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

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

The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up

Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.

Pengaruh Core Stabilization Exercise Terhadap Penurunan Nyeri Chronic Low Back Pain: Critical Review

Latar Belakang: Low back pain (LBP) merupakan keadaan nyeri punggung bawah. Nyeri yang timbul pada low back pain bukan merupakan suatu penyakit ataupun diagnosis, melainkan istilah untuk nyeri yang dirasakan di area anatomi yang terkena dengan berbagai variasi lamanya terjadi nyeri. Pada beberapa kejadian nyeri awal dapat berlanjut selama periode 3 bulan dan akhirnya berkembang menjadi chronic low back pain (CLBP). Tujuan: Studi ini adalah untuk mengetahui pengaruh penurunan nyeri setelah diberikan core stabilization exercise (CSE) terhadap chronic low back pain berdasarkan literature yang ada dan mengetahui jenis latihan core stabilization exercise pada chronic low back pain berdasarkan literature yang ada. Metode: Penelitian ini adalah menggunakan studi critical review. Hasil: Dari hasil studi ini ditemukan 8 dari 148 artikel yang sesuai dengan kriteria inklusi. Pada studi ini 8 artikel yang digunakan sebagai landasan studi yang dilanjutkan untuk tahap appraisal. Hasil dari appraisal terdapat 6 artikel memiliki nilai Quartile 1 (Q1) dan 2 artikel yang memiliki nilai Quartile 2 (Q2). Lalu penilaian PEDro scale didaptkan 7 artikel yang memiliki bias rendah > 5 dan 1 artikel memiliki bias yang tinggi ?5. Kesimpulan: Berdasarkan hasil studi yang telah dilakukan pada pengaruh core stabilization exercise terhadap penurunan nyeri pada chronic low back pain berdasarkan studi pada literature yang ada dapat disimpulkan bahwa core stabilization exercise berpengaruh dalam penurunan nyeri pada chronic low back pain.