ArticlePDF AvailableLiterature Review

The Effectiveness of Lumbar Extensor Training: Local Stabilization or Dynamic Strengthening Exercises. A Review of Literature.

Authors:
  • Fizjo-Sport Europe
  • Orvit Clinic Toruń / Fizjo-Sport

Abstract

Background: Deconditioning of the lumbar extensor musculature (lumbar erector spinae and multifidus) is a risk factor for low back injury and pain. The article presents various aspects of scientific reports which confirm the effectiveness of lumbar extensor exercises. Material and methods: The articles to be reviewed were extracted from the MedLine and PubMed data - bases. The following key words were used as search terms: lumbar multifidus muscle exercises, low back global exercise, motor control exercise in chronic low back pain, low back stabilization exercise. Results: A number of prior investigations have described lumbar multifidus atrophy and replacement by fat after low back injury. Restoration of the tonic activity of the multifidus muscle is an essential condition in regaining health and spine functions. On the other hand, conditioning and strengthening exercises are considered valuable in effectively 'pre-habilitating' and reducing injury risk for athletes. Conclusions: 1. The lumbar low load specific stabilization exercises would be more efficient than muscle strengthening in the improvement of chronic low back pain. 2. Conditioning and strengthening exercises are considered valuable in effectively 'pre-habilitating' and reducing injury risk for athletes.
561
ARTYKUŁ PRZEGLĄDOWY / REVIEW ARTICLE
Sku tecz ność ćwi czeń mię śni pro stow ni ków krę go słu pa
lę dźwio we go sta bi li za cja lo kal na czy glo bal ne
wzmac nia nie. Prze gląd pi śmien nic twa
The Effectiveness of Lumbar Extensor Training:
Local Stabilization or Dynamic Strengthening
Exercises. A Review of Literature
Michał Hadała
1,2(A,B,C,D,E,F,G)
, Szymon Gryckiewicz
1(B,C,D,E,F)
1
Fizjo-Sport Poland
2
Fisio-Sports Spain
STRESZCZENIE
Wstęp. Sła ba kon dy cja mię śni pro stow ni ków krę go słu pa (bio dro wo -że bro wy, naj dłu ższy i wie lo dziel ny) jest
czyn ni kiem ry zy ka ura zu i bó lu od cin ka lę dźwio we go (LBP - low back pa in). W pra cy przed sta wio no ró żne aspek -
ty ewi den cji na uko wej po twier dza ją ce sku tecz ność ćwi czeń mię śni pro stow ni ków krę go słu pa lę dźwio we go.
Ma te riał i me to dy. W pro ce sie wy szu ki wa nia ar ty ku łów ko rzy sta no z baz ar ty ku łów Me dLi ne i Pub Med. Przy
wy szu ki wa niu prac uwzględ nio no na stę pu ją ce sło wa klu czo we: ćwi cze nie na mię sień wie lo dziel ny część -
dźwio wa (lum bar mul ti fi dus mu sc le exer ci se), ćwi cze nie glo bal ne krę go słu pa lę dźwio we go (low back glo bal exer -
ci se), ćwi cze nie na kon tro lę mo to rycz ną w prze wle kłych do le gli wo ściach krę go słu pa lę dźwio we go (mo tor con trol
exer ci se in chro nic low back), ćwi cze nie sta bi li za cyj ne krę go słu pa lę dźwio we go (low back sta bi li za tion exer ci se).
Wy ni ki. Licz ne ba da nia naukowe przed sta wia ją atro fię mię śnia wie lo dziel ne go i za stą pie nie go przez tkan kę
tłusz czo wą po przebytym epizodzie bólowym. Od two rze nie to nicz nej ak tyw no ści mię śnia wie lo dziel ne go jest
pod sta wo wym wa run kiem przy wró ce nia zdro we go i funk cjo nal nie spraw ne go krę go słu pa. Natomiast ćwiczenia
kondycyjne i siłowe stanowią ważny element w prewencji urazów u sportowców i osób aktywnych fizycznie.
Wnio ski. 1. Sta bi li za cja od cin ka lę dźwio we go krę go słu pa jest bar dziej efek tyw na u pa cjen tów z prze wle -
kły mi do le gli wo ścia mi krę go słu pa. 2. Ćwi cze nia kon dy cyj ne i si ło we sta no wią wa żny ele ment w pre wen cji
i re duk cji ura zów u spor tow ców.
Słowa kluczowe: kręgosłup, ćwiczenia prostowników, stabilizacja, mięśnie
SUMMARY
Background. Deconditioning of the lumbar extensor musculature (lumbar erector spinae and multifidus)
is a risk factor for low back injury and pain. The article presents various aspects of scientific reports which
confirm the effectiveness of lumbar extensor exercises.
Material and methods. The articles to be reviewed were extracted from the MedLine and PubMed data -
bases. The following key words were used as search terms: lumbar multifidus muscle exercises, low back
global exercise, motor control exercise in chronic low back pain, low back stabilization exercise.
Results. A number of prior investigations have described lumbar multifidus atrophy and replacement by fat
after low back injury. Restoration of the tonic activity of the multifidus muscle is an essential condition in
regaining health and spine functions. On the other hand, conditioning and strengthening exercises are
considered valuable in effectively ‘pre-habilitating’ and reducing injury risk for athletes.
Conclusions. 1. The lumbar low load specific stabilization exercises would be more efficient than muscle
strengthening in the improvement of chronic low back pain. 2. Conditioning and strengthening exercises are
considered valuable in effectively ‘pre-habilitating’ and reducing injury risk for athletes.
Key words: spine, extensor training, stabilization, muscles
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Traumatologia Rehabilitacja
© MEDSPORTPRESS, 2014; 6(6); Vol. 16, 561-572
DOI: 10.5604/15093492.1135044
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WSTĘP
Ból od cin ka lę dźwio we go (LBP - low back pa in)
jest bar dzo czę sto spo ty ka nym pro ble mem w spo łe -
czeń stwie; od 60% do 80% po pu la cji ludz kiej do -
świad cza pod czas swo je go ży cia epi zo du bó lo we go
od cin ka lę dźwio we go, a 60 % do 86 % lu dzi ma wię -
cej niż je den epi zod LBP [1].
Za rów no dla spor tow ców, jak i dla ogółu spo łe -
czeń stwa, spraw ność mię śni krę go słu pa lę dźwio we go
jest bra na pod uwa gę ja ko wa żny aspekt kon dy cji fi -
zycz nej. Su ge ru je się, że sła ba kon dy cja mię śni pro -
stow ni ków krę go słu pa (bio dro wo -że bro wy, naj dłu ż -
szy i wie lo dziel ny) jest czyn ni kiem ry zy ka dla ura zu
oraz bó lu w ob rę bie od cin ka lę dźwio we go, a nad po -
pra wą wy dol no ści mię śnio wej mo żna pra co wać po -
przez sto so wa nie ćwi czeń, bę dą cych efek tyw nym
na rzę dziem w pro ce sie re duk cji te go ry zy ka.
Li te ra tu ra do no si o efek tyw no ści ćwi czeń po pra -
wia ją cych wy trzy ma łość i si łę mię śnio wą w pro ce sie
le cze nia prze wle kłych nie spe cy ficz nych do le gli wo ści
od cin ka lę dźwio we go (CNSLBP - chro nic non spe ci fic
low back pa in), po przez zmniej sze nie bó lu i po pra wę
funk cji w ak tyw no ściach dnia co dzien ne go [2]. Jed nak
w ostat nich la tach po ja wia ją się py ta nia do ty czą ce me -
tod, w któ rych sto su je się ćwi cze nia po to, aby okre ślić
pa ra me try i me cha ni zmy dzia ła nia tych ćwi czeń.
Wie le ba dań wy ka za ło, że mię sień wie lo dziel ny
od cin ka lę dźwio we go (LM lum bar mul ti fi dus) od -
gry wa istot ną ro lę w prze wle kłych na wro tach nie -
spe cy ficz nych do le gli wo ści od cin ka lę dźwio we go
(NSLBP – non spe ci fic low back pa in) [3-7].
Licz ne
ba da nia wska zu ją, że tre ning sta bi li za cji seg men tar nej
na kie ro wa ny na edu ka cję pa cjen ta w za kre sie ak ty wa cji
mię śnia wie lo dziel ne go jest bar dziej efek tyw ny niż tre -
ning wzmac nia ją cy gru pę mię śni po wierz chow nych
(pro sty brzu cha, sko śne brzu cha, pro stow nik grzbie tu),
za rów no je śli cho dzi o po pra wę w ob rę bie mor fo lo gii
mię śnia wie lo dziel ne go, jak i re duk cję do le gli wo ści bó -
lo wych od cin ka lę dźwio we go [6].
Spe cjal ną uwa gę skie ro wa no na ćwi cze nia, któ rych
ce
lem jest od ru cho we utrzy ma nie na pię cia mię śnio we -
go pod no szą ce go sta bil ność od cin ka lę dźwio we go
[1,4,8,9]. Po mi mo że nie ma for mal nej de fi ni cji, któ ra
pre cy zyj nie okre śla czym ćwi cze nia sta bi li za cji od -
cin ka lę dźwio we go, to jed nak pro ces ten ma na ce lu
po pra wę kon tro li ner wo wo -mię śnio wej, si ły i wy trzy -
ma ło ści mię śni znaj du ją cych się w „cen trum” i od po -
wie dzial nych za utrzy ma nie sta bil no ści dy na micz nej
krę go słu pa i tu ło wia. W ostat nich la tach wy szcze gól -
nio no ró żne gru py mię śnio we, do któ rych skla sy fi ko -
wa no głę bo kie i po wierz chow ne mię śnie krę go słu pa
lę dźwio we go. Kla sy fi ka cja ta znacz nie uła twia do bór
od po wied nich ćwi czeń w pro ce sie re ha bi li ta cji [4,9].
BACKGROUND
Low back pain (LBP) is very common in so -
cieties: approximately 60% to 80% of the population
will experience an episode of LBP during their life -
time, and 60% to 86% of these people will have more
than one episode of LBP [1].
For athletes as well as the general population
alike, conditioning the muscles of the lower back
could be considered an important aspect of overall
fitness. It has been suggested that deconditioning of
the lumbar extensor musculature (lumbar erector
spinae and multifidus) is a high risk factor for low
back injury and pain, and that conditioning these
muscles through exercises might offer an effective
means of reducing this risk.
The literature supports the effectiveness of active
reconditioning exercises in the treatment of CNSLBP
(chronic nonspecific low back pain), by reducing
pain and improving function in activities of daily life
[2]. However, a number of questions regarding the
manner of their application have been raised during
recent years and the parameters and mechanisms of
action of such exercises still remain to be determined.
A number of studies have indicated that the
lumbar multifidus (LM) muscle plays an important
role in the recurrence of CNSLBP [3-7]. Seve ral
investigations suggest that segmental muscle sta bi -
lization training, that is a training directed at teach ing
patients to activate their LM, is superior to „su per -
ficial” strengthening of global muscle groups (rec tus
abdominis, obliquus abdominis, erector spinae), both
in improving LM morphology and in relieving low
back pain [6].
There has been a focus on exercises that aim to
maintain or improve lumbar spine stability through
reflex-driven maintenance of muscle tone [1,4,8,9].
Although no precise formal definition of lumbar
stabilization exercises ex ists, this approach is aimed
at improving neuromus cular control, strength, and
endurance of the muscles that are central to main -
taining dynamic spine and trunk stability. In the re -
cent years, various muscle groups have been distin -
guished, including deep and superficial muscles of
the lumbar spine. This typology makes the selection
of appropriate exercises in the rehabilitation process
considerably easier [4,9].
This paper sets out to present various aspects of
scientific reports on the effectiveness of lumbar
extensor exercises based on local and global work.
Hadała M. i wsp. Skuteczność ćwiczeń mięśni prostowników kręgosłupa lędźwiowego
562
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W ar ty ku le pod ję to pró bę przed sta wie nia ró żnych
aspek tów ewi den cji na uko wej do ty czą cej sku tecz no -
ści ćwi czeń mię śni pro stow ni ków krę go słu pa lę dź -
wio we go opar tych na pra cy lo kal nej i glo bal nej.
MA TE RIAŁ I ME TO DY
W li te ra tu rze na uko wej mo żna zna leźć ar gu men -
ty po pie ra ją ce po szcze gól ne ro dza je ćwi czeń dla
mię śni pro stow ni ków krę go słu pa lę dźwio we go. To
co zwra ca uwa gę, to zmien na ak tyw ność po szcze gól -
nych mię śni pod czas ćwi czeń. Oce na pra cy mię śnio -
wej w po rów na niu do ba dań pro wa dzo nych na pa -
cjen tach z do le gli wo ścia mi prze wle kły mi su ge ru je,
że wie le z pro po no wa nych ćwi czeń zwięk sza wy dol -
ność pro stow ni ków sta wu bio dro we go, a nie po pra -
wia wy daj no ści mię śni pro stow ni ków krę go słu pa.
W pro ce sie wy szu ki wa nia ar ty ku łów ko rzy sta no
z baz ar ty ku łów Me dLi ne i Pub Med. Przy wy szu ki -
wa niu prac wy ko rzy sta no na stę pu ją ce ha sła: ćwi cze -
nia na mię sień wie lo dziel ny część lę dźwio wa (lum -
bar mul ti fi dus mu sc le exer ci se), ćwi cze nia glo bal ne
krę go słu pa lę dźwio we go (low back glo bal exer ci se),
ćwi cze nia na kon tro lę mo to rycz ną w prze wle kłych
do le gli wo ściach krę go słu pa lę dźwio we go (mo tor
con trol exer ci se in chro nic low back), ćwi cze nia sta -
bi li za cyj ne krę go słu pa lę dźwio we go (low back sta bi -
li za tion exer ci se). Po nad to część za cy to wa nych ar ty -
ku łów, któ re zo sta ły opu bli ko wa ne w la tach wcze -
śniej szych, sta no wi fun da ment roz wo ju sta bi li za cji
i w la tach póź niej szych pra ce te by ły cy to wa ne wie -
lo krot nie przez ró żnych au to rów, jed nak sta ra no się
wy brać pra ce, któ re ory gi nal ne. Dla te go też przy
wy bo rze prac wy ko rzy sta no kry te rium cza so we obej -
mu ce 70% prac z ostat nich 10 lat, z cze go 40% sta -
no wi ły pra ce z ostat nich 5 lat. 30% prac, któ re wy bra -
no do bi blio gra fii, mia ły po nad 10 lat. Tu taj głów nym
kry te rium by ła ilość pu bli ka cji da ne go au to ra czy też
gru py ba daw czej w da nej dzie dzi nie na uko wej oraz
do ro bek na uko wy z oma wia ne go te ma tu.
Wy se lek cjo no wa ne pra ce po dzie lo no na dwie gru -
py. Pierw sza opi su ją ca zmia ny funk cjo nal ne, gdzie zo -
sta ły uję te wy ni ki ćwi czeń na sta bi li za cję lo kal ną zwa -
rów nież seg men tar ną lub sta bi li za cją głę bo ką. Dru -
gru pę sta no wi ły pra ce opar te na wzmac nia niu mię -
śni pro stow ni ków, gdzie zo sta ły uję te wy ni ki opi su ją ce
zmia ny hi per tro ficz ne osią ga ne po przez pra cę glo bal ną.
WY NI KI
Lo kal na sta bi li za cja od cin ka lę dźwio we go
tre ning mię śnia wie lo dziel ne go
Mię śnie wie lo dziel ne głów ny mi sta bi li za to ra mi
tzw. stre fy neu tral nej od cin ka lę dźwio we go, a dys -
MATERIAL AND METHODS
The relevant literature presents arguments sup -
porting particular types of exercise to condition the
lumbar extensors. What draws research attention is
the fact that the activity of particular muscles chan -
ges during exercise. Assessments of muscular work
in studies of patients with chronic ailments suggest
that many of the proposed exercises improve the
function of the hip extensors, while they do not
improve the function of the spine extensors.
Articles to be reviewed were extracted from the
MedLine and PubMed databases. The following key
words were used as search terms: lumbar multifidus
muscle exercise, low back global exercise, motor
control exercise in chronic low back pain, and low
back stabilization exercise. Some of the articles
which were published further into the past constitute
the basis for the development of stabilization exer -
cises and were later cited by numerous authors. We
intended to select mainly original studies. Accor -
ding ly, we relied on a time criterion when choosing
works to be reviewed, with 70% of the cited articles
published within the last 10 years (40% within the
last 5 years), and the remaining 30% published be -
fore that time. Here the main criterion was the num -
ber of relevant publications by a given author or
research team and their achievements in the area of
interest.
The selected articles were divided into two
groups. Articles in the first group describe functional
changes with reference to the results of local
stabilization exercises, also called segmental or deep
stabilization exercises. The second group comprises
papers investigating the strengthening of extensor
muscles with reference to hypertrophic changes
brought about by global work.
RESULTS
Local stabilization of the lumbar spine
– multifidus muscle training
The lumbar multifidus muscles are important
stabilizers of this neutral zone, and dysfunction in
Hadała M. et al. Effectiveness of lumbar extensor exercises
563
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funk cja tych mię śni jest ści śle zwią za na z LBP. Po nad -
to przyj mo wa nie nie pra wi dło wej po zy cji, któ ra wy -
bie ga po za po zy cję neu tral ną, pre ten du je do wy stę -
po wa nia do le gli wo ści bó lo wych w ob rę bie od cin ka
lę dźwio we go [10]. Ale z dru giej stro ny, in ne do nie -
sie nia na uko we po twier dza ją, że dys ko po chod ne do le -
gli wo ści bó lo we krę go słu pa lę dźwio wo -krzy żo we go
wpły wa ją na zmia nę po ło że nia środ ka cię żko ści cia ła,
za bu rza jąc sy me trycz ne ob cią ża nie koń czyn dol nych,
tym sa mym zmie nia ją po sta wę [11]. Za tem w kon tek -
ście nie pra wi dło wej po sta wy i LBP wa żne jest uw -
zględ
nie nie po zy cji neu tral nej, po szcze gól nych seg -
men tów sta wo wych i bio me cha ni ki ru chu [12].
Ba da nia bio me cha nicz ne po zwo li ły na do kład niej -
sze zro zu mie nie me cha ni zmów ura zów i bó lu od cin ka
lę dźwio we go, szcze gól nie w za kre sie sta bi li za cji
w „stre fie neu tral nej” krę go słu pa lę dźwio we go, dzię -
ki to nicz nej ak ty wa cji i kon tro li mię śnio wej. Pan ja bi
opi sał po ję cie stre fy neu tral nej ja ko część (ob szar)
za kre su ru chu po mię dzy krę ga mi, mie rzo ny od po zy -
cji neu tral nej, w któ rej ruch krę go słu pa od by wa się
przy jed no cze snym mi ni mal nym opo rze ze stro ny pa -
syw nych struk tur krę go słu pa [13]. Wil ke i wsp. stwier -
dzi li, że ak tyw ność mię śnia wie lo dziel ne go przyczy -
nia się do ge ne ro wa nia po nad dwóch trze cich sztyw -
no ści mię śnio wej krę go słu pa na po zio mie stre fy neu -
tral nej [14]. Funk cjo nal nie mię sień wie lo dziel ny jest
po dzie lo ny na włók na głę bo kie i po wierz chow ne,
z któ rych głę bo kie prze bie ga ją przez 2 seg men ty krę -
gowe i ma ją funk cję to nicz ną, na to miast włók na po -
wierz chow ne obej mu ją od 3 do 5 krę gów i po sia da ją
funk cję fa zo wą [15,16].
Do tych czas licz ne ba da nia po twier dzi ły atro fię
mię śnia wie lo dziel ne go i za stą pie nie go przez tkan kę
tłusz czo wą po do zna nym ura zie. Pro ces ten jest ści -
śle sko re lo wa ny z prze wle kłym nie spe cy ficz nym bó -
lem od cin ka lę dźwio we go [3,17,18]. Hod ges i wsp.
do star czy li ko lej nych do wo dów, pod da jąc ba da niom
tkan ki mię śnio we świ ni i za ob ser wo wali szyb ko na -
stę pu ją cą atro fię mię śnia wie lo dziel ne go w prze cią -
gu 3 dni, po wy wo ła niu, na po trze by ba da nia, ura zu
ko rze nia ner wo we go [19]. Hi des i wsp. zwróc li uwa -
gę, że wzo rzec atro fii mię śnia wie lo dziel ne go jest ra -
czej lo kal ny niż glo bal ny, gdzie w ba da niu po rów na -
no roz miar te go mię śnia oraz obu stron ną sy me trię
po mię dzy gru pą osób z prze wle kły mi do le gli wo ścia -
mi bó lo wy mi od cin ka lę dźwio we go a pa cjen ta mi
zdro wy mi, bez żad nych ob ja wów bó lo wych [20].
Wal l work i wsp. uza sad ni li, że atro fia mię śnia wie lo -
dziel ne go jest zwią za na z ogra ni czo ny mi mo żli wo -
ścia mi na pię cia mię śnia [21].
Wpływ bó lu na ak tyw ność mię śni wie lo dziel nych
i pro stow ni ków pod czas ćwi czeń wy pro stu tu ło wia
oce ni li Dickx i wsp. Zba da li skurcz mię śnia przed
these muscles is strongly associated with LBP. More -
over, assuming an incorrect posture out of bounds of
the neutral posture promotes lumbar pain [10]. Yet
the problem can also be considered from a different
perspective, since there are reports which confirm
that discopathy-related pain of the sacral and lumbar
spine leads to shifts in the center of mass as well as
disturbing symmetrical distribution of load on the
lower extremities, which consequently affects the
posture [11]. Thus, when discussing incorrect postu -
res and LBP, it is important to account for the neutral
position, individual joint segments and motion bio -
mechanics [12].
Biomechanical research has improved our under -
standing of the mechanisms of low back injury and
pain, specifically regarding the ability to stabilize the
„neutral zone” of the lumbar spine through tonic
muscle control. Panjabi described the neutral zone as
the part of the range of intervertebral motion, mea -
sured from the neutral position, in which spinal mo -
tion can occur with minimal non-muscular passive
resistance from the spine [13]. Wilke et al. found that
the actions of the multifidus account for more than
two-thirds of the stiffness of the spine within the
neutral zone [14]. Functionally, the LMs are divided
into deep and superficial fibers, with deep fibers
spanning 2 vertebral segments and functioning toni -
cally, and the superficial fibers spanning 3 to 5 levels
and functioning phasically [15,16].
A number of prior investigations have describ -
ed LM atrophy and replacement by fat after low back
injury, a pathological process that is closely correlat -
ed with CNSLBP [3,17,18]. Hodges et al. demon -
strated, in a porcine model, a rapid onset of LM
atrophy within 3 days after an experimentally induc -
ed nerve root injury [19]. Hides et al. provided fur -
ther evidence that the pattern of LM atrophy is local
rather than general in a study that compared multi -
fidus size and bilateral symmetry between chronic
LBP patients and healthy asymptomatic subjects
[20]. Wallwork et al. demonstrated that LM atrophy
was associated with a reduction in the ability to
voluntarily contract the muscle [21].
Dickx et al. assessed the effect of pain on the
activity of the multifidus muscle and extensors du -
ring trunk extension exercises. They analyzed con -
trac tions of the muscle before and after exercise,
both before and after inducing pain. While, in the
absence of pain, the multifidus and back extensors
demonstrated considerable activity, it was reduced
for all the muscles on both sides and at a few levels
of the spine after induction of pain by injection at the
level of one segment on one side [22].
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ćwi cze nia mi oraz po ćwi cze niach, przed i po wy wo -
ła niu bó lu. O ile w sy tu acji bezbó lo wej ak tyw ność
mię śni wie lo dziel nych i pro stow ni ków grzbie tu by ła
znacz na, to po in iek cyj nym wy wo ła niu bó lu na po -
zio mie jed ne go seg men tu po jed nej stro nie, do cho -
dzi ło do zmniej sze nia ak tyw no ści tych mię śni po
obu stro nach i na kil ku są sied nich po zio mach krę go -
słu pa [22].
Oce ny sku tecz no ści trzech ró żnych spo so bów le -
cze nia mię śnia wie lo dziel ne go pod ką tem zwięk sze -
nia prze kro ju po przecz ne go te go mię śnia u pa cjen -
tów z LBP do ko nał Dan ne els i wsp. [4,23]. W gru -
pie 59 osób, przy dzie lo no pa cjen tów w spo sób lo so -
wy do jed ne go z trzech za pro po no wa nych pro gra -
mów: 1) tre ning sta bi li za cji, 2) tre ning sta bi li za cji
po łą czo ny z dy na micz nym opo rem, 3) tre ning sta bi -
li za cji po łą czo ny z dy na micz no -sta tycz nym opo rem.
Prze krój po przecz ny mię śnia wie lo dziel ne go znacz -
nie wzrósł na po zio mie wszyst kich krę gów tyl ko
w gru pie wy ko nu ją cej tre ning sta bi li za cji po łą czo ny
z dy na micz no -sta tycz nym opo rem. Au to rzy do szli
do wnio sku, że utrzy my wa nie kom po nen ty sta tycz -
nej po mię dzy skur czem kon cen trycz nym i eks cen -
trycz nym by ło de cy du ją ce dla od bu do wy mię śnia.
Po dob nie pro blem opi sa no kil ka lat póź niej, gdzie
au to rzy uzna li, że wpraw dzie tre ning w wy ższym ob -
cią że niu mo że być ko rzyst ny dla od wró ce nia za ni ku
mię śnio we go u pa cjen tów z prze wle kłym bó lem krę -
go słu pa i przy no sić dłu go trwa łe skut ki w re duk cji
lu, jed nak wąt pli wym jest, aby ten tre ning przy -
wra cał to nicz ną ak ty wa cję mię śnia wie lo dziel ne go,
co jest nie zbęd nym wa run kiem przy wró ce nia zdro -
wia i funk cji krę go słu pa [24].
Pró bę od po wie dzi na py ta nie, czy pro gram ćwi -
czeń ma ją cych na ce lu zwięk sze nie zdol no ści skur -
czu mię śnia wie lo dziel ne go po pra wi stan funk cjo -
nal ny, czy też zre du ku je LBP pod jął Sung [25]. Au -
tor ten opi sał krót ko ter mi no we ba da nie, w któ rym
oce nia no wpływ 4-ty go dnio we go pro gra mu ćwi czeń
sta bi li zu ją cych krę go słup w gru pie pa cjen tów z LBP.
Wy ni ki wska zy wa ły na zna czą cą po pra wę w za kre -
sie funk cji mię śnia wie lo dziel ne go. Hi des i wsp. opi -
sa li efek ty tre nin gu sta bi li za cyj ne go na kie ro wa ne go
na po pra wę prze kro ju po przecz ne go mię śnia wie lo -
dziel ne go wśród za wo do wych spor tow ców (kry kiet)
z do le gli wo ścia mi od cin ka lę dźwio we go, stwier dza -
jąc przy, tym że atro fia mię śnia wie lo dziel ne go mo -
że wy stę po wać rów nież u za wo do wych spor tow ców.
Au to rzy wy ka za li, że tre ning sta bi li za cji zwięk sza po -
le prze kro ju po przecz ne go mię śnia wie lo dziel ne go
oraz, że spe cy ficz ny tre ning był zwią za ny ze zmniej -
sze niem symp to mów bó lo wych na po zio mie od cin ka
lę dźwio we go. Ich wy ni ki wy ka za ły, że spe cy ficz ny
tre ning, któ re go ce lem jest ak ty wa cja mię śnia wie lo -
Danneels et al. assessed the efficacy of 3 different
treatment modalities on multifidus CSA (cross-sec -
tional area) in chronic LBP patients [4,23]. A group
of 59 patients were randomly allocated to one of
3 programs: 1) stabilization training 2) stabilization
training combined with dynamic resistance, and 3)
stabilization training combined with dynamic-static
resistance. The CSA of the LM muscle significantly
increased at all vertebral levels only in the dynamic-
static resistance-training group. The authors con clud -
ed that the static holding component between con -
centric and eccentric contraction phases was critical
to induction of muscle regrowth.
The problem was similarly presented a few years
later, and the authors admitted that a more severe
training regime might be beneficial in order to re -
verse muscular loss in patients with chronic back
pain and might bring long-lasting effects in pain
reduction, but it is still unlikely to bring back the
tonic activation of the multifidus muscle, which is an
essential condition in regaining health and spine
functions [24].
Sung set out to determine whether an exercise
program designed to increase the ability to contract
the LM improved functional status or reduced LBP
[25]. He described a short-term cohort study that
assessed the effect of a 4-week spinal stabilization
exercise program in a group of LBP patients, re port -
ing a significant improvement in LM function. Hides
et al. described the effects of stabilization training
on LM CSA among elite athletes (cricketers) with
LBP, concluding that LM atrophy can exist in highly
active, elite athletes. The authors demonstrated that
the stabilization training increased the CSA of the
LM, and that the training was associated with
a reduction in LBP symptoms. Their results showed
that specific training that aims at activation of the
LM is associated with both an increase in functional
status and a reduction in LBP [26]. In an earlier study
by Hides et al., LM function recovery was not neces -
sarily associated with the resolution of painful symp -
toms in LBP patients [27].
MacDonald et al. found that changes in motor
control of the LM were seen in patients who prima -
rily demonstrated impairment of the shorter fibers,
and that these changes were greater on the previously
painful side of the low back. These findings support
the use of a specifically designed stabilization exer -
cise specifically targeting the deeper shorter fibers
that serve to stabilize the spine [28].
In a multicenter randomized controlled trial,
Ferreira et al. compared general exercises and lum -
bar stabili zation exercises in patients with chronic
LBP. The lumbar stabilization exercise groups show ed
Hadała M. et al. Effectiveness of lumbar extensor exercises
565
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dziel ne go jest zwią za ny za rów no z po pra wą sta nu
funk cjo nal ne go, jak i z re duk cją do le gli wo ści bó lo -
wych krę go słu pa lę dźwio we go [26]. We wcze śniej -
szych ba da niach Hi des i wsp. stwier dzi li, że od zy -
ska nie funk cji mię śnia wie lo dziel ne go nie mu si być
po wią za ne z roz wią za niem do le gli wo ści bó lo wych
krę go słu pa lę dźwio we go [27].
Mac Do nald i wsp. za ob ser wo wa li, że do zmian
w kon tro li mo to rycz nej mię śnia wie lo dziel ne go do cho -
dzi ło wśród pa cjen tów, u któ rych przede wszyst kim
pra ca włó kien krót kich mię śnia wie lo dziel ne go by ła za -
bu rzo na, i te zmia ny by ły więk sze po tej stro nie krę go -
słu pa, po któ rej pier wot nie wy stę po wał ból. Te wy ni ki
po twier dza ją sto so wa nie spe cjal nie za pro gra mo wa nych
spe cy ficz nych ćwi czeń sta bi li zu ją cych, w któ rych ak ty -
wo wa ne włók na krót sze le żą ce głę biej [28].
Fer re ira i wsp. w ba da niu ran do mi zo wa nym po -
rów na li ogól ne ćwi cze nia i ćwi cze nia sta bi li zu ją ce
krę go słup u pa cjen tów z prze wle kłym bó lem krę go -
słu pa lę dźwio we go. Gru pa wy ko nu ją ca ćwi cze nia
sta bi li zu ją ce od ci nek lę dźwio wy, uzy ska ła nie znacz -
nie lep sze wy ni ki niż gru pa re ali zu ją ca ćwi cze nia
ogól ne po upły wie 8 ty go dni w za kre sie ska li VAS
i w wy ni kach kwe stio na riu sza Ro land Mor ris Di sa -
bi li ty Qu estion na ire (RMDQ). Nie stwier dzo no istot -
nych ró żnic po mię dzy obie ma gru pa mi [29].
Van i wsp. zwró ci li uwa gę, iż u nie któ rych pa -
cjen tów wzro ko wy fe ed back w cza sie rze czy wi stym,
wy ko rzy stu ją cy USG do opty ma li za cji wy daj no ści
skur czu izo me trycz ne go mię śnia wie lo dziel ne go,
mo że być klu czo wym bodź cem w pra wi dło wej ak ty -
wa cji. Au to rzy za sto so wa li re -edu ka cję mo to rycz ną
pod czas tre nin gu na pię cia mię śnia wie lo dziel ne go;
w jed nej gru pie za sto so wa no fe ed back słow ny, na to -
miast w dru giej gru pie słow ny i wzro ko wy. Oka za ło
się, że oso by, któ re ko rzy sta ły z wi zu al ne go sprzę że -
nia zwrot ne go uzy ska ły lep szą wy dol ność je śli cho -
dzi o ja kość na pię cia mię śnia wie lo dziel ne go, jak
rów nież mia ły lep szą pa mięć w za kre sie ak ty wa cji
te go mię śnia pod czas wy ko ny wa nia po now ne go po -
mia ru ty dzień póź niej [30].
Glo bal ne ćwi cze nia wzmac nia ją ce pro stow ni ki
krę go słu pa lę dźwio we go
Ćwi cze nia wzmac nia ją ce mię śnie krę go słu pa lę -
dźwio we go uwa ża się za war to ścio we i sku tecz ne
w pre wen cji ura zów spor to wych [31]. Stel le i wsp.
do ko na li prze glą du spe cy ficz nych ćwi czeń ma ją cych
na ce lu po pra wić wy dol ność mię śni pro stow ni ków
krę go słu pa lę dźwio we go. Za pro po no wa no ró żne
ćwi cze nia, któ re po pra wia ją wy dol ność pro stow ni -
ków krę go słu pa lę dźwio we go, wli cza jąc w to: wy ci -
ska nia na ła wecz ce, na krze śle rzym skim z ogra ni -
czo ną pra cą pro stow ni ków sta wu bio dro we go, ćwi -
marginally better outcomes than the general exer cise
group after 8 weeks in VAS and the Roland Morris
Disability Ques tionnaire score, but there was no sig -
nificant difference between the two groups [29].
Van et al. used real-time US-aided visual feed -
back to improve the isometric contraction capability
of the LM in healthy subjects. The authors applied
motor learning principles to train the subjects in
voluntary contraction of the multifidus and gave
verbal feedback to one group, and verbal and visual
feedback to the other. They found that providing the
subjects with visual feedback of their performance
resulted in better quality muscle contraction of
the LM as well as better memory of how to contract
the multifidus after reassessment a week later [30].
Global exercises strengthening the lumbar
extensors
Conditioning and strengthening exercises are
considered valuable in effectively ‘pre-habilitating”
and reducing injury risk for athletes [31]. Stelle et al.
reviewed specific exercises designed to condition the
lumbar extensor musculature. A variety of exercises
have been proposed to effectively condition the
lumbar extensors including benches and roman chair
(free weights exercises, deadlifts, squats, good-morn -
ings, etc.), floor and stability ball exercise (bridging,
four-point kneeling, etc.) and resistance machines
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566
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cze nia z han tla mi (mar twy ciąg, przy sia dy, opa dy tu -
ło wia), ćwi cze nia na pod ło dze, ćwi cze nia sta bi li za -
cyj ne z pił ką (mo sty, ćw. w klę ku pod par tym) i ćwi -
cze nia na ma szy nach (z opo rem i bez opo ru dla mied -
ni cy). Je że li pod czas ćwi czeń pro stow ni ków krę go słu-
pa, oprócz sa me go od cin ka lę dźwio we go, do pra cy
włą cza się ruch mied ni cy na ko ści udo wej (ruch
w sta wie bio dro wym), wte dy wy ni ki pod ką tem na -
by tej si ły mo gą nie być do koń ca obiek tyw ne je śli
cho dzi o si łę mię śni pro stow ni ków krę go słu pa [32].
Clark i wsp. po nad to za su ge ro wa li, że nie pra wi dło -
wa ak ty wa cja pro stow ni ków krę go słu pa lę dźwio we -
go i więk sza ak ty wa cja pro stow ni ków bio dra su ge ru -
je, że ma my do czy nie nia z kom pen sa cją ze stro ny
pro stow ni ków bio dra [33,34]. W po rów na niu do ba -
dań pro wa dzo nych na pa cjen tach z do le gli wo ścia mi
prze wle kły mi su ge ru je się, że więk szość z tych pro -
po no wa nych ćwi czeń zwięk sza wy dol ność pro stow -
ni ków sta wu bio dro we go, a nie po pra wia wy daj no ści
mię śni pro stow ni ków krę go słu pa lę dźwio we go.
Ćwi cze nia, w któ rych wy ko rzy stu je się opór dla
mied ni cy wy łą cza jąc ruch bio der, wy da ją się być naj -
bar dziej efek tyw ne w za kre sie wy dol no ści pro stow -
ni ków krę go słu pa i ma ją naj więk szą war tość w re ha -
bi li ta cji, któ rej ce lem jest przede wszyst kim pre wen -
cja ura zów. Ogra ni cze nie zwią za ne jest z za pew nie -
niem izo lo wa ne go ru chu wy pro stu w od cin ku lę dź -
wio wym w sto sun ku do bio der, a więc zró żni co wa -
nie mię śni od po wie dzial nych za ka żdy z tych ru chów.
Na le ży za uwa żyć, że w więk szo ści sys te mów gdzie
unie ru cho mio ne bio dra, ruch jest ge ne ro wa ny przez
ak tyw ność pro stow ni ków krę go słu pa lę dźwio we go
(pro stow nik grzbie tu i wie lo dziel ny po wierz chow -
ny), jak rów nież przez część pier sio wą pro stow ni -
ków i do dat ko wo przez obu stron ne na pię cie mię śnia
czwo ro bocz ne go lę dźwi. Sto pień ak ty wa cji, któ ry
za uwa żo no wśród pro stow ni ków krę go słu pa lę dź -
wio we go w tych ba da niach, sta no wi je dy nie wska -
zów kę co do sku tecz no ści wy ko ny wa nia ćwi czeń
po pra wia ją cych si łę i wy dol ność tych mię śni.
Aktualnie istnieją dowody na poparcie ćwiczeń
wyłączających ruch bioder jako efektywnych ćwi -
czeń siłowych dla prostowników kręgosłupa lędź -
wio wego w prewencji urazów. Niemniej jed nak
więk szość dłu go ter mi no wych ba dań, w któ rych wy -
ko rzy sta no te sty si ło we z wy łą cze niem ru chu bio der
w tre nin gu u osób z do le gli wo ścia mi prze wle kły mi
krę go słu pa lę dźwio we go, su ge ru je, że ta kie po dej -
ście wpły wa niesku tecz nie na po pra wę ak ty wa cji
pro stow ni ków krę go słu pa. Na przy kład jest znacz na
ró żni ca po mię dzy po zio mem ak ty wa cji mię śni
w nie któ rych ba da niach pod czas ćwi cze nia mar twe -
go cią gu, któ re nie wy da je się prze no sić si ły na pro -
stow ni ki krę go słu pa po za koń cze niu 10-ty go dnio we -
(those with and without pelvic restraints) [32]. If the
pelvis is able to move, then measurements of
strength obtained may not be valid reflections of the
strength of the lumbar extensor musculature. Clark
et. al further quantified this, suggesting that de recruit -
ment of the lumbar extensors and further recruitment
of the hip extensors indicates they are ‘taking over”
the load [33,34]. Compared to studies of patients
with chronic ailments, it is suggested that most of the
proposed exercises improve the function of the hip
extensors, while not improving the function of the
lumbar extensors.
Exercises using pelvic restraints appear po ten tial -
ly most effective at conditioning the lumbar ex ten -
sors and may be of the greatest value in rehabilitation
aiming primarily to prevent injury. This restraint
ensures isolation of lumbar extension movement
from hip extension movement and thus differen tia -
tion of the muscles producing each respectively.
However, it should be noted that, in most systems,
the movement produced by the low back is a product
of the action of the lumbar extensor musculature
(lumbar erector spinae and multifidus) as well as the
thoracic portions of the extensor musculature in
addition to bilateral contraction of the quadratus
lumborum. The degree of activation seen in the lum -
bar extensors in these studies provides only an indi -
cation as to the effectiveness of the exercise for
effective strength and endurance adaptations.
There is evidence to support exercises based on
systems that restrain hip movement as effective strength
exercises for the lumbar extensors in preventing
injuries. At the same time, the majority of chronic
training studies which have utilized pelvic restraint
strength testing in order to examine adaptation in the
lumbar extensors suggest that these approaches
do not effectively condition the lumbar extensors.
For example, there is a drastic contrast between the
activation levels shown in some studies for the dead -
lift, which does not appear to transfer to improved
lumbar extensor strength after completion of a 10-
week training program utilizing deadlifts [35,36,37].
However, health and fitness providers and facilities,
strength and conditioning coaches, athletes and the
general population should consider the specificity of
exercises if they have the goal of optimally condi -
tioning the lumbar extensors, specifically perhaps as
a prehabilitation method for addressing low back
pain risk.
Hadała M. et al. Effectiveness of lumbar extensor exercises
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go tre nin gu [35,36,37]. Dla te go oso by pro pa gu ją ce
zdro wie: tre ne rzy, spor tow cy i ca ła po pu la cja, po -
win ny uwzględ niać zró żni co wa ną spe cy fi kę ćwi czeń
je śli ma ją na ce lu opty ma li za cję kon dy cji pro stow ni -
ków krę go słu pa lę dźwio we go skie ro wa ną na zmniej -
sze nie ry zy ka bó lu w od cin ku lę dźwio wym.
DYS KU SJA
W ba da niach kli nicz nych u pa cjen tów z ostrym
bó lem krę go słu pa wy ka za no sku tecz ność ćwi czeń
sta bi li za cyj nych opar tych o nie wiel kie ob cią że nia
w za kre sie przy wró ce nia kon tro li mo to rycz nej i se lek -
tyw nej zmia ny w ob rę bie mię śnia wie lo dziel ne go
[38]. Jed nak w nie któ rych przy pad kach, ćwi cze nia
opar te o wy so kie ob cią że nia mo gą być ko niecz ne, aby
przy wró cić zmia ny struk tu ral ne u pa cjen tów z prze -
wle kłym bó lem krę go słu pa lę dźwio we go, zwłasz cza
w po pu la cji spor tow ców. Dan ne els i wsp. wy ka za li, że
u nie któ rych pa cjen tów z prze wle kłym bó lem krę go -
słu pa lę dźwio we go, ak ty wa cja w ni skim ob cią że niu
nie jest wy star cza ją ca, aby od wró cić atro fię mię śnia
wie lo dziel ne go; tyl ko pro gram tre nin gu sta bi li za cyj -
ne go w po łą cze niu z pro gra mem wzmac nia ją cym był
sku tecz ny, w za kre sie przy wró ce nia od po wied nie go
roz mia ru te go mię śnia [4]. Rów nież na pod sta wie dłu -
go ści trwa nia bó lu i za bu rze nia spraw no ści, roz pa try -
wa no po łą cze nie ćwi czeń sta bi li za cyj nych i in ten syw -
ne go tre nin gu opo ro we go dla od cin ka lę dźwio we go
[4,23]. Dla te go też pro gre syw ny tre ning z ro sną cym
ob cią że niem mo że być po moc ny do przy wró ce nia pra -
wi dło wej funk cji i struk tu ry mię śnia. Co wa żne, typ,
ro dzaj ob cią że nia i czę sto tli wość ćwi czeń po win ny
być do sto so wa ne in dy wi du al nie do pa cjen ta.
Jed nak nie wszyst kie do nie sie nia na uko we po -
twier dza ją sku tecz ność tre nin gu na kie ro wa ne go
na po pra wę struk tu ral ną mię śnia. Wil le mink i wsp.
wy ka za li, że 24-ty go dnio wy wy izo lo wa ny tre ning
pro stow ni ków krę go słu pa z wy ko rzy sta niem dy na -
micz ne go opo ru, do pro wa dził do po pra wy sta nu funk -
cjo nal ne go w gru pie pa cjen tów płci mę skiej z prze -
wle kły mi nie spe cy ficz ny mi do le gli wo ścia mi bó lo -
wy mi od cin ka lę dźwio we go, bez zna czą cych zmian
w mor fo lo gii mię śnia wie lo dziel ne go. Nie by ło istot -
nych zmian w za war to ści tłusz czu w prze kro ju po -
przecz nym mię śnia wie lo dziel ne go (1,8%-2,2%)
pod czas le cze nia [39]. Wy ni ki te zgod ne z ba da -
nia mi prze pro wa dzo ny mi przez Dan ne els i wsp.,
któ rzy rów nież nie od no to wa li istot nych zmian w za -
kre sie tkan ki tłusz czo wej w prze kro ju po przecz nym
mię śnia wie lo dziel ne go po 10-ty go dnio wym tre nin -
gu sta bi li za cji po łą czo nym z pro gre syw nym tre nin -
giem opo ro wym dla mię śni tu ło wia i koń czyn dol -
nych [4]. Po mi mo bra ku po pra wy mor fo lo gii mię -
DISCUSSION
The efficacy of low load stabilization exercises
on restoring motor control and inducing selective
chan ges in the multifidus muscle has been demon -
strated in clinical trials with acute LBP patients [38].
However, in some cases high load exercises may be
necessary to reverse the structural changes in chronic
LBP patients, especially in the population of athletes.
Danneels et al. demonstrated that, in some chronic
LBP patients, low level activation is not sufficient to
reverse multifidus atrophy; only a stabilization train -
ing program in combination with a strengthening
program was efficient to restore its size [4]. Also, on
the basis of the duration of pain and disability level,
the combination of stabilization exercises and
intensive lumbar resistance training was advised
[4,23]. Therefore, progressive exercise training with
increasing load may be advised to restore normal
muscle function and structure. Importantly, the type,
load, and frequency of the exercises should be
tailored towards the individual patient.
Still, not all reports confirm the efficacy of train -
ing focused on improving the structure of muscles.
Willemink et al. show that 24 weeks of dynamic
resistance training of the isolated lumbar extensors
led to improved functional status in a group of male
patients with CNSLBP without significant changes
in LM morphology. There were no significant chan -
ges in LM FCSA (1.8%–2.2%) during treatment
[39]. These findings are in line with a study by Dan -
neels et al., who also reported no significant changes
in FCSA after 10 weeks of a combined stabilization
and progressive resistance-training regime for the
trunk and lower leg muscles [4]. Despite the lack of
improvement of multifidus morphology, patients may
benefit from enhanced and restored functional status
associated with better CNS-mediated activation of the
muscle. These conclusions suggest that improvement
in LM morphology is not a critical success factor in
restoring function of patients with CNSLBP (in the
short term of 6 months).
Kader et al. analyzed the effect of various forms
of therapy in LBP, which employed educating pa -
tients, exercises on balls, and injecting methylpredni -
solone into the multifidus muscle. After 10 weeks,
the most effective analgesic effect was seen in those
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śnia wie lo dziel ne go, mo żna po pra wić i przy wró cić
pa cjen tom stan funk cjo nal ny zwią za ny z lep szą ak ty -
wa cją mię śnia przez OUN. Za tem po pra wa mor fo lo gii
te go mię śnia u pa cjen tów z prze wle kłym nie spe cy ficz -
nym bó lem krę go słu pa nie sta no wi klu czo we go ele -
men tu w te ra pii (w krót kim okre sie 6 mie się cy).
Ka der i wsp. zba da li wpływ ró żnych form te ra pii
w le cze niu LBP, gdzie wy ko rzy sta no ele ment edu ka -
cji pa cjen ta, ćwi cze nia na pił kach oraz po da nie do
mię śnia wie lo dziel ne go w spo sób in iek cyj ny me thyl -
pred ni so lo nu. Oka za ło się, że naj ko rzyst niej szy efekt
prze ciw bó lo wy po 10 tyg. przy nio sło za sto so wa nie
le ku prze ciw za pal ne go, a efek ty w po szcze gól nych
gru pach zo sta ły zwe ry fi ko wa ne za po mo cą kwe stio -
na riu szy. Jed nak na żad nym z eta pów ba dań nie oce -
nio no tkan ki mię śnio wej i pra cy mię śni [40].
Co mer ford i wsp. zwró ci li uwa gę, że nie któ re ćwi -
cze nia te ra peu tycz ne ma ją na ce lu wzmoc nie nie sła -
bych mię śni tu ło wia, a in ne po pra wę kon tro li trans la cji
w sta wie [41,42]. Au to rzy wska zu ją na ró żni ce tre nin -
go we zwią za ne z pro giem ak ty wa cji mię śni w ka żdym
ro dza ju ćwi czeń. Ćwi cze nia wzmac nia ją ce ak ty wu ją
szyb kie jed nost ki mo to rycz ne, przez co mię śnie ule ga -
szyb sze mu zmę cze niu, na to miast tre ning kon tro li
mo to rycz nej ak ty wu je wol ne jed nost ki mo to rycz ne
przy mniej szych ob cią że niach, uła twia jąc w ten spo sób
utrzy my wa nie funk cjo nal nych po staw. Pro ble mem kli -
nicz nym jest za pew nie nie oce ny ćwi cze nia i wy eli mi -
no wa nia błę dów tak, aby uzy skać pra wi dło wy próg ak -
ty wa cji mię śni pod czas kon kret ne go ćwi cze nia.
Hod ges ar gu men tu je, że wzmac nia nie mię śni
i po ten cja łu si ły jest in nym pro ce sem, niż tre ning
głęb szych, wy raź nie od ręb nych mię śni od po wia da ją -
cych za kon tro lę mo to rycz ną [43,44]. Oba pro ce sy
wy ma ga ne do osią gnię cia wy so kie go po zio mu ak -
tyw no ści, któ ra jest nie zbęd na w za wo do wym spo r -
cie. Ana lo gią ja ką mo żna przy wo łać, jest my śle nie
o ukła dzie mię śnio wo -szkie le to wym jak o „kom pu -
te rze”. Tre ning w wy so kim ob cią że niu, gdzie do mi -
nu je ak ty wa cja mię śni po mię dzy 30-75% MVC (ma -
xi mum vo lun ta ry con trac tion), do ty czy zmian struk -
tu ry mię śni i mo że my go po rów nać do mo der ni za cji
„sprzę tu kom pu te ro we go”. Kom pu ter pra cu je szyb -
ciej, uru cha mia bar dziej skom pli ko wa ne apli ka cje
i pro gra my po pro ce sie mo der ni za cji. Ni sko pro go wy
tre ning kon tro li mo to rycz nej (15–25% MVC) nie
zmie nia struk tu ry mię śnia w wiel kim za kre sie, lecz
przede wszyst kim po pra wia zdol ność ośrod ko we go
ukła du ner wo we go do ko or dy na cji na pięć mię śni,
przez co po pra wia or ga ni za cję i efek tyw ność ru chu.
Mo żna to od nieść do uak tu al nie nia opro gra mo wa nia,
aby kom pu ter wy ko ny wał swo je za da nia bar dziej
efek tyw nie oraz by mógł uzy skać jak naj wię cej ze
sprzę tu już ist nie ją ce go.
receiving the anti-inflammatory medicine. The effect
in individual groups was verified with a ques tion -
naire, while muscle tissue and muscle work were not
assessed at any stage of the study [40].
Comerford et al. note that some therapeutic exer -
cises are aimed at strengthening weak trunk muscles,
while others improve translational control in joints
[41,42]. The authors refer to differences in training
related to muscle activation threshold in each type of
exercise. Strengthening exercises activate fast motor
units, and because of that muscles get tired faster.
Motor control training, on the other hand, activates
slow motor units at lower loads, which facilitates
maintaining functional postures. It is a clinical pro -
blem to assess an exercise and eliminate errors so
that the correct muscle activation threshold is found
for a particular exercise.
Hodges argues that strengthening muscles and
increasing strength potential is a process different
than training deeper-lying, clearly separate muscles,
which are responsible for motor control [43,44].
Both processes are required to achieve a high level of
activity, which is indispensable in every professional
sport. By analogy, the human musculo-skeletal sys -
tem can be compared to a computer. High load
training with dominant muscle activation at 30-75%
of the MVC (maximum voluntary contraction) cau -
ses structural changes in muscles and can be com -
pared to modernizing computer hardware. A com pu ter
works faster and launches more complex ap plications
and programs when it has been moderniz ed. Low
threshold motor control training (15-20% of MVC)
does not change muscle structure to a large extent;
instead, it improves the ability of the central nervous
system to coordinate the tone of muscles, which
improves organization and effectiveness of movement.
It is like updating software in order for the computer to
perform its tasks more effectively and to use the
existing hardware to the largest extent possible.
Atrophy seen in the multifidus muscle in people
with low back dysfunction is construed as a form of
impaired motor control rather than simple disuse
weakness. Thus, traditional strengthening exercises
will often fail to correct this fault, just as daily phy -
sical activities fail to maintain a normal segmental
CSA at the pathological level. Certainly, the histo -
rical lack of success of the rehabilitation and medical
professions in treating low back pain using the wide
variety of strength based clinical models used over
the last 50 years should serve as sufficient motivation
to refer to more evidence-based models as an exp -
lanation for the condition.
The model embraced by the University of Queen -
sland shows that deep fibers of the multifidus muscle
Hadała M. et al. Effectiveness of lumbar extensor exercises
569
1_Hadala:Layout 1 2015-01-20 14:44 Strona 9
Przy kła dem, któ ry po twier dza ewi den cja na uko -
wa jest atro fia mię śnia wie lo dziel ne go, któ rą mo żna
za ob ser wo wać u osób z dys funk cją od cin ka lę dźwio -
we go. Atro fia przed sta wia na jest w po sta ci za bu rzeń
kon tro li mo to rycz nej te go mię śnia, a nie po pro stu
je go sła bo ści. Sto so wa nie tra dy cyj nych ćwi czeń
wzmac nia ją cych bę dzie czę sto niesku tecz ne w po -
pra wie te go za bu rze nia, sko ro co dzien na ak tyw ność
nie utrzy mu je pra wi dło wych po zio mów prze kro ju
po przecz ne go mię śnia w seg men cie, z któ re go ge ne -
ro wa ne do le gli wo ści bó lo we. Oczy wi ście hi sto rycz -
ny brak suk ce su w za kre sie re ha bi li ta cji i le cze nia bó -
lów krę go słu pa opar ty był przez ostat nie 50 lat na mo -
de lu si ły i po wi nien słu żyć ja ko wy star cza ją ca mo ty wa -
cja do spoj rze nia na wię cej do wo dów na uko wych o
par -
tych o mo del, któ ry sta ra się wy ja śnić ta ki stan.
Przy ję ty mo del przez Uni wer sy tet Qu een sland
udo wad nia, że głę bo kie włók na mię śnia wie lo dziel -
ne go pra cu ją głów nie ja ko kon tro ler ru chu trans la cji
w sta wie (bez an ta go ni sty), na to miast włók na po -
wierz chow ne nie wy łącz nie ro ta to rem czy pro -
stow ni kiem ak ty wu ją cym się to nicz nie w cza sie ćwi -
czeń sta tycz nych. Włók na głę bo kie więc wa żnym
ele men tem zin te gro wa nej mu sku la tu ry cia ła. Z dru -
giej jed nak stro ny po strze ga nie, mię sień wie lo -
dziel ny jest wa żniej szy niż pro stow ni ki po wierz -
chow ne nie za wsze ma swo je prze ło że nie na re zul ta -
ty te ra pii. Z kli nicz ne go punk tu wi dze nia naj trud -
niej sza wy da je się być tu taj in te gra cja tych struk tur
w je den spraw nie funk cjo nu ją cy me cha nizm.
WNIO SKI
1. Za rów no sta bi li za cja od cin ka lę dźwio we go (ni ski
próg ak ty wa cji pra ca to nicz na), jak i kon wen -
cjo nal ne dy na micz ne ćwi cze nia wzmac nia ją ce
(wy so ki próg ak ty wa cji pra ca fa zo wa) po pra -
wia ją pa ra me try fi zjo lo gicz ne mię śni pro stow ni -
ków krę go słu pa. m.in. ak ty wa cję, wy trzy ma łość, si -
łę, dzię ki cze mu zmniej sza ją ból od cin ka lę dźwio -
we go i po pra wia ją funk cję ru cho wą pa cjen ta.
2. W po rów na niu do dy na micz nych ćwi czeń wzmac -
nia ją cych, ćwi cze nia sta bi li zu ją ce ko ry gu ją od po -
wiedź CUN po pra wia jąc re la cję na pię cia pro stow -
ni ków przy ma łym ką cie zgię cia od cin ka lę dź -
wio we go.
3. Sta bi li za cja od cin ka lę dźwio we go krę go słu pa
(pra ca na mię śniu wie lo dziel nym) jest bar dziej
efek tyw na niż po pra wa si ły u pa cjen tów, gdzie
wy stę pu ją prze wle kłe do le gli wo ści bó lo we krę -
go słu pa lę dźwio we go.
4. Ćwi cze nia kon dy cyj ne i si ło we sta no wią wa żny
ele ment w pre wen cji oraz re duk cji ry zy ka ura zu
u spor tow ców.
work mainly as a controller of translation in a joint
(without an antagonist), while superficial fibers are
not only a rotator or an extensor activated tonically
during static exercises. Deep fibers are thus an im -
portant element of the integrated body musculature.
On the other hand, perceiving the multifidus muscle
as more important than the superficial extensors is
not always reflected in the therapeutic results. From
the clinical point of view, it seems most difficult to
integrate both structures in one functioning me -
chanism.
CONCLUSIONS
1. Both lumbar spine stabilization (low activation
threshold – tonic work) as well as conventional
dynamic strengthening exercises (high activation
threshold – phasic work) improve physiological
parameters of the spine extensors, such as acti -
vation, endurance, or strength. As a result lumbar
pain is relieved and the patient’s motor functions
improve.
2. In comparison with dynamic strengthening exer -
cises, stabilizing exercises correct the CNS res -
ponse, improving the relation of extensor tone at
a small flexion angle in the lumbar spine.
3. Stabilization of the lumbar spine (multifidus
muscle exercises) is more effective than improv -
ing strength in patients with chronic lumbar spine
dysfunction.
4. Both conditioning and strengthening exercises
constitute important elements in preventing and
reducing the risk of injury in athletes.
Hadała M. i wsp. Skuteczność ćwiczeń mięśni prostowników kręgosłupa lędźwiowego
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Hadała M. et al. Effectiveness of lumbar extensor exercises
571
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Hadała M. i wsp. Skuteczność ćwiczeń mięśni prostowników kręgosłupa lędźwiowego
572
Adres do korespondencji / Address for correspondence
dr Mi chał Ha da ła
Fi zjo -Sport Na uki Sto so wa ne w Spo rcie Od dział Pol ska
ul. Sto kro tek 10, 35-604 Rze szów, e-ma il: mi chal ha da la@wp.pl
Liczba słów/Word count: 7506 Tabele/Tables: 0 Ryciny/Figures: 0 Piśmiennictwo/References: 44
Otrzymano / Received 27.03.2014 r.
Zaakceptowano / Accepted 31.07.2014 r.
1_Hadala:Layout 1 2015-01-20 14:44 Strona 12
... In normal gravity, repetitive lifting is a welldescribed risk factor for degenerative lower back disorders, and the concept of an upper safety limit for a combination of lifted weight and lifting frequency has been internationally adopted (12). On the other hand, prolonged disuse of lumbar extensor muscles may cause low back pain (21). Moreover, low back pain and disability may be mitigated by resistance exercise (30). ...
... The lumbar multifidus muscle has been identified as important for good spinal health in terrestrial studies (17), and atrophy in the multifidus has been closely related to lumbar flattening after 6 months space flight (7). Presumably, the lumbar extensor muscle activity levels in the present flywheel exercises, ranging from 31 to 122% MVIC, would be sufficient to prevent substantial atrophy (21) if implemented as a regular (e.g., 2-3 times/ week) countermeasure exercise regimen from day 1 of spaceflight. It is another matter whether such exercise is optimal to counteract low back pain; it has in fact been argued that low loaded stabilizing exercise, promoting motor control of the lumbar multifidus muscle, constitutes a salient feature in preventing deconditioning associated low back pain (21). ...
... Presumably, the lumbar extensor muscle activity levels in the present flywheel exercises, ranging from 31 to 122% MVIC, would be sufficient to prevent substantial atrophy (21) if implemented as a regular (e.g., 2-3 times/ week) countermeasure exercise regimen from day 1 of spaceflight. It is another matter whether such exercise is optimal to counteract low back pain; it has in fact been argued that low loaded stabilizing exercise, promoting motor control of the lumbar multifidus muscle, constitutes a salient feature in preventing deconditioning associated low back pain (21). ...
Article
Sjöberg, M, Eiken, O, Norrbrand, L, Berg, HE, and Gutierrez-Farewik, EM. Lumbar loads and muscle activity during flywheel and barbell leg exercises. J Strength Cond Res XX(X): 000-000, 2021-It is anticipated that flywheel-based leg resistance exercise will be implemented in future long-duration space missions, to counter deconditioning of weight-bearing bones and postural muscles. The aim was to examine low back loads and muscle engagements during flywheel leg press (FWLP) and flywheel squat (FWS) and, for comparisons, free-weight barbell back squat (BBS). Eight resistance-trained subjects performed 8 repetition maximums of FWLP, FWS, and BBS. Motion analysis and inverse dynamics-based musculoskeletal modeling were used to compute joint loads and muscle forces. Muscle activities were measured with electromyography (EMG). At the L4-L5 level, peak vertebral compression force was similarly high in all exercise modes, whereas peak vertebral posteroanterior shear force was greater (p < 0.05) in FWLP and BBS than in FWS. Among the back-extensor muscles, the erector spinae longissimus exerted the greatest peak force, with no difference between exercises. Peak force in the lumbar multifidus was lower (p < 0.05) during FWLP than during FWS and BBS. Peak EMG activity in the lumbar extensor muscles ranged between 31 and 122% of maximal voluntary isometric contraction across muscles and exercise modes, with the greatest levels in the lumbar multifidus. The vertebral compression forces and muscle activations during the flywheel exercises were sufficiently high to presume that when implementing such exercise in space countermeasure regimens, they may be capable of preventing muscle atrophy and vertebral demineralization in the lumbar region.
... In contrast, the GL and ES activity reached levels of 17% and 23% MVIC, respectively. Thus, the SBWS exercise can potentially be used as a safe initial intervention in patients with limited muscle endurance in low back muscles, prior to the execution of more challenging exercises, such as the body-weight supine bridge exercise [26][27][28][29][30][31]. ...
Article
Full-text available
(1) Background: The static body-weight wall-squat (SBWS) exercise is often included in the early rehabilitation stages of the lower limb. To establish its effectiveness and optimise its application, it is important to precisely quantify the muscle contribution to different versions of this exercise. (2) Methods: We analysed the electromyographic activity of lower limb and lumbar muscles during the SBWS with knees flexed at 45° by manipulating three different variables: horizontal distance of the ankles from the wall; scapular or pelvic location of the centre of pressure Cwall of the force exerted by the wall on the back; rearfoot or forefoot location of the centre of pressure CGR of the ground reaction force. (3) Results: The forefoot-to-rearfoot CGR shift significantly increased the vastus medialis, vastus lateralis, and tibialis anterior activity up to 23%, 26%, and 44% of the maximum voluntary isometric contraction (MVIC). The lumbar muscle activity was maximised (23% MVIC) shifting CGR at the forefoot, Cwall at the scapular zone, and placing the feet far from the wall. (4) Conclusions: These SBWS methods might be effective for quadriceps, tibialis anterior, and lumbar muscles strengthening in the early phase of rehabilitation intervention as soon as the patient can tolerate partial weight-bearing. The exercise appears suitable for patients with low back pain and limited lumbar muscle endurance, or quadriceps weakness and inhibition secondary to a knee injury.
... 7,8 One possible reason for the inconsistent outcomes observed in conservative treatment of LBP is changes in muscle health secondary to atrophy, denervation or degeneration, which result in loss of functional contractile tissue, and may make some individuals nonresponsive to exercise interventions. [9][10][11] Therefore, an approach to identify which patients will ultimately respond to exercise-based treatments is currently needed. ...
Article
Exercises to strengthen and stabilize the trunk musculature are a common conservative treatment strategy for low back pain (LBP), despite the possible presence of impairments in muscle activation in this population. Intravoxel incoherent motion (IVIM) MRI permits evaluation of activation‐induced blood flow through diffusion‐weighted images that are sensitized to microvascular blood flow. In the current study we aimed to evaluate IVIM signal changes after exercise in patients with LBP compared with pain‐free healthy controls and determine if these changes were related to reductions in disability with a 12‐week rehabilitation program. We hypothesize that the magnitude of changes in IVIM parameters in the lumbar extensor muscles will be smaller in patients with LBP compared with those without LBP, and that these magnitudes will be correlated with responsiveness to a 12‐week, resistance‐based exercise program. IVIM MR data for molecular diffusion (D), blood flow pseudodiffusion (D*) and perfusion fraction (f) were collected before and immediately after an ~ 3‐min session of high‐intensity lumbar extension resistance exercise in 16 healthy participants and 17 participants with LBP. Improvements in LBP‐related disability after the 12‐week, machine‐based, high‐intensity exercise rehabilitation program were measured in the LBP group. We observed a significant increase in all IVIM parameters (f, D*, D) in response to exercise (p < 0.0001) and an interaction of group‐by‐time for D (p = 0.016). Thresholds were identified using receiver operating characteristic (ROC) curves for diffusion and pseudodiffusion coefficients, which predicted a reduction in LBP‐related disability in response to the 12‐week, exercise‐based rehabilitation program. Exercise was associated with an increase in (f), capillary blood flow‐based pseudodiffusion (D*) and diffusion coefficient (D), regardless of the presence of LBP. Additionally, subgroup analysis identified patients who were not responsive to the acute exercise session, for whom, based on ROC analysis, there was no clinically significant change in disability following the 12‐week program. Intravoxel incoherent motion imaging allows for evaluation of muscle perfusion changes in response to exercise. This technique identified individuals with low back pain who did not respond to a 12‐week, exercise‐based rehabilitation program. This may be a valuable tool for improved patient selection for conservative management.
... 4 Indeed, the lack of paraspinal muscle hypertrophy is thought to contribute to the high rates of recurrence in this population. 4,5 Given the high proportion of patients with LBP who use analgesics with therapeutic exercise, and the opposing effects of their use on muscle adaptation, motor drive, and exercise tolerance, it is possible, and perhaps likely, that analgesic use is a fundamental detractor to the outcome of exercise-based rehabilitation. Remarkably, however, there are essentially no objective data in the field on how patients with LBP use analgesic medications relative to exercise-based rehabilitation. ...
... Some studies compared the efficiency of core exercises to that of conventional spine exercises, and core stabilization exercises were found to be more effective in reducing pain, improving functional status by decreasing disability of NSCLBP patients (Inani et al., 2013), but also more effective than muscular strength exercises (Alhakami et al., 2019). The conclusion of a systematic review was that lumbar low load specific stabilization exercises would be more efficient than muscle strengthening in the improvement of CLBP, but strengthening exercises are considered more valuable in effectively 'pre-habilitating' and in reducing the injury risk (Hadala & Gryckiewicz, 2014). ...
... Specific muscle dysfunction appears to be associated with pain, stabilization exercises have gained popularity in the conservative treatment of patients with spinal pain, but the evidence for the effectiveness of this approach is limited [30,31]. Previous studies have reported that neck muscle training is effective to reduce the neck pain [32]. ...
Article
Introduction Stabilization exercise may be an important approach to alleviate neck pain. However, its use has not been well established. We conduct a narrative review and meta-analysis to evaluate the efficacy of stabilization exercise to control neck pain. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of stabilization exercise on neck pain are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model. Results Five RCTs involving 217 patients are included in the meta-analysis. Compared with control intervention for neck pain, stabilization exercises has no notable impact on pain intensity (Std. MD=−0.55; 95% CI=−1.24 to 0.14; P=0.12), neck disability index (Std. MD=−0.44; 95% CI=−1.01 to 0.13; P=0.13), SF-36 physical health (Std. MD=−0.18; 95% CI=−0.61 to 0.26; P=0.43), SF-36 mental health (Std. MD=−0.03; 95% CI=−0.47 to 0.41; P=0.89), but can remarkably decrease depression scale (Std. MD=−1.05; 95% CI=−1.59 to −0.50; P=0.0002). Conclusions Stabilization exercises shows similar impact on pain intensity, neck disability index, SF-36 physical health and SF-36 mental health, but significant reduced depression scale compared with control intervention in patients with neck pain.
... Special considerations for persons who have LBP include avoidance of exercises that cause peripheralization of pain (the spread of pain from the back toward the extremities), and potential use of spinal stabilization exercises [94]. There is a general consensus that core stabilization and strength is key for LBP improvement, however specific clinical practice guidelines for lower extremity amputees are not explicitly defined [7,24,[95][96][97][98][99][100][101]. ...
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Purpose: Approximately 185 000 individuals undergo limb amputations every year. Of this population, 40% experience lower extremity amputations. A common musculoskeletal condition that develops after amputation is chronic low back pain (LBP). LBP may be a consequence of one or combined mechanical factors including muscle atrophy, strength loss, level of amputation, kinematic traits of movement, mechanical loading and forces, prosthetic design/use and leg length discrepancy. Secondary consequences of LBP may collectively include the dependence of pain medications, impaired physical function, and diminished quality of life (QOL). Methods: A systematic literature search using PubMed was conducted to identify articles of low back pain in lower limb amputees. Results: Long-term interventions are needed to reduce the incidence, prevalence, and secondary impacts of LBP in amputees. Resistance exercise has strong potential to help correct mechanical deficits in lower limb amputees. Resistance exercise adaptations that can be beneficial for this population include improved neuromuscular control, increases in lumbar and core muscle strength cross-sectional area, and improved gait motion parameters. Conclusions: This narrative review provides an overview of the key mechanical and physiological factors which may contribute to chronic LBP in amputees, and discusses the use of resistance exercise training to combat these mechanical factors to improve pain symptoms. • IMPLICATIONS FOR REHABILITATION • Low back pain is more prevalent in the amputee population compared to the general population. • Low back pain may be due several mechanical factors that develop after a unilateral amputation. • Lower extremity amputees with chronic low back pain experience compounded physical activity avoidance and functional limitations. • Chronic low back pain in amputees erodes quality of life more than people with back pain or amputation alone. • Therapeutic interventions, such as core strengthening and stabilization exercises, have strong potential to provide low back pain relief for amputees.
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Introduction: This report examines the effects of a multimodal rehabilitation program which includes cognitive, physical, and somatosensory rehabilitation after right temporo-parietal tumor resection on cognitive, motor, somatosensory, and electrophysiological parameters. Case description: A 22-year-old patient presented with sensory loss in the dominant left hand and reduced writing ability after right temporo-parietal lobe resection. Cognitive, motor, and sensory evaluations were carried out pre and post-treatment. The patient's spontaneous electroencephalo-gram (EEG) and an EEG during application of transcutaneous electrical nerve stimulation (TENS) (TENS EEG) were recorded. As a reference for the patient's electrophysiological values, EEGs of 4 healthy individuals were also taken. Over a period of 1 year, the patient received multimodal rehabilitation which includes cognitive, physical, and somato-sensory rehabilitation on 2 days each week. Outcomes: An improvement of the patient's cognitive capacities, motor strength, superficial, deep and cortical sensations was achieved. After rehabilitation, an increase in parietal and occipital alpha activity as well as in frontal and parietal beta activity was seen both in spontaneous EEG and in TENS EEG. With increasing TENS intensity, alpha and beta power increased as well. Conclusion: Our findings suggest that a multimodal rehabilitation program may improve cognitive, sensory, and motor effects after resection due to tumor surgery.
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Background We evaluated the learning time and remember of the exercises which given the home exercise program low back pain patients. Methods The study included patients aged 20-65 years who had been suffering from a mechanical low back pain. All patients were informed about the study and an informed consent was obtained from each of them. A socio-demographic form probing age, gender, and educational status was filled in by the patients. All the patients were taught five exercises which were aimed at increasing trunk and lower extremity muscle length, strength, and endurance by the same physiotherapist and the exercises were repeated by the patients in the presence of the physiotherapist until they were performed fully and appropriately. In the meantime, total number of repetitions and the duration of learning the exercises (seconds) were noted for each patient. Patients were instructed to perform these exercises for 15 days with 10 sets a day. On the 15-day follow-up session, patients were asked to perform the assigned exercises and those who performed them correctly were recorded as “remembering”. Results The patients learned the hamstring stretch, lumbar stretch, and flexor stretch in a shorter period and learned the hamstring stretch with fewer repetitions compared to other exercises. Additionally, lumbar stretch was the most remembered exercise. Discussion We suggest that instead of giving patients multiple complex exercises, patient-specific exercises that can be easily learned and performed without forgetting can be selected and thus lumbar stretch is a suitable option for this purpose.
Article
Background: Due to a significant burden associated with training sessions and matches, female football players often suffer from lumbar pain. Physical exercise is considered an effective form of therapy for this condition. The exercises in the Kinetic Control concept are one of the forms of motor control training. Objective: The aim of the study was to evaluate the effectiveness of motor control training according to the Kinetic Control concept on the level of lumbar spine pain, degree of disability, functional level and load distribution of lower limbs in football players. Methods: The study included 18 football players, randomly divided into two study groups: A - female players implementing their training plan with additional Kinetic Control training (n= 9) and B (control) - female players implementing their training plan only (n= 9). Pain intensity was measured using Visual Analogue Scale (VAS) and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). The asymmetry index was assessed in a balance test with open and closed eyes and a countermovement jump (CMJ). Results: There was a significant statistical difference between the groups (p< 0.05) in measurements using VAS, ODI and BPFS, in favor of group A. Asymmetry index values in tests on the dynamometer platform did not differ significantly between the groups (p> 0.05). A statistically significant correlation was found between the asymmetry index score in the closed-eye balance test (r= 0.567, p= 0.049) and the CMJ landing phase (r= 0.641, p= 0.033), and the level of pain measured using VAS. Conclusions: Motor control training in the Kinetic Control concept reduced the pain symptoms of the lumbar spine and the degree of disability and increased the functional level in football female players.
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To review the specificity of exercises designed to condition the lumbar extensor musculature (ie, lumbar erector spinae and multifidus). A review of studies examining effects of exercises designed to condition the lumbar extensors was conducted. Included were studies that examined the acute activation and chronic adaptation of the lumbar extensor musculature in response to benches and roman chair trunk extensions, free weights exercises (ie, deadlifts, squats, good-mornings, etc), floor and stability ball exercise (ie, trunk extensions, bridging, four-point kneeling, etc) and resistance machines (ie, those with and without pelvic restraints). Evidence suggests that the reviewed exercises designed to condition the lumbar extensors all may result in significant activation of this musculature during their performance. However, examination of training studies shows that for benches and roman chair trunk extensions, free weights exercises, floor and stability ball exercise and resistance machines without appropriate pelvic restraints, evidence suggests that they may be less effective for inducing chronic adaptations in the lumbar extensors as a result of their performance. Contrastingly, resistance machines that employ appropriate pelvic restraint to isolate lumbar extension are better evidenced to confer specific adaptations to the lumbar extensors. Numerous exercise approaches have been designed with the intention of conditioning the lumbar extensors. Those examined appear to activate the lumbar extensors; however, the specificity of many of these exercises for producing chronic adaptations may be questionable, potentially due to the compound nature of them allowing involvement of other musculature such as the hip extensors. Many of the reviewed exercises offer potential to condition the lumbar extensors, however, isolation of lumbar extension through appropriate pelvic restraint appears important for optimising specific adaptations in the lumbar extensors.
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To consider the efficacy of 10 weeks of Romanian deadlift (DL) training in increasing lumbar extension strength compared to isolated lumbar extension (LUMX) training. Comparison of pre- and post-test data for Romanian deadlift 1RM, and lumbar extension torque between and within groups. Male trained subjects (n = 36; (x¯±SD) 24.9 ± 6.5 years; 178.5 ± 5.2 cm; 81.6 ± 10.0 kg). Pre- and post-testing included a Romanian deadlift 1RM and isometric strength tests every 12° through full range of motion on the MedX lumbar extension machine (MedX, Ocala, FL). Repeated measures analysis of variance (ANOVA) with Bonferroni adjustments revealed that 1RM Romanian deadlift significantly increased from pre- to post-test in the DL group (p < 0.008; 143.3 ± 23.4 kg to 166.3 ± 21.9 kg) and the LUMX group (p < 0.008; 135.8 ± 23.1 kg to 146.0 ± 25.5 kg). In contrast, tested functional torque (TFT) significantly increased at 6 out of 7 joint angles (p < 0.008) for the LUMX group only. The control group showed no significant differences pre- to post-test. These data suggest that the Romanian deadlift does not enhance lumbar extension torque. However, performing specific isolated lumbar extension training appears to improve both lumbar extension torque and Romanian deadlift 1RM.
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To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP). Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise. Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only. Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.
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Introduction: Lumbosacral back pain is the most prevalent musculoskeletal condition. The aim of this study was to examine the impact of discopathic lumbosacral pain on displacement of the body's centre of gravity and foot-ground pressure. Materials and methods: The study involved 30 patients (20 females and 10 males) with discopathic lumbosacral pain at the L(4)-L(5) and L(5)-S(1) levels, who underwent physiotherapeutic rehabilitation in the Rehabilitation Centre in Zamość. The mean age of the patients was 50.03 years ±16.15 (females - 47.5 ±16.8; males - 61.1 ±12.33). A Stability 2.0 stabilometric platform was used to assess the displacement of the body's centre of gravity and foot-ground pressure. Results: The results revealed that the amplitude of centre of gravity displacement was significantly lower in the frontal plane than in the sagittal plane, irrespective of whether the test was performed with closed or open eyes. All study participants showed a predominance of posterior tilt. As regards deviations in the frontal plane, 66.67% of the patients favoured the right lower limb, while 33.33% put more weight on the left lower limb. Conclusions: 1. Discopathic lumbosacral pain influenced the displacement of the body's centre of gravity and the symmetry of lower extremity loading. 2. Physiotherapy in patients with discopathic lumbosacral pain should be aimed at restoring the body's displaced centre of gravity and ensuring symmetrical loading of the lower extremities.
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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. 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%. 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. 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.
Article
Study design: This study investigated the influence of five different muscle groups on the monosegmental motion (L4-L5) during pure flexion/extension, lateral bending, and axial rotation moments. Objectives. The results showed and compared the effect of different muscle groups acting in different directions on the stability of a single motion segment to find loading conditions of in vitro experiments that simulate more physiologically reasonable loads. Summary of Background Data. In spine biomechanics research, most in vitro experiments have been carried out without applying muscle forces, even though these forces stabilize the spinal column in vivo. Methods. Seven human lumbosacral spines were tested in a spine tester that allows simulation of up to five symmetrical muscle forces. Changing pure flexion/extention, lateral binding, and axial rotation moments up to +/-3.75 Nm were applied without muscle forces, with different muscle groups and combinations. The three-dimensional monosegmental motion was determined using an instrumented spatial linkage system. Results. Simulated muscle forces were found to strongly influence load-deformation characteristics. Muscle action generally increased the range of motion and the natural zone of the motion segments. This was most evident for flexion and extension. After five pairs of symmetrical, constant muscle forces were applied (80 N per pair) the range of motion decreased about 93% in flexion and 85% in extension. The total natural zone for flexion and extension was decreased by 83% muscle action. The multifluids muscle group had the strongest influence. Conclusion. This experiment showed the important of including at least some of the most important muscle groups in invitro experiments in lumbar spine specimens.
Article
Study design: A prospective single-arm trial. Objective: To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). Summary of background data: LM morphology is associated with the recurrence of CNSLBP. Methods: Sixteen male patients underwent a dynamic isolated resistance-training program for the lower back muscles of approximately 10 sessions in 12 weeks. In the next 12 weeks, frequency of training was tailored to the patients' need. Participants underwent lumbar magnetic resonance imaging at baseline (T0), after 12 weeks (T12), and after 24 weeks (T24). Functional cross-sectional area was obtained by analyzing the magnetic resonance images. Functional status was assessed using the patient-specific functional scale, Roland-Morris disability questionnaire, and global perceived effect scale. Results: Roland-Morris disability questionnaire and patient-specific functional scale scores showed significant and clinically relevant improvements between baseline and T12, with 44% and 39%, respectively. Between T12 and T24, these scores did not change significantly. Seven participants (44%) reported clinically relevant improvements in global perceived effect at T12. At T24, 1 more participant reported a relevant global perceived effect improvement, whereas 2 participants (13%) reported worsening of their condition. The magnetic resonance imaging analysis showed minor nonsignificant changes in functional cross-sectional area. Conclusion: Our study shows that 10 weeks of dynamic isolated training of the lumbar extensors, once a week, leads to clinically relevant improvements in functional status of men with CNSLBP, without accompanying improvements in functional cross-sectional area of LM. These findings suggest that improvement in LM morphology is not a critical success factor in restoring functional status of patients with CNSLBP, at least in the short term (6 mo).
Article
Lumbar paraspinal muscle dysfunction and Low Back Pain are strongly correlated. The best treatment for non-specific Low Back Pain is still controversial. To evaluate the efficacy of lumbar multifidus muscle retraining exercises and perifacet multifidus injections in the treatment of Low Back Pain. 63 patients with non-specific LBP, with or without leg pain, and magnetic resonance images of paraspinal muscle degeneration only, were randomised to one of three treatment groups: A- Back education and standard physiotherapy for 10 weeks, B- Back education and gym ball exercise for 10 weeks or C- Perifacet injection into the lumbar multifidus muscle with methylprednisolone. The Oswestry Disability Index was used as the primary outcome measure and the SF-36, modified Zung depression index, modified somatic perception and McGill pain questionnaires were used as secondary outcome measures. 56 patients completed the trial. The Oswestry Disability Index improved in general from a mean of 29.9 to 25.9, but there were no statistically significant differences between the groups. Low back pain improved most in group C (P<0.02), while physical activities and social functioning were improved the most in group B (P<0.03). Perifacet injection and back education including a gym ball exercise program may be more effective than back education alone in relieving pain and improving physical capacity respectively. Back education including gym ball exercise could be used for non-specific Low Back Pain, as the ultimate goal should be to restore function.
Article
To evaluate electromyographic activity of several paraspinal muscles during localized stabilizing exercises and multijoint or global stabilizing exercises. Cross-sectional counterbalanced repeated measures. Research laboratory. Volunteers (N=25) without low-back pain. Subjects performed (1) localized stabilizing exercises (callisthenic exercises with only body weight as resistance): static lumbar extension, stable (on floor) and unstable static unipedal forward flexion, stable dynamic unipedal forward flexion, and unstable supine bridge; and (2) global stabilizing exercises (70% of maximum voluntary isometric contraction [MVIC]): dead lift and lunge. Mean and maximum amplitude of the electromyographic RMS of the lumbar and thoracic multifidus spinae and erector spinae. Electromyographic signals were normalized to the MVIC achieved during a back-extension exercise. Normalizing to the MVIC, paraspinal muscles were significantly (P<.05) most active, with mean and peak amplitudes of 88.1% and 113.4% during the dynamic stable dead lift at 70% of MVIC, respectively. The supine bridge on the unstable surface obtained the significantly lowest values of 29.03% and 30.3%, respectively. The other exercises showed intermediate values that ranged from 35.4% to 61.6%. Findings from this study may be helpful to strength trainers and physical therapists in their choice of exercises for strengthening paraspinal muscles. Our results suggest that in asymptomatic young experienced subjects, the dead lift at 70% of MVIC provides higher levels of mean and peak electromyographic signals than localized stabilizing exercises and other types of global stabilizing exercises.
Article
The effects of faulty postures include disturbances of the symmetric distribution of compressive and tensile forces acting on both sides of the body axis and the emergence of harmful shear forces. The torques of antigravity muscles also change unfavourably. This may lead to the development of a repetitive strain syndrome, stenosis of intervertebral foramina, compression of nerve roots and back pain. The development of back pain syndromes is significantly affected by the performance of various work-related tasks in non-ergonomic positions. The aim of the study was to investigate the association between back pain syndromes and the quality of body posture, especially in the context of work ergonomics. The study enrolled 125 persons: 39 adults with a childhood history of scoliosis, 39 midwives, and 47 physiotherapists. Body posture was assessed in all participants. In midwives and physiotherapists, body position during the performance of work-related tasks was also evaluated. The frequency and severity of pain was assessed with the Jackson-Moskowitz measure. The study revealed that over 80% of the participants suffered from spinal pain. In most cases, the pain was intermittent and was felt in the lumbar spine. The occurrence of pain among midwives and physiotherapists was not directly dependent on the predominant type of abnormal spinal position assumed during the performance of occupational tasks or the quality of body posture. The complaint was also reported by ca. 85% of persons with a history of scoliosis. An incorrect body posture (especially scoliosis) and performance of work-related tasks in non-ergonomic positions increase the probability of back pain.