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Is the novel suspension exercises superior to core stability exercises on some EMG coordinates, pain and range of motion of patients with disk herniation?

DOI:10.1007/s11332-021-00848-2
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Yasser Mohebbi Rad
Yasser Mohebbi Rad
Yasser Mohebbi Rad
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Mohammad Reza Fadaei Chafy at Islamic Azad University of Rasht
Mohammad Reza Fadaei Chafy
Alireza Elmieh at Islamic Azad University of Rasht
Alireza Elmieh
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Information about comparing the effectiveness of exercise methods on management of disk herniation is limited. The aim of this study was to compare the effect of two programs of suspension and core stability exercises on some electromyography (EMG) coordinates, pain and range of motion of patients with disk herniation. Thirty-two men with disk herniation participated in this clinical trial study which was randomly divided into three groups of suspension exercises (n: 12, age: 34.25 ± 8.81, BMI: 24.01 ± 2.7), core stability exercises (n: 10, age: 35 ± 10.3, BMI: 25 ± 2.27) and control (n: 10, age: 34.4 ± 6.67, BMI: 23.76 ± 1.45). Electrical activity of rectus abdominis, internal and external oblique and erector spinae muscles was masured by superficial EMG, back pain by McGill Pain Questionnaire and range of motion by Modified Schober test, one day before and immediately after of intervention period. The experimental groups performed an 8-week training period while the control group was only followed up. Data were analyzed using paired sample t test and analysis of covariance test and statistical significance was set at 0.05. Suspension group showed significant improvement in EMG of rectus abdominis, internal and external oblique muscles (respectively, p = 0.030, p = 0.017, p = 0.022) and pain (p = 0.001) compared to core stability group; but there was no significant difference between two groups in EMG of erector spinae muscle and range of motion. Changes in both training groups were significant in all variables compared to control groups (p ˂ 0.05). Our findings showed that although both exercises were effective in patients with lumbar disk herniation, but the effectiveness of suspension exercises in increasing muscle activation and reducing pain was more pronounced than core stability exercises. Iranian Registry of Clinical Trials (IRCT): IRCT20191016045136N1.
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Sport Sciences for Health (2022) 18:567–577
https://doi.org/10.1007/s11332-021-00848-2
ORIGINAL ARTICLE
Is thenovel suspension exercises superior tocore stability exercises
onsome EMG coordinates, pain andrange ofmotion ofpatients
withdisk herniation?
YasserMohebbiRad1· Mohammad RezaFadaeiChafy1 · AlirezaElmieh1
Received: 7 July 2021 / Accepted: 23 September 2021 / Published online: 20 October 2021
© The Author(s), under exclusive licence to Springer-Verlag Italia S.r.l., part of Springer Nature 2021
Abstract
Information about comparing the effectiveness of exercise methods on management of disk herniation is limited. The aim
of this study was to compare the effect of two programs of suspension and core stability exercises on some electromyogra-
phy (EMG) coordinates, pain and range of motion of patients with disk herniation. Thirty-two men with disk herniation
participated in this clinical trial study which was randomly divided into three groups of suspension exercises (n: 12, age:
34.25 ± 8.81, BMI: 24.01 ± 2.7), core stability exercises (n: 10, age: 35 ± 10.3, BMI: 25 ± 2.27) and control (n: 10, age:
34.4 ± 6.67, BMI: 23.76 ± 1.45). Electrical activity of rectus abdominis, internal and external oblique and erector spinae
muscles was masured by superficial EMG, back pain by McGill Pain Questionnaire and range of motion by Modified Schober
test, one day before and immediately after of intervention period. The experimental groups performed an 8-week training
period while the control group was only followed up. Data were analyzed using paired sample t test and analysis of covari-
ance test and statistical significance was set at 0.05. Suspension group showed significant improvement in EMG of rectus
abdominis, internal and external oblique muscles (respectively, p = 0.030, p = 0.017, p = 0.022) and pain (p = 0.001) compared
to core stability group; but there was no significant difference between two groups in EMG of erector spinae muscle and
range of motion. Changes in both training groups were significant in all variables compared to control groups (p˂0.05). Our
findings showed that although both exercises were effective in patients with lumbar disk herniation, but the effectiveness of
suspension exercises in increasing muscle activation and reducing pain was more pronounced than core stability exercises.
Iranian Registry of Clinical Trials (IRCT): IRCT20191016045136N1.
Keywords Suspension exercise· Core stability· Electromyography· Disk herniation
Introduction
Disk herniation can be defined as displacement of disk mate-
rial beyond the margins of the intervertebral disk space [1] It
is considered the most frequent cause of lumbosacral radicu-
lopathy [2]. Lumbar disk herniation affects about 39% of
chronic low back pain (LBP) patients [3]. Pain is caused by
herniated disk pressure on nerve roots and the spinal cord in
patient with disk herniation and causes failure or weakness
of muscles around spine [4]. The most effective muscles
involved in trunk stability include multifidus, erector espinae
(ES), rectus abdominis (RA), internal oblique (IO), external
oblique (EO) and transverse abdominis (TA) [5–7]. Research
shows that the electrical activity of these muscles is reduced
by LBP [8, 9]. Also, pain and decrease in normal spine func-
tion lead to reduced lumbar range of motion (ROM) [10].
Core stability exercise is one of the most commonly used
rehabilitation strategies for improving dynamic stability of
the lumbar spine in people with chronic LBP [11]. Core
stability refers to an effective recruitment of core muscles
(including the abdominal, back, pelvic and hip muscles)
leading to an optimal production of force and precise con-
trol of lumbopelvic–hip movement, as well as appropriate
load transfer from the spine to the pelvis and distal segment.
As such, it is thought to be a determinant factor for effective
motor performance [12]. Past research has been shown that
* Mohammad Reza Fadaei Chafy
mfadaei2000@yahoo.com
1 Department ofPhysical Education andSport Science,
Faculty ofHumanities, Rasht Branch, Islamic Azad
University, Rasht, Iran
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Nustatyta, jog norint sumažinti nugaros skausmą, pratimai, atliekami ant nestabilaus paviršiaus, yra veiksmingesni nei tokie patys pratimai, atliekami ant stabilaus paviršiaus (Marshall, & Murphy, 2008). Nestabilumą galima sukelti atliekant stabilizavimo pratimus ant nestabilių plokštumų (Rad, Chafy & Elmieh, 2021) arba naudojant funkcinius diržus (TRX) (Melrose & Dawes, 2015). Stabilizavimo pratimai ant nestabilių plokštumų stiprina stuburą stabilizuojančius raumenis (Gianola et al., 2016;Shin, 2014;Thuc, 2018), o dėl to sumažėja skausmas (Dillen et al. 2021). ...
Effects of Different Physiotherapy Interventions on Pain and Function in Persons Experiencing Lower Back Pain
Article
Full-text available
  • May 2022
Background. Lower back pain is one of the most common reasons people seek help from a physiotherapist. One of the techniques used in rehabilitation is resistance exercises with instability, such as exercises with TRX belts or on unstable planes. The aim. To evaluate the effects of different interventions on pain and functional status in individuals with lower back pain. Methods. The study included 30 subjects (mean age 47.53 ± 5.412) with lower back pain. Subjects in the study group underwent lower back stabilization exercises with TRX straps and in the control group using unstable planes. The tests were performed twice: before and after 15 intervention sessions. Results. Pain intensity after interventions was significantly reduced (p<0.05) in both groups. In the group with exercises with TRX belts, the pain was significantly reduced more (p<0.05) than in the group on unstable planes. Torso muscle endurance after interventions was significantly increased (p<0.05) in both groups. Abdominal and back muscle endurance after interventions increased significantly (p<0.05) in both groups. In the group with exercises with TRX belts, the endurance of the left and right torso muscles and abdominal and back muscles was significantly increased (p<0.05) compared to the group where exercises were performed on unstable planes. The amplitudes of lower back flexion after interventions were significantly increased (p<0.05) in both groups, as were the amplitudes of lower back and left flexion (p<0.05). However, no significant difference was found between groups (p>0.05). Conclusions. After the interventions, the functional condition of both groups improved and the intensity of the experienced pain decreased. Exercise with TRX straps improved the endurance of the lateral torso and abdominal muscles more and reduced pain more than exercises on unstable planes for individuals experiencing lower back pain. Keywords: lower back pain, stabilization exercises, unstable planes, TRX straps.
Efficacy of Core Stability in Non-Specific Chronic Low Back Pain
Article
Full-text available
  • Apr 2021
(1) Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.
Effect of Core Stabilizing Training on Young Individuals Presenting Different Stages of Degenerative Disc Disease-Preliminary Report
Article
Full-text available
The aim of this study was to assess the efficacy of stabilizing training for the deep core muscles of the lumbar spine in subjects with degenerative disc disease. This study was conducted on 38 participants. The participants were divided into two groups: the extrusion group (EXT, n = 17) and the protrusion group (PRO, n = 21). All the subjects underwent a four-week-long core stability exercise-based treatment (five sessions/week). Clinical outcome measures were assessed pre-intervention (pre), post-intervention (post) and four weeks after the intervention (follow-up). The primary outcome measures were the spinal range of motion (ROM; Spinal Mouse® device) and the Oswestry Disability Index (ODI). In the PRO group, the ROM decreased from 88.52° pre-intervention to 83.33° post-intervention and to 82.82° at follow-up (p = 0.01), while the ODI decreased from 16.14 points pre-intervention to 6.57 points post-intervention, with 9.42 points at follow-up (p < 0.01). In the EXT group, the ROM decreased from 81.00° pre-intervention to 77.05° post-intervention, then increased to 77.94° at follow-up (p = 0.03), while the ODI decreased from 22.58 points pre-intervention to 15.41 points post-intervention and to 14.70 points at follow-up (p < 0.001). Although the stabilizing exercise sessions improved the clinical outcomes in each group, we cannot make conclusions as to whether the type of intervertebral disc damage significantly affects the results of stabilizing exercise-based treatment.
The Effect of Suspension and Conventional Core Stability Exercises on Characteristics of Intervertebral Disc and Chronic Pain in Office Staff Due to Lumbar Herniated Disc
Article
Full-text available
  • May 2020
Background: The purpose of this study was to identify the effects of eight weeks of conventional and suspension core stability exercises by use of the designed device on characteristic of intervertebral discs in low back pain. Methods: A total of 27 men with chronic low back (CLB) pain due to lumbar disc herniation in L4-L5 and L5-S1 regions were enrolled in this quasi-experimental study. After assessing the pain intensity using a visual analog scale (VAS) and determining the disc herniation index using MRI, each group of patients were asked to perform either conventional or suspension exercises for eight weeks, each week consisting of three training sessions. The pain intensity was assessed at the end of the first, second, third, fourth and eighth weeks and the disc hernia index was determined again at the end of the eight weeks of exercises. Results: The results indicated significant changes in the intensity of pain in both groups through the period of eight weeks of exercise with a remarkable pain relief. In relation to the structural characteristics of the intervertebral disc, data analysis did not reveal any significant change between the pre- and post-test. Conclusion: Considering the beneficial effects of the stability exercises and specially suspension stability exercises with respect to pain alleviation and reduced use of sedatives and anti-inflammatory drugs, this method can be helpful at early stages of treatment for chronic pains.
Abdominal muscle activation: An EMG study of the Sahrmann five-level core stability test
Article
Full-text available
Background: Sahrmann five-level core stability test protocol has been used to evaluate the ability of the core muscles to stabilize the spine. However, validation studies on the Sahrmann protocol are limited. Objective: The purpose of this study was to compare the different levels of Sahrmann five-level core stability (levels 1–5) on the muscle activity of rectus abdominis (RA), external oblique (EO), and transverse abdominis/internal oblique (TrA/IO). Methods:Twenty-two asymptomatic male participants aged 21.36±1.59 years were recruited. Participants were instructed to perform maximum voluntary contraction (MVC) and five levels of Sahrmann five-level core stability test guided with a pressure biofeedback unit (PBU). The surface electromyography (EMG) data of each muscle during five levels of Sahrmann five-level core stability test were normalized as a percentage of MVC. Results: Results showed significant differences in the normalized EMGs of RA [χ2(4) = 64.80, p<0.001], EO [χ2(4) = 58.11, p<0.001], and TrA/IO [χ2(4) = 56.00, p<0.001] between the five levels of Sahrmann five-level core stability test. Post-hoc analysis revealed Sahrmann levels 5 and 3 have significantly higher abdominal EMG signals than levels 4, 2, and 1 (p<0.001). Conclusion: In conclusion, the Sahrmann five-level core stability test differs according to the level of Sahrmann tests. Significantly higher abdominal muscle activities were observed during levels 3 and 5. Therefore, the classification exchange in levels 3 and 4 of the Sahrmann five-level core stability test should be reconsidered in the future. Keywords: Abdominal muscles; muscle activity; surface EMG; core stability.
Comparison among low intensity bridge exercises using suspension devices based on muscle activity and subjective difficulty
Article
Background: Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty. Objective: To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty. Methods: Nineteen asymptomatic male participants were included. Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected. Results: The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p< 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p< 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p< 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p< 0.05). Conclusions: Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.
Spatial distribution of lumbar erector spinae muscle activity in individuals with and without chronic low back pain during a dynamic isokinetic fatiguing task
Article
Background Individuals with chronic low back pain (CLBP) commonly present with increased trunk muscle fatigability; typically assessed as reduced time to task failure during non-functional isometric contractions. Less is known about the specific neuromuscular responses of individuals with CLBP during dynamic fatiguing tasks. We investigate the regional alteration in muscle activation and peak torque exertion during a dynamic isokinetic fatiguing task in individuals with and without CLBP. Methods Electromyography (EMG) was acquired from the lumbar erector spinae unilaterally of 11 asymptomatic controls and 12 individuals with CLBP, using high-density EMG (13 × 5 grid of electrodes). Seated in an isokinetic dynamometer, participants performed continuous cyclic trunk flexion-extension at 60o/s until volitional exhaustion. Findings Similar levels of muscle activation and number of repetitions were observed for both groups (p > 0.05). However, the CLBP group exerted lower levels of peak torque for both flexion and extension moments (p < 0.05). The centre of lumbar erector spinae activity was shifted cranially in the CLBP group throughout the task (p < 0.05), while the control participants showed a more homogenous distribution of muscle activity. Interpretation People with CLBP displayed altered and potentially less efficient activation of their lumbar erector spinae during a dynamic fatiguing task. Future studies should consider using high-density EMG biofeedback to optimise the spatial activation of the paraspinal musculature in people with low back pain (LBP).
New insights into lumbar flexion tests based on inverse and direct kinematic musculoskeletal modeling
Article
Measurement of maximal lumbar flexion is considered to be a crucial element in the assessment of lumbar spine mechanics in situations as diverse as physiotherapy, orthopaedics, ergonomics, sport or aging. However, currently, there is no consensus on a reference test. This study aims to characterise five maximal lumbar flexion tests (four classical tests and a new, specifically-developed test designed to constrain pelvic retroversion) based on a three-dimensional, participant-specific musculoskeletal model. Twenty-six male and female participants performed the five tests. Movements were modelled in OpenSim to estimate change in length in lumbar, hamstring and gluteus muscles, together with lumbar flexion and pelvic tilt. These so-called “inverse” kinematic results were compared using a two-way ANOVA (sex × test). In a second step, lumbar muscle change in length was computed using a direct kinematic method. Lumbar flexion and lumbar muscle change in length were found to be greater when participants were in seated postures, with little pelvic retroversion. Female participants were observed to have less lumbar flexion than male participants (77±14° and 91±12°, respectively). Hip extensor muscles (hamstrings and gluteus) were fully stretched during each of the five tests. Our results highlight the specific roles of hamstrings, gluteus and lumbar muscles into reaching maximal lumbar flexion. Coupling inverse and direct kinematic methods proved to be a useful tool to enhance our knowledge of lumbar tests. Our findings help to characterise the role of the muscles involved in lumbar flexion, and we propose some recommendations for improving and standardising these tests.
Recruitment of Shoulder Prime Movers and Torso Stabilizers During Push-Up Exercises Using a Suspension Training System
Article
  • Jan 2019
Context: Suspension training devices use body weight resistance and unstable support surfaces that may facilitate muscle recruitment during push-up exercises. Objective: The authors examined muscle recruitment with surface electromyography on 4 shoulder and 4 torso muscles during (1) standard push-ups, (2) feet-suspended push-ups, (3) hands-suspended push-ups, and (4) dual-instability push-ups in which feet were suspended and hands were on unstable surfaces. Design: Cross-sectional design with repeated measures. Setting: Biomechanics laboratory. Participants: Thirty-two healthy men and women (mean age, 24.3 y; mean body mass index, 24.6 kg·m-2) participated. Intervention: Participants were tested while performing 2 repetitions each of 4 variations of push-ups. Main outcome measures: Muscle recruitment, normalized to maximum voluntary isometric contraction, was measured in 4 prime movers (anterior deltoid, pectoralis major, serratus anterior, and triceps brachii) and 4 torso stabilizers (external oblique, internal oblique, rectus abdominis, and upper erector spinae). Results: Muscle recruitment in the anterior deltoid, pectoralis major, and serratus anterior during suspended exercises was no greater than during standard push-ups. In contrast, torso stabilizer recruitment was significantly greater in the external oblique, internal oblique, and rectus abdominis during all 3 suspended exercises compared with standard push-ups. Suspended exercises under a dual-instability condition did not generate greater levels of muscle activation compared with conditions of single instability. Conclusions: Push-ups performed with suspension training systems may provide benefit if one's goal is to enhance torso muscle training. One unstable surface may be sufficiently challenging for the client or athlete when performing push-up exercises with a suspension training device.
Effect of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work
Article
Background: This study compared the short- and long-term effects of different exercise programs on lumbar muscle function, cross-sectional area of the multifidus muscle, functional disability and low back pain in people who perform sedentary work. Methods: A total of 70 volunteer women with sedentary occupations suffering from low back pain were randomized to either the lumbar stabilization exercise program group or the lumbar muscle strengthening exercise program group. All subjects entered the 20-week exercise programs. The measurement of the cross-sectional area of the multifidus muscle was executed by using an ultrasound system, isokinetic peak torque was measured applying an isokinetic dynamometer. Findings: The results indicated that the 20-week exercise programs reduced low back pain and functional disability. Positive effects for the cross-sectional area of the multifidus muscle, functional disability and low back pain lasted for 4 weeks after the application of lumbar muscle strengthening exercise program and for 12 weeks after the application of lumbar stabilization exercise program. The lumbar muscle strength increased and lasted for 8 weeks after both exercise programs. Interpretation: The 20-week lumbar stabilization exercise and muscle strengthening exercise programs were efficacious in decreasing LBP and functional disability in people performing sedentary work, however the lumbar stabilization exercise program was more effective, and this effect lasted for 12 weeks after completion of the program.
The effect of stabilization exercises along with self-care training on transverse abdominal activity, pain, and disability in mothers with low back pain having children with CP: a RCT
Article
  • Sep 2019
Objective: Many mothers of children with cerebral palsy (CP) experience low back pain (LBP), so the purpose of this study was to investigate the effect of stabilization exercises along with self-care training on transverse abdominal muscle activity, pain, disability and depression in them. Design: In this single-blinded randomised clinical trial, 32 mothers with CP children were selected were randomly divided into two groups. Both groups received self-care training individually. For the experimental group, in addition to the self-care training, 24 sessions of stabilization exercises were held. Outcome measures included Visual Analog Scale, Roland-Morris Disability Questionnaire, Persian version of Beck Depression Inventory-II and ultrasonography. Results: In the experimental group the transverse abdominal muscle activity during abdominal hollowing exercises were significantly increased (p <0.05). There was no significant difference between the two groups in pain, disability and depression (p >0.05). Conclusion: Stabilization exercises could improve the voluntary activity of transverse abdominal muscle of mothers of children with cerebral palsy.