal","volume":"12","issue":"3","author":[{"family":"Noormohammadpour","given":"Pardis"},{"family":"Kordi","given":"Mahla"},{"family":"Mansournia","given":"Mohammad Ali"},{"family":"Akbari-Fakhrabadi","given":"Maryam"},{"family":"Kordi","given":"Ramin"}],"issued":{"date-parts":[["2018","6","4"]]},"container-title":"Asian spine journal","container-title-short":"Asian Spine J.","journalAbbreviation":"Asian Spine J.","DOI":"10.4184/asj.2018.12.3.490","PMID":"29879777","PMCID":"PMC6002169","citation-label":"5808266","Abstract":"STUDY DESIGN: Single-blinded randomized controlled trial. PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP. METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups. RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p < 0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p < 0.05). CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP.","CleanAbstract":"STUDY DESIGN: Single-blinded randomized controlled trial.PURPOSE: To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP).OVERVIEW OF LITERATURE: CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP.METHODS: In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland-Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups.RESULTS: The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p CONCLUSIONS: This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP."}]25 The investigators also used a sample of health care providers which may differ from the general population. Still, the study shows positive potential of a CSE intervention.Another study showed that a CSE intervention led to a significantly greater reduction in pain than a routine physical therapy intervention.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.","id":"5147713","page":"1002-1006","type":"article-journal","volume":"33","issue":"4","author":[{"family":"Akhtar","given":"Muhammad Waseem"},{"family":"Karimi","given":"Hossein"},{"family":"Gilani","given":"Syed Amir"}],"issued":{"date-parts":[["2017","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.334.12664","PMID":"29067082","PMCID":"PMC5648929","citation-label":"5147713","Abstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.","CleanAbstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain.METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment.RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively.CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain."}]9 The subjects in the CSE intervention group attended 40-minute sessions once weekly for six weeks and performed the same exercises at home twice per week.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.","id":"5147713","page":"1002-1006","type":"article-journal","volume":"33","issue":"4","author":[{"family":"Akhtar","given":"Muhammad Waseem"},{"family":"Karimi","given":"Hossein"},{"family":"Gilani","given":"Syed Amir"}],"issued":{"date-parts":[["2017","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.334.12664","PMID":"29067082","PMCID":"PMC5648929","citation-label":"5147713","Abstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.","CleanAbstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain.METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment.RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively.CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain."}]9 The intervention included exercises such as planks, pelvic floor exercises, and diaphragmatic strengthening exercises.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial.","id":"5147713","page":"1002-1006","type":"article-journal","volume":"33","issue":"4","author":[{"family":"Akhtar","given":"Muhammad Waseem"},{"family":"Karimi","given":"Hossein"},{"family":"Gilani","given":"Syed Amir"}],"issued":{"date-parts":[["2017","8"]]},"container-title":"Pakistan journal of medical sciences quarterly","container-title-short":"Pak. J. Med. Sci. Q.","journalAbbreviation":"Pak. J. Med. Sci. Q.","DOI":"10.12669/pjms.334.12664","PMID":"29067082","PMCID":"PMC5648929","citation-label":"5147713","Abstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain. METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment. RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively. CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.","CleanAbstract":"BACKGROUND & OBJECTIVE: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain.METHODS: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment.RESULTS: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively.CONCLUSION: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain."}]9 Interestingly, although the pelvic floor and diaphragm are also considered core musculature,ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 very few studies with CSE interventions seemed to mention exercises specifically targeting these areas. It certainly cannot be determined if these specific exercises influenced the positive results of the study, but further examination of these additional core areas could be helpful. In general, although the two above studies do not assess clinical significance, there is still potential for CSE to produce uniquely positive results. Based on the above results, general exercise may be similarly effective as stabilization exercises in treating non-specific CLBP. It would also be important to understand if stabilization exercises could reduce low back pain specifically associated with lumbar instability, since instability would be a logical indication for a stabilization intervention. Hicks et al. developed a clinical prediction rule that may help identify patients who may benefit from a CSE program, which includes patients who are younger than 40 years old, have an average straight leg raise of greater than 91 degrees, have aberrant spinal movements, and have a positive prone instability test.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program.","id":"612649","page":"1753-1762","type":"article-journal","volume":"86","issue":"9","author":[{"family":"Hicks","given":"Gregory E"},{"family":"Fritz","given":"Julie M"},{"family":"Delitto","given":"Anthony"},{"family":"McGill","given":"Stuart M"}],"issued":{"date-parts":[["2005","9"]]},"container-title":"Archives of Physical Medicine and Rehabilitation","container-title-short":"Arch. Phys. Med. Rehabil.","journalAbbreviation":"Arch. Phys. Med. Rehabil.","DOI":"10.1016/j.apmr.2005.03.033","PMID":"16181938","citation-label":"612649","Abstract":"OBJECTIVE: To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain (LBP). DESIGN: A prospective, cohort study of patients with nonradicular LBP referred to physical therapy (PT). SETTING: Outpatient PT clinics. PARTICIPANTS: Fifty-four patients with nonradicular LBP. INTERVENTION: A standardized stabilization exercise program. MAIN OUTCOME MEASURE: Treatment response (success or failure) was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks. RESULTS: Eighteen subjects were categorized as treatment successes, 15 as treatment failures, and 21 as somewhat improved. After using regression analyses to determine the association between standardized examination variables and treatment response status, preliminary clinical prediction rules were developed for predicting success (positive likelihood ratio [LR], 4.0) and failure (negative LR, .18). The most important variables were age, straight-leg raise, prone instability test, aberrant motions, lumbar hypermobility, and fear-avoidance beliefs. CONCLUSIONS: It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination. The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises.","CleanAbstract":"OBJECTIVE: To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain (LBP).DESIGN: A prospective, cohort study of patients with nonradicular LBP referred to physical therapy (PT).SETTING: Outpatient PT clinics.PARTICIPANTS: Fifty-four patients with nonradicular LBP.INTERVENTION: A standardized stabilization exercise program.MAIN OUTCOME MEASURE: Treatment response (success or failure) was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks.RESULTS: Eighteen subjects were categorized as treatment successes, 15 as treatment failures, and 21 as somewhat improved. After using regression analyses to determine the association between standardized examination variables and treatment response status, preliminary clinical prediction rules were developed for predicting success (positive likelihood ratio [LR], 4.0) and failure (negative LR, .18). The most important variables were age, straight-leg raise, prone instability test, aberrant motions, lumbar hypermobility, and fear-avoidance beliefs.CONCLUSIONS: It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination. The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises."}]26 A list of other various tests that can be used to assess core stability is provided in Appendix B. Puntumetakul et al. found that a CSE intervention resulted in significantly improved pain intensity, functional disability, patient satisfaction, and the transverse abdominus and internal oblique/rectus abdominus recruitment ratio immediately after the intervention and at 3-month follow-up compared to a control intervention in individuals with CLBP and clinical lumbar instability.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability.","id":"6061438","page":"1189-1199","type":"article-journal","volume":"7","author":[{"family":"Puntumetakul","given":"Rungthip"},{"family":"Areeudomwong","given":"Pattanasin"},{"family":"Emasithi","given":"Alongkot"},{"family":"Yamauchi","given":"Junichiro"}],"issued":{"date-parts":[["2013","11","19"]]},"container-title":"Patient preference and adherence","container-title-short":"Patient Prefer. Adherence","journalAbbreviation":"Patient Prefer. Adherence","DOI":"10.2147/PPA.S50436","PMID":"24399870","PMCID":"PMC3875242","citation-label":"6061438","Abstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability. METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks. RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (P< 0.01). Furthermore, CSE enhanced deep abdominal muscle activation better than in the CG (P< 0.001), whereas the CG had deterioration of deep back muscle activation compared with the CSE group (P< 0.01). For within-group comparison, CSE provided significant improvements in all pain-related outcomes over follow-up (P< 0.01), whereas the CG demonstrated reduction in pain intensity during instability catch sign only at 10 weeks (P< 0.01). In addition, CSE showed an improvement in deep abdominal muscle activation (P< 0.01), whereas the CG revealed the deterioration of deep abdominal and back muscle activations (P< 0.05). CONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment.","CleanAbstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability.METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks.RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (PCONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment."}]4 The core stabilization intervention was 10 weeks and consisted of three phases: the first phase emphasized isolated activation of transverse abdominus and lumbar multifidus, the second phase focused on controlling these muscles during extremity movements, and the third phase focused on controlling the muscles during functional tasks.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability.","id":"6061438","page":"1189-1199","type":"article-journal","volume":"7","author":[{"family":"Puntumetakul","given":"Rungthip"},{"family":"Areeudomwong","given":"Pattanasin"},{"family":"Emasithi","given":"Alongkot"},{"family":"Yamauchi","given":"Junichiro"}],"issued":{"date-parts":[["2013","11","19"]]},"container-title":"Patient preference and adherence","container-title-short":"Patient Prefer. Adherence","journalAbbreviation":"Patient Prefer. Adherence","DOI":"10.2147/PPA.S50436","PMID":"24399870","PMCID":"PMC3875242","citation-label":"6061438","Abstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability. METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks. RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (P< 0.01). Furthermore, CSE enhanced deep abdominal muscle activation better than in the CG (P< 0.001), whereas the CG had deterioration of deep back muscle activation compared with the CSE group (P< 0.01). For within-group comparison, CSE provided significant improvements in all pain-related outcomes over follow-up (P< 0.01), whereas the CG demonstrated reduction in pain intensity during instability catch sign only at 10 weeks (P< 0.01). In addition, CSE showed an improvement in deep abdominal muscle activation (P< 0.01), whereas the CG revealed the deterioration of deep abdominal and back muscle activations (P< 0.05). CONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment.","CleanAbstract":"BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability.METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks.RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (PCONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment."}]4 By contrast, Shamsi et al. found that a CSE intervention led to similar improvements in core stability endurance test times, disability, and pain intensity as a general exercise intervention that focused on activating paraspinals and abdominal muscles in individuals with non-specific CLBP.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.","id":"6061371","page":"171-178","type":"article-journal","volume":"32","issue":"3","author":[{"family":"Shamsi","given":"Mohammad Bagher"},{"family":"Rezaei","given":"Mandana"},{"family":"Zamanlou","given":"Mehdi"},{"family":"Sadeghi","given":"Mehdi"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","2","11"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2015.1117550","PMID":"26864057","citation-label":"6061371","Abstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.","CleanAbstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients."}]10 No significant differences were found between the groups immediately after the intervention.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.","id":"6061371","page":"171-178","type":"article-journal","volume":"32","issue":"3","author":[{"family":"Shamsi","given":"Mohammad Bagher"},{"family":"Rezaei","given":"Mandana"},{"family":"Zamanlou","given":"Mehdi"},{"family":"Sadeghi","given":"Mehdi"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","2","11"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2015.1117550","PMID":"26864057","citation-label":"6061371","Abstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.","CleanAbstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients."}]10 The intervention consisted of 16 total sessions performed 3 times per week and included contraction of local stabilization muscles.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.","id":"6061371","page":"171-178","type":"article-journal","volume":"32","issue":"3","author":[{"family":"Shamsi","given":"Mohammad Bagher"},{"family":"Rezaei","given":"Mandana"},{"family":"Zamanlou","given":"Mehdi"},{"family":"Sadeghi","given":"Mehdi"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","2","11"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2015.1117550","PMID":"26864057","citation-label":"6061371","Abstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.","CleanAbstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients."}]10 Exercises were progressed similarly as the study above, as subjects would contract the local muscles during functional tasks.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.","id":"6061371","page":"171-178","type":"article-journal","volume":"32","issue":"3","author":[{"family":"Shamsi","given":"Mohammad Bagher"},{"family":"Rezaei","given":"Mandana"},{"family":"Zamanlou","given":"Mehdi"},{"family":"Sadeghi","given":"Mehdi"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","2","11"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2015.1117550","PMID":"26864057","citation-label":"6061371","Abstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.","CleanAbstract":"INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no signi?cant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients."}]10 Focused on objective rather than clinical measurements, Javadian et al. compared an experimental intervention that included core stabilization and general exercises to a control intervention that only included general exercises, which were performed by individuals with non-specific CLBP.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: A randomized clinical trial.","id":"6061437","page":"98-102","type":"article-journal","volume":"6","issue":"2","author":[{"family":"Javadian","given":"Yahya"},{"family":"Akbari","given":"Mohammad"},{"family":"Talebi","given":"Ghoadamali"},{"family":"Taghipour-Darzi","given":"Mohammad"},{"family":"Janmohammadi","given":"Naser"}],"issued":{"date-parts":[["2015"]]},"container-title":"Caspian journal of internal medicine","container-title-short":"Caspian J. Intern. Med.","journalAbbreviation":"Caspian J. Intern. Med.","PMID":"26221508","PMCID":"PMC4478459","citation-label":"6061437","Abstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P< 0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. CONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.","CleanAbstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP).METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test.RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (PCONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation."}]27 Lumbar segmental instability can be depicted as excessive vertebral translation or rotation, but both 8-week interventions significantly reduced most of the translation and rotation motions of the L3-L5 vertebral segments after the interventions.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: A randomized clinical trial.","id":"6061437","page":"98-102","type":"article-journal","volume":"6","issue":"2","author":[{"family":"Javadian","given":"Yahya"},{"family":"Akbari","given":"Mohammad"},{"family":"Talebi","given":"Ghoadamali"},{"family":"Taghipour-Darzi","given":"Mohammad"},{"family":"Janmohammadi","given":"Naser"}],"issued":{"date-parts":[["2015"]]},"container-title":"Caspian journal of internal medicine","container-title-short":"Caspian J. Intern. Med.","journalAbbreviation":"Caspian J. Intern. Med.","PMID":"26221508","PMCID":"PMC4478459","citation-label":"6061437","Abstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P< 0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. CONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.","CleanAbstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP).METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test.RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (PCONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation."}]27 However, the experimental intervention led to significantly lower translation of L4 and L5 and lower rotation of L5.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: A randomized clinical trial.","id":"6061437","page":"98-102","type":"article-journal","volume":"6","issue":"2","author":[{"family":"Javadian","given":"Yahya"},{"family":"Akbari","given":"Mohammad"},{"family":"Talebi","given":"Ghoadamali"},{"family":"Taghipour-Darzi","given":"Mohammad"},{"family":"Janmohammadi","given":"Naser"}],"issued":{"date-parts":[["2015"]]},"container-title":"Caspian journal of internal medicine","container-title-short":"Caspian J. Intern. Med.","journalAbbreviation":"Caspian J. Intern. Med.","PMID":"26221508","PMCID":"PMC4478459","citation-label":"6061437","Abstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P< 0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. CONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.","CleanAbstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP).METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test.RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (PCONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation."}]27 These results therefore indicate that CSE may significantly improve lumbar segmental instability better than general exercise.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: A randomized clinical trial.","id":"6061437","page":"98-102","type":"article-journal","volume":"6","issue":"2","author":[{"family":"Javadian","given":"Yahya"},{"family":"Akbari","given":"Mohammad"},{"family":"Talebi","given":"Ghoadamali"},{"family":"Taghipour-Darzi","given":"Mohammad"},{"family":"Janmohammadi","given":"Naser"}],"issued":{"date-parts":[["2015"]]},"container-title":"Caspian journal of internal medicine","container-title-short":"Caspian J. Intern. Med.","journalAbbreviation":"Caspian J. Intern. Med.","PMID":"26221508","PMCID":"PMC4478459","citation-label":"6061437","Abstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P< 0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. CONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.","CleanAbstract":"BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP).METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test.RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (PCONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation."}]27 While core exercises may not significantly improve clinical symptoms, it is possible that the exercises may improve lumbar segment kinematics. Producing clinically meaningful results is likely more important, but these results suggest that CSE may provide some benefits for lumbar stability. Since the above studies did not utilize long follow-up periods, longer-term follow-up of clinical symptoms may better capture if improved kinematics will lead to reductions in pain and disability. Although the results of the effectiveness of CSE over general exercise are mixed, it would be important to confirm if CSE are actually properly activating the desired muscles since few of the above studies objectively analyzed the activation of particular core muscles in the interventions. It could be possible that activating certain group of muscles (i.e. deep vs. superficial) at the appropriate times could lead to more promising results. Teyhen et al. examined the effects of six specific common core exercises, performed by healthy adults without low back pain, on core muscle thickness.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 A description of the six exercises performed in the study and a graph of the resulting activations of the transverse abdominis and internal oblique muscles are included in Appendix C. The ADIM was measured as a specific exercise but was also incorporated in the other exercises.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 Horizontal side support, or a side plank or side bridge, led to the largest increase in transverse abdominis thickness, whereas the abdominal sit-back and supine lower extremity extender led to smallest change.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 The horizontal side support and abdominal crunch produced the largest increases in internal oblique thickness.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 The ADIM and quadruped opposite upper and lower extremity lift, or bird dog, produced a relatively large increase in transverse abdominis thickness without a large increase in internal oblique thickness.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 From these results, it would appear that the ADIM and bird dog are the most effective exercises for isolated activation of deep core musculature without significant activation of superficial core musculature. While it is not conclusive that isolated deep core activation is more beneficial for treating CLBP, these two exercises should certainly at least be considered in a CSE program. The side plank exercise could also be considered as it produces high transverse abdominis activation, although it may be difficult for individuals with shoulder pathology.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 This would likely be an exercise to omit for patients with shoulder issues.As a result of the above study, Selkow et al. used only the ADIM, bird dog, and side plank exercises (and progressions of the exercises) in their 4-week CSE intervention and found that the intervention significantly improved transverse abdominis activation and timing (less delayed activation) better than a control group in subjects with and without low back pain.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Transversus abdominis activation and timing improves following core stability training: a randomized trial.","id":"5817110","page":"1048-1056","type":"article-journal","volume":"12","issue":"7","author":[{"family":"Selkow","given":"Noelle M"},{"family":"Eck","given":"Molly R"},{"family":"Rivas","given":"Stephen"}],"issued":{"date-parts":[["2017","12"]]},"container-title":"International journal of sports physical therapy","container-title-short":"Int. J. Sports Phys. Ther.","journalAbbreviation":"Int. J. Sports Phys. Ther.","PMID":"29234556","PMCID":"PMC5717480","citation-label":"5817110","Abstract":"Background: Patients with non-specific low back pain (LBP) often present with a decrease in transversus abdominis (TrA) muscle activation and delayed onset of contraction with extremity movements, potentially contributing to recurrent LBP. Core stability is required for extremity movement and if the timing of when the TrA contracts is not corrected patients may continue to experience LBP. Hypothesis/Purpose: The purpose of this study was to assess the effects of a four-week core stability rehabilitation program on TrA activation ratio and when the TrA initiates contraction during upper extremity movements in subjects with and without LBP. It was hypothesized that those with LBP would experience greater changes in TrA activation and onset of contraction by the TrA compared to the healthy group. Study Design: Randomized Clinical Trial. Methods: Forty-two participants volunteered (21 healthy and 21 LBP). Ultrasound imaging measured the TrA activation ratio and time of initial contraction of the TrA during upper extremity movement into flexion. Half of the healthy and LBP participants were assigned to the exercise group. Participants reported twice a week to the athletic training facility to complete an exercise progression of three exercises. After four weeks, all participants returned to have TrA activation and timing measured again. Results: Pertaining to demographics, there were no differences between the healthy and LBP participants. There was a group interaction for both TrA activation ratio (p=.049) and onset of initial contraction (p=.008). Those in the exercise group showed an increase in TrA activation ratio (1.85?±?0.09) compared to the control group (1.79?±?0.08), as well as an improvement in the onset of contraction (2.07?±?0.08 seconds) compared to the control group (2.23?±?0.09 seconds) after the four-week rehabilitation program. Strong effect sizes for TrA activation ratio (0.71 [0.06-1.35]) and initial onset of TrA contraction (-1.88 [-2.63 - -1.11]) were found indicating clinical differences related to the interventions. Conclusion: TrA activation and timing were altered following a four-week core stability program in people with and without LBP. Clinicians should consider incorporating these exercises for improving the function of the TrA. Level of Evidence: Therapy, level 2b.","CleanAbstract":"Background: Patients with non-specific low back pain (LBP) often present with a decrease in transversus abdominis (TrA) muscle activation and delayed onset of contraction with extremity movements, potentially contributing to recurrent LBP. Core stability is required for extremity movement and if the timing of when the TrA contracts is not corrected patients may continue to experience LBP.Hypothesis/Purpose: The purpose of this study was to assess the effects of a four-week core stability rehabilitation program on TrA activation ratio and when the TrA initiates contraction during upper extremity movements in subjects with and without LBP. It was hypothesized that those with LBP would experience greater changes in TrA activation and onset of contraction by the TrA compared to the healthy group.Study Design: Randomized Clinical Trial.Methods: Forty-two participants volunteered (21 healthy and 21 LBP). Ultrasound imaging measured the TrA activation ratio and time of initial contraction of the TrA during upper extremity movement into flexion. Half of the healthy and LBP participants were assigned to the exercise group. Participants reported twice a week to the athletic training facility to complete an exercise progression of three exercises. After four weeks, all participants returned to have TrA activation and timing measured again.Results: Pertaining to demographics, there were no differences between the healthy and LBP participants. There was a group interaction for both TrA activation ratio (p=.049) and onset of initial contraction (p=.008). Those in the exercise group showed an increase in TrA activation ratio (1.85?±?0.09) compared to the control group (1.79?±?0.08), as well as an improvement in the onset of contraction (2.07?±?0.08 seconds) compared to the control group (2.23?±?0.09 seconds) after the four-week rehabilitation program. Strong effect sizes for TrA activation ratio (0.71 [0.06-1.35]) and initial onset of TrA contraction (-1.88 [-2.63 - -1.11]) were found indicating clinical differences related to the interventions.Conclusion: TrA activation and timing were altered following a four-week core stability program in people with and without LBP. Clinicians should consider incorporating these exercises for improving the function of the TrA.Level of Evidence: Therapy, level 2b."}]29 Therefore, these three exercises have potential to improve the degree and timing of activation of deep core musculature. A segmental stabilization intervention that was intended to target the transverse abdominis and lumbar multifidus was compared to a superficial strengthening intervention designed to target the rectus abdominis, obliques, and erector spinae in subjects with non-specific CLBP.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.","id":"3728568","page":"1013-1017","type":"article-journal","volume":"65","issue":"10","author":[{"family":"Fran?a","given":"Fábio Renovato"},{"family":"Burke","given":"Thomaz Nogueira"},{"family":"Hanada","given":"Erica Sato"},{"family":"Marques","given":"Amélia Pasqual"}],"issued":{"date-parts":[["2010"]]},"container-title":"Clinics","container-title-short":"Clinics (Sao Paulo)","journalAbbreviation":"Clinics (Sao Paulo)","DOI":"10.1590/S1807-59322010001000015","PMID":"21120303","PMCID":"PMC2972594","citation-label":"3728568","Abstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.","CleanAbstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%.RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity."}]30 The segmental stabilization intervention, which included exercises in supine hooklying, prone, and quadruped positions, was found to indeed lead to a significant increase in transverse abdominis activation compared to the superficial strengthening intervention that actually led to a slight decrease in activation after the intervention.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.","id":"3728568","page":"1013-1017","type":"article-journal","volume":"65","issue":"10","author":[{"family":"Fran?a","given":"Fábio Renovato"},{"family":"Burke","given":"Thomaz Nogueira"},{"family":"Hanada","given":"Erica Sato"},{"family":"Marques","given":"Amélia Pasqual"}],"issued":{"date-parts":[["2010"]]},"container-title":"Clinics","container-title-short":"Clinics (Sao Paulo)","journalAbbreviation":"Clinics (Sao Paulo)","DOI":"10.1590/S1807-59322010001000015","PMID":"21120303","PMCID":"PMC2972594","citation-label":"3728568","Abstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.","CleanAbstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%.RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity."}]30 The segmental stabilization intervention also significantly improved pain and disability more than the latter intervention.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.","id":"3728568","page":"1013-1017","type":"article-journal","volume":"65","issue":"10","author":[{"family":"Fran?a","given":"Fábio Renovato"},{"family":"Burke","given":"Thomaz Nogueira"},{"family":"Hanada","given":"Erica Sato"},{"family":"Marques","given":"Amélia Pasqual"}],"issued":{"date-parts":[["2010"]]},"container-title":"Clinics","container-title-short":"Clinics (Sao Paulo)","journalAbbreviation":"Clinics (Sao Paulo)","DOI":"10.1590/S1807-59322010001000015","PMID":"21120303","PMCID":"PMC2972594","citation-label":"3728568","Abstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.","CleanAbstract":"OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%.RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity."}]30 These results suggest that exercises that target superficial core muscles may not necessarily improve activation of deep core musculature, as depicted by Teyhen et al., and there may be an association between increased activation of deep core musculature and improved pain and function. An 8-month CSE program led to a significant increase in lumbar multifidus cross-sectional area in both healthy women and women with CLBP.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain.","id":"6061410","page":"841-847","type":"article-journal","volume":"28","issue":"4","author":[{"family":"Kliziene","given":"Irina"},{"family":"Sipaviciene","given":"Saule"},{"family":"Klizas","given":"Sarunas"},{"family":"Imbrasiene","given":"Daiva"}],"issued":{"date-parts":[["2015"]]},"container-title":"Journal of back and musculoskeletal rehabilitation","container-title-short":"J. Back Musculoskelet. Rehabil.","journalAbbreviation":"J. Back Musculoskelet. Rehabil.","DOI":"10.3233/BMR-150596","PMID":"25881694","citation-label":"6061410","Abstract":"BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA). OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction. METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training. RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values. CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP.","CleanAbstract":"BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA).OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction.METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training.RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values.CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP."}]31 Exercises included supine bridging and extremity movements in various positions while maintaining neutral spine position and were performed twice per week for 45 minutes each.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain.","id":"6061410","page":"841-847","type":"article-journal","volume":"28","issue":"4","author":[{"family":"Kliziene","given":"Irina"},{"family":"Sipaviciene","given":"Saule"},{"family":"Klizas","given":"Sarunas"},{"family":"Imbrasiene","given":"Daiva"}],"issued":{"date-parts":[["2015"]]},"container-title":"Journal of back and musculoskeletal rehabilitation","container-title-short":"J. Back Musculoskelet. Rehabil.","journalAbbreviation":"J. Back Musculoskelet. Rehabil.","DOI":"10.3233/BMR-150596","PMID":"25881694","citation-label":"6061410","Abstract":"BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA). OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction. METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training. RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values. CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP.","CleanAbstract":"BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA).OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction.METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training.RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values.CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP."}]31 Another study did not find particular advantages for a CSE intervention. Similar thickness of the obliques and transverse abdominis was found after both a CSE intervention and general exercise intervention in subjects with non-specific CLBP.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.","id":"6061391","page":"277-283","type":"article-journal","volume":"32","issue":"4","author":[{"family":"Shamsi","given":"MohammadBagher"},{"family":"Sarrafzadeh","given":"Javad"},{"family":"Jamshidi","given":"Aliashraf"},{"family":"Zarabi","given":"Vida"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","5"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2016.1138559","PMID":"27253335","citation-label":"6061391","Abstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance. OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP. METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes. RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them. CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.","CleanAbstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance.OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP.METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes.RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them.CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study."}]32 The interventions only significantly differed in right rectus abdominis thickness.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.","id":"6061391","page":"277-283","type":"article-journal","volume":"32","issue":"4","author":[{"family":"Shamsi","given":"MohammadBagher"},{"family":"Sarrafzadeh","given":"Javad"},{"family":"Jamshidi","given":"Aliashraf"},{"family":"Zarabi","given":"Vida"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","5"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2016.1138559","PMID":"27253335","citation-label":"6061391","Abstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance. OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP. METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes. RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them. CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.","CleanAbstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance.OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP.METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes.RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them.CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study."}]32 The CSE focused on contracting deep core musculature while performing other tasks while the general exercise intervention focused on activating paraspinals and superficial abdominal muscles.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.","id":"6061391","page":"277-283","type":"article-journal","volume":"32","issue":"4","author":[{"family":"Shamsi","given":"MohammadBagher"},{"family":"Sarrafzadeh","given":"Javad"},{"family":"Jamshidi","given":"Aliashraf"},{"family":"Zarabi","given":"Vida"},{"family":"Pourahmadi","given":"Mohammad Reza"}],"issued":{"date-parts":[["2016","5"]]},"container-title":"Physiotherapy Theory and Practice","container-title-short":"Physiother. Theory Pract.","journalAbbreviation":"Physiother. Theory Pract.","DOI":"10.3109/09593985.2016.1138559","PMID":"27253335","citation-label":"6061391","Abstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance. OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP. METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes. RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them. CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.","CleanAbstract":"BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance.OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP.METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes.RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them.CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study."}]32These studies in general indicate value in several core exercises in improving deep core activation and possibly subsequently improving pain and other outcomes. The ADIM seems to be the most crucial component in activating transverse abdominis, so any interventions attempting this activation should likely include maintaining ADIM during the exercises. Supine bridge, bird dog, and forward and side plank seem to also be particularly effective and have been included in many of the studies demonstrating positive results in this paper. Overall, it appears that CSE interventions produce similar benefits as general exercise interventions for treating non-specific CLBP. At the most, CSE interventions have been shown to inconsistently produce better effects in the short term, typically related to pain and function. Still, the advantages may not be clinically meaningful. Less research generally appears available for specific lumbar pathologies. Due to this limited amount of research, strong conclusions cannot be established on the effectiveness of CSE on the specific pathologies, although some positive results could be expected. In the above studies, CSE was most commonly compared to general exercises or control groups but not to other conservative or surgical treatments. It would be interesting to observe results from other direct comparisons, particularly with surgical treatment as surgery would induce greater costs and resources. There is no optimal or “gold standard” CSE program, and the above studies have used a variety of methods to implement CSE, including body weight, exercise balls, specialized equipment, and aquatic therapy, although most of the interventions used similar approaches and progressions. Sessions would often start by focusing on isolated activation of deep core musculature and then progress to changing positions or moving extremities and lastly to more functional movements while maintaining deep core activation. Most of the interventions were of relatively short duration of no more than a couple of months and long-term follow-ups were rarely performed, and when performed, did not produce particularly beneficial results. Akuthota et al. provided a clear summary of principles for a CSE program that seem to be incorporated in many of the interventions discussed in this paper.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 The authors provide a succinct example CSE program that is included in Appendix D. The authors emphasize maintaining neutral spine position and diaphragmatic breathing as well as abdominal bracing during exercises.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 Unstable surfaces and the use of exercise balls and other equipment can be used in progressions, but heavy resistance on the lumbar extensors should be avoided.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5 Many of these exercises are similar to the ones that demonstrated significant core activation in the Teyhen et al. study. The exercises in the program can certainly guide the creation of a potentially effective CSE intervention. Ultimately, CSE and general exercise interventions may both lead to similarly positive outcomes, such as improved pain and function, in patients with back conditions or back pain. None of the studies or reviews noted adverse effects or events from the CSE or general exercise interventions, so since both interventions are likely to produce similar results, patient and physical therapist preference or the presence of additional impairments, such as lumbar instability or co-morbidities, may guide clinical decisions. At the very least, core exercises should certainly be considered when structuring a therapeutic exercise program, as core musculature seem to have a valuable role in improving outcomes in individuals with lumbar pathologies or non-specific CLBP.Appendix A – Anatomy of Selected Core MusculatureFigure 1: Overview of Abdominal Wall musculature. From deepest to most superficial: transverse abdominis, rectus abdominis, internal oblique, external oblique. Image reprinted from medcaretips.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Muscles of Abdominal Wall | ","id":"6090171","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6090171","CleanAbstract":"No abstract available"}]33Figure 2: External Oblique muscle. Image reprinted from physio-pedia.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Abdominal Muscle Anatomy - Physiopedia","id":"6089468","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6089468","CleanAbstract":"No abstract available"}]34Figure 3: Internal Oblique muscle. Image reprinted from physio-pedia.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Abdominal Muscle Anatomy - Physiopedia","id":"6089468","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6089468","CleanAbstract":"No abstract available"}]34Figure 4: Rectus Abdominis muscle. Image reprinted from physio-pedia.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Abdominal Muscle Anatomy - Physiopedia","id":"6089468","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6089468","CleanAbstract":"No abstract available"}]34Figure 5: Transverse Abdominis muscle (highlighted in light red). Image reprinted from physio-pedia.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Abdominal Muscle Anatomy - Physiopedia","id":"6089468","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6089468","CleanAbstract":"No abstract available"}]34Figure 6: Erector spinae (from lateral to medial: iliocostalis, longissimus, spinalis) and Lumbar Multifidus muscles. Image reprinted from Emory.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"emory.edu/ANATOMY/AnatomyManual/back.html","id":"6090244","type":"webpage","issued":{},"URL":"","accessed":{"date-parts":[["2018","12","1"]]},"citation-label":"6090244","CleanAbstract":"No abstract available"}]35171450016510000Appendix B – Core Stability Tests Table 1: List of several core stability tests. Reprinted from Akuthota et al.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5Appendix C – Description and Core Activation of Common Core Stability ExercisesFigure 1: Description of Common Core Stabilization Exercises. Reprinted from article by Teyhen et al.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28Figure 2: Activation of Transverse Abdominis and Internal Oblique During Core Stabilization Exercises. Reprinted from article by Teyhen et al.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging.","id":"4021959","page":"596-605","type":"article-journal","volume":"38","issue":"10","author":[{"family":"Teyhen","given":"Deydre S"},{"family":"Rieger","given":"Jennifer L"},{"family":"Westrick","given":"Richard B"},{"family":"Miller","given":"Amy C"},{"family":"Molloy","given":"Joseph M"},{"family":"Childs","given":"John D"}],"issued":{"date-parts":[["2008","10"]]},"container-title":"The Journal of Orthopaedic and Sports Physical Therapy","container-title-short":"J. Orthop. Sports Phys. Ther.","journalAbbreviation":"J. Orthop. Sports Phys. Ther.","DOI":"10.2519/jospt.2008.2897","PMID":"18827329","citation-label":"4021959","Abstract":"STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P< .001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.","CleanAbstract":"STUDY DESIGN: Cross-sectional study design.OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (PCONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription."}]28 Appendix D – Core Stabilization Exercise Program Example Table 1: Example structure and characteristics of a core stabilization exercise program. Reprinted from article by Akuthota et al.ADDIN F1000_CSL_CITATION<~#@#~>[{"title":"Core stability exercise principles.","id":"6072401","page":"39-44","type":"article-journal","volume":"7","issue":"1","author":[{"family":"Akuthota","given":"Venu"},{"family":"Ferreiro","given":"Andrea"},{"family":"Moore","given":"Tamara"},{"family":"Fredericson","given":"Michael"}],"issued":{"date-parts":[["2008","2"]]},"container-title":"Current sports medicine reports","container-title-short":"Curr. Sports Med. Rep.","journalAbbreviation":"Curr. Sports Med. Rep.","DOI":"10.1097/01.CSMR.0000308663.13278.69","PMID":"18296944","citation-label":"6072401","Abstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.","CleanAbstract":"Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions."}]5References:ADDIN F1000_CSL_BIBLIOGRAPHY1. Donatelli R. The Anatomy and Pathophysiology of the CORE. In: Sports-specific Rehabilitation. illustrated. Elsevier Health Sciences; 2007.2. Brumitt J, Matheson JW, Meira EP. 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The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging. Physiother Theory Pract 2016;32(4):277-283. doi:10.3109/09593985.2016.1138559.33. Muscles of Abdominal Wall | . Available at: . Accessed December 1, 2018.34. Abdominal Muscle Anatomy - Physiopedia. Available at: . Accessed December 1, 2018.35. The Vertebral Column and Spinal Cord. Available at: . Accessed December 1, 2018. ................
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