b.p.t project

8/12/2019 B.P.T project

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A

PROJECT REPORT

EFFECTIVENESS OF THE CORE

STABILIZATION EXERCISES IN

STRENGTHENING THE LOW BACK

MUSCLES IN YOUNGER FEMALES

SUBMITTED TO

MAHARSHI DAYANAND UNIVERSITY, ROHTAK

FOR THE PARTIAL FULLFILMENT OF DEGREE OF

BACHELOR OF PHYSIOTHERAPY & REHABILITATION

SESSION: 200 ! 200"

Guided by: Submitted by:

#$% SAVITA SINGH SHAMA GUPTA

M.P.T. (Orthopae!"#$ Ro%% No. &&')Depart*e+t o Ph-#!otherap- B.Ph.T. F!+a% Year

GAUR BRAHMAN INSTITUTE OF PHYSIOTHERAPY

AN# REHABILITATION


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BRAHMANVAS ROHTAK

C E R T I F I C A T E

This is to certify that the project work entitled EFFECTIVENESS OF THE CORE

STABILIZATION EXERCISES IN STRENGTHENING THE LOW BACK MUSCLES IN

YOUNGER FEMALES submitted by SHAMA GUPTA in partial fulfillment of the

requirements for the award of degree of Bachelo o! Ph"#$o%hea&" of the Maha#h$

'a"a(a() U($*e#$%"+ Roh%a, -Ha"a(a., is a bonafide research work carried by her

under my supervision and guidance during the academic year 2003-200! "either this

project nor any part of it has been submitted for any degree or diploma!

#ignature of $uide

-'/ SAVITA SINGH. %!&!T! '(rthopaedics)

*epartment of &hysiotherapy

Place0

'a%e0

)


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ACKNOWLE'GEMENT

The writing of this project work, although a task undertaken by one person, is in reality

a bringing together of ideas of seniors, colleagues , friends and e+perts in the field of

&hysiotherapy!

ith e+treme gratitude and indebtness, wish to e+press my regards,

sincere thanks and e+press my deep sense of gratitude and thanks to my guide '/

Sa*$%a S$(1h+ %!&!T! '(rthopaedics) for her valueable guidance, for taken keen

interest in this dissertation and for timely assistance and invaluable suggestions! t is

with esteemed pleasure that am presenting this dissertation!

.irst and foremost thank almighty, without whose help this would not

have been possible!

also wish to give my sincere thanks to her for providing the infrastructure

necessary for the project work and helping me out when it was needed the most!

e+press my sincers thanks to '/ Nea$2a%$+ ' Sa%$#h Ba34and *r

Ra*$()e Sha2a of &hysiotherapy *epartment for their helpful suggestions and

advice in my crucial time to carry my work!

would like to acknowledge the help rendred by, M/ Nae#h Va#h$#% for

his guidance and cooperation in statistical analysis of this project!

/


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am thankful to the &hysiotherapy *epartment La3oa%o" S%a!!of the

Ga4 Bah2a( I(#%$%4%e o! Ph"#$o%hea&" a() Reha3$l$%a%$o(+ Bah2a(*a#+

Roh%a, for their support and help!

am also thankful to all the subjects who volunteered to participate in this

study!

/ast but not the least, would like to thanks my parents who always have

so much confidence in me and always provided me content silent support and

inspiration !

'#hama $upta)

0


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DedicatedTo My God

AndMy Parents

And

All My Well Wishers

'


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CONTENTS

cknowledgement

*edication

1hapters &age "o!

! INTRO'UCTION 0-

natomy of core muscles 2-2

4iomechanics 25-3

hat is 1ore 32

%uscles which make the core 33

1ore stabili6ation 33

mportance of core stabili6ation 3

.unctions of core stabili6ation 35

&rinciples of core stabili6ation 35

ims and purpose of the study 37

$oal of study 37

1


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#tatement of the study 3

#ignificance of the study 3

8ypothesis 39

2! REVIEW OF LITERATURE 3:-7

3! RESEARCH 'ESIGN AN' METHO'OLOGY -0

"ature of the #tudy 9

;esearch setting 9

#ampling 9

*esign 9

"o! of samples 9

*uration 9

Time of e+ercise 9

rea of study 9

$roup :

1onsent and ethical approval :

#election 1riteria :

nclusion criteria :


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(perational tools 5

%ethodology 52

&rocedure 52-7:

=alidity > ;eliability 7:

dvice for younger females 0

! OBSERVATION AN' 'ATA ANALYSIS -

*ata analysis 2-

5! RESULTS AN' 'ISCUSSION 5-

;esult 7

*iscussion 7

*elimitation of study

7! CONCLUSION 9-:

! FURTHER FUTURE STU'Y 90-9

9! REFERENCES 92-95

:! APPEN'ICES 97-:5

ppendi+


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CHAPTER -13


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INTRODUCTION

INTRO'UCTION

4ack muscles are very prone to weakness which leads to low back ache! t is

e+tremely common problem, a prick mankind has to pay for their upright posture!

cc! to studies, almost 90? of person in modern society e+periences backache in

their life!t is a common reason for referral for &hysiotherapist!

need therefore arises for the strengthening of /ow back muscles to prevent the

individuals from going to weakness!


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balanced when you move! f your core muscles are strong and they contract when

they should@

Aour posture is better!

Aour body is balanced!

Aour movement is more efficient and powerful!

Aou are less likely to be injured!

1ore stability benefits everyone, from older people to top professional athletes!

co-ordination!

iv! dentifying e+ercise which ma+imally activate the trunk muscles may make it possible

to develop an efficient > less time consuming general strength program that

conditions the trunk muscles!

v! t train the trunk musculature during functional activities!


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ANATOMY OF CORE MUSCLES

5UA'RATUS LUMBORUM 06

O$1$( a() $(#e%$o( 7

t arises by aponeurotic fibers from the iliolumbar ligament and the adjacent portion of the

iliac crest for about 5 cm!, and is inserted into the lower border of the last rib for about half

its length, and by four small tendons into the apices of the transverse processes of the

upper four lumbar vertebrae!

)


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(ccasionally a second portion of this muscle is found in front of the preceding! t arises

from the upper borders of the transverse processes of the lower three or four lumbar

vertebrC, and is inserted into the lower margin of the last rib!

Ac%$o(#6

The quadratus lumborum can perform three actions@

a) /ateral fle+ion of vertebral column, with ipsilateral contraction

b)


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c) .i+es ribs for forced e+piration

RECTUS AB'OMINIS 06

O$1$( 7

t arises from pubic crest > pubic symphysis!

I(#e%$o(6

1artilage of 5th-thribs > +iphoid process!

Ac%$o(# 06

a) .le+es vertebral column

b) compress abdomen to aid in defeacation, urination

c) .orced e+piration

Ne*e S4&&l" 06T D T2

0


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EXTERNAL OBLI5UE 06


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of the corresponding ribs, the lowest to the ape+ of the cartilage of the last rib, the

intermediate ones to the ribs at some distance from their cartilages!

The five superior serrations increase in si6e from above downward, and are received

between corresponding processes of the serratus anterior muscleE the three lower ones

diminish in si6e from above downward and receive between them corresponding

processes from the latissimus dorsi! .rom these attachments the fleshy fibers proceed in

various directions!

I(#e%$o( 6

t inserts into ila-iac crest > linea alba! Those from the lowest ribs pass nearly vertically

downward, and are inserted into the anterior half of the outer lip of the iliac crestE the

middle and upper fibers, directed downward and forward, become aponeurotic at

appro+imately the midclavicular line! This aponeurosis formed from fibres from either side

of the e+ternal oblique decussates at the linea alba!

The aponeurosis of the e+ternal oblique muscle forms the inguinal ligament! The muscle

also contributes to the inguinal canal!

Fust deep to the e+ternal oblique is the internal oblique muscle!

I((e*a%$o(6

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The e+ternal oblique muscle is innervated by ventral branches of the lower 7 intercostal

'thoracoabdominal) nerves and the subcostal nerve on each side!

T DT2 > liohypogastric nerve

Va#c4la$#a%$o(6

The cranial portion of the muscle is supplied by the lower intercostal arteries, whereas the

caudal portion is suplied by a branches of either the deep circumfle+ iliac artery or the

iliolumbar artery!

Ac%$o(#6

The e+ternal oblique functions to pull the chest downwards and compress the abdominal

cavity, which increases the intra-abdominal pressure! t also has limited actions in both

fle+ion and rotation of the vertebral column!

a) 1ontraction of both sides lead to compression of abdomen

b) 1ontraction of one side allows bending of vertebral column laterally!

INTERNAL OBLI5UE 06nternal-farther from surface!


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t compresses the abdomen!

Ne*e #4&&l" 06'a) 4ranches of thoracic T9 D T2

'b) liohypogastric nerve

'c) llioinguinal nerve

ERECTOR SPIN8 6

The


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the erector divides into three columns, each of which has three parts!

))


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O$1$( 7

The erector spinae arises from the anterior surface of a broad and thick tendon, which

is attached to the medial crest of the sacrum, to the spinous processes of the lumbar

and the eleventh and twelfth thoracic vertebrC, and the supraspinal ligament, to the

back part of the inner lip of the iliac crests and to the lateral crests of the sacrum,

where it blends with the sacrotuberous and posterior sacroiliac ligaments!

#ome of its fibers are continuous with the fibers of origin of the $lutCus ma+imus!

The muscular fibers form a large fleshy mass which splits, in the upper lumbar regioninto three columns, vi6!, a lateral, the liocostalis, an intermediate, the /ongissimus,

and a medial, the #pinalis!


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I(#e%$o(-ngles of the rib!

Lo(1$##$24# 7

O$1$(- Transverse processes at inferior vertebral level!

I(#e%$o(- Transverse processes at superior vertebral levels and mastoid process!

S&$(al$#

O$1$( 6#pinous processes of inferior vertebral levels!

I(#e%$o(- #pinous processes of superior vertebral levels and the base of the

skull!

Ac%$o( 7

These muscles are involved in holding the vertebral column erect! f the erector spinae

muscles contract on one side, the result is lateral movement of the trunk and neck!

Va#c4la$9a%$o( 7

)0


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ll of these muscles are supplied segmentally by the deep cervical artery, posterior

intercostals arteries, subcostal arteries, and lumbar arteries!

MULTIFI'US 06

O$1$( 06

t originates from sacrum,ilium,transverse process of lumbar,thoracic > inferior

cervical vertebrae!

I(#e%$o( 06

t inserts into spinous process of a more superior vertebrae!

Ac%$o( 06

t e+tends the vertebral column > rotates it to opposite side!

Ne*e #4&&l" 06*orsal rami of spinal nerve!

)'


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BIOMECHANICS

41J %(=


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e!g! &icking up something from the floor!

%K#1/ fle+ion!

b) ;eaching up > to the side to pick something off a shelf is a combination of

e+tension > rotation!

%echanics of #pinal #tabili6ationMwhat is stabili6ation

t is commonly accepted that what makes a back NbadO is some kind of instability or

imbalance! #tandard approaches to back rehabilitation usually involve mobili6ing joints

)


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and strengthening muscles! $enerally this has taken the form of passive manipulation for

the joints combined with e+ercises to strengthen either abdominal muscles as in sit-ups,

or back e+tensors!

The length of fibers of the stabili6ers does not change very much over the course of a

movement! nstead they remain consistently short to hold the joint in its neutral 6one

'before the end range where the ligaments get involved), to help it keep its integrity while

it is handling load or doing larger motion!

$lobal and local muscles

#tabili6ation in this sense of deep support is found to be primarily the role of what

4ergmark terms NlocalO muscles, as distinct from NglobalO muscles! /ocal muscles are

usually deeper and closer to the joint than the muscles involved in moving the joint, the

global muscles! /ocal muscles also often attach directly to the joint capsules! $lobal

muscles are more superficial and tend to be larger! They are responsible for transferring

and balancing e+ternal loads and for bigger movements! The local musclesB length

changes very little and thereby does not have a big impact on the actual movement of the

joint! The job of local muscles is primarily to stabili6e the joint while the other muscles do

the moving!

%ultifidus and transversus

Two muscles have been identified as primary stabili6ers of the low back@ lumbar

multifidus and transversus abdominis! 4ecause of their location and the direction of their

)2


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fibers, these muscles control the lumbar and lumbo-sacral joints specifically, rather than

acting on the relationship of thora+ and pelvis!

ith reference to the trunk, %c$ill provided evidence that the deep fibres of the lumbar

multifidus undergo only minimal changes in length throughout the range of motion! This is

due to their pro+imity to the center of rotation of the lumbar joints and suggests that this

specific component of the back muscles contributes minimally to the production of motion!

n addition, due to the transverse orientation of the

muscle fibres of the transversus abdominis, biomechanically, it cannot contribute toe+tension, fle+ion or lateral fle+ion of the spineP

Thus the transversus abdominis and lumbar multifidus, have primary roles that do not

include the production of motion!

The responsibility of these deep support muscles--transversus abdominis and lumbar

multifidus--is not to move the spine, but to stabili6e it so that other muscles can move the

trunk without compromising the integrity of the joints! .or the lumbar spine, transversus

and lumbar multifidus are e+amples of local muscles, while rectus abdominis and the

e+ternal obliques are e+amples of global muscles Q Nglobal musclesOR


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The co-contraction of the transversus, in particular the sub-umbilical portion, and lumbar

multifidus muscles on each side of the spine will be able to increase the stiffness of the

lumbar segments without interfering with trunk movement! The result of their contraction

does not interfere with rotation, mobility of the trunk in general, or with the freedom of

motion of the limbs! n fact, it hardly moves the spine at all@ it actually holds it in place!

1o-contraction at the level of deep, local, muscles can create support without restricting

bigger movement! n dance, yoga and martial arts, it is important because it allows the

mover to be strong in the belly and still free above!

4ack muscles

#oft tissues around the spine also play a key role in low back pain! There is a large and

comple+ group of muscles that work together to support the spine, help hold the body

upright and allow the trunk of the body to move, twist and bend in many directions!

Types of muscles

Three types of back muscles that help the spine function are e+tensors, fle+ors and

obliques!

') The e+tensor muscles are attached to the posterior 'back) of the spine enable

standing and lifting objects! These muscles include the large paired muscles in the lower

back 'erector spinae), which help hold up the spine, and gluteal muscles!

'2) The fle+or muscles are attached to the anterior 'front) of the spine 'which includes the

abdominal muscles) enable fle+ing, bending forward, lifting and arching the lower back!

/&


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'3) The oblique muscles are attached to the sides of the spine and help rotate the spine

and maintain proper posture!


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1hronic stress can also lead to muscle weakness and back pain! #tress causes back

muscles to tighten in a fight or flight response, depriving muscles of energy needed to

support the spine!

nother key structure in low back pain is the hamstring muscles, the large muscles in the

back of the thighs! &atients with tight hamstrings tend to develop low back pain, and

those with low back pain tend to develop tight hamstrings! The theory is that tight

hamstrings limit motion in the pelvis, so the motion gets transferred to the bottom lumbar

motion segments and increases the stress in the low back! ;ehabilitation focuses onstrengthening the muscles and stretching the hamstring muscles!

%uscles and proper posture contribute to low back pain

%uscle strength and fle+ibility are essential to maintaining the neutral spine position!

eak abdominal muscles cause hip fle+or muscles to tighten causing an increase in the

curve of the low back! n unhealthy posture results when the curve is overe+tended

called lordosis or swayback! &roper posture corrects muscle imbalances that can lead to

low back pain by evenly distributing weight throughout the spine!

/)


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WHAT IS CORE

1ore referred to as the &(


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system needs to be appropriately trained to allow it to function efficiently during

dynamic kinetic chain activities

WHICH MUSCLES MAKE THE CORE

1ore has been described as a bo+ with the@-

.;("T D by 4*(%"/#

41J - by &;#&"/# > $/KT


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connected with layers of soft tissue such as cartilage and ligaments! They are also

connected by muscles! f these muscles are strong and working in the proper order,

you have a solid base for movement and to absorb the impact of the ground through

your body!

IMPORTANCE OF CORE STABILIZATION

ll the parts of your body are connected to one another, directly or indirectly! Think of

a chain as the connectionE for e+ample, imagine a chain starting at your foot and

running through your ankle, calf, knee, thigh, and hip to your pelvis and spine! This is

called the kinetic chain, and it means that moving one part of your body can affect

another body part! Aour trunk is where the kinetic chains come together!

"ow imagine throwing a ball, and imagine that as you throw, you step on a rock and

twist your ankle! hen your ankle twists, your knee and hip follow along, and the

smooth motion you were making with your throwing arm is disrupted! Aou might injure

any joint along the chain from your ankle to your arm, and the ball you were throwing

goes off in the wrong direction! ThatHs the kinetic chain, connecting all the parts of your

body together into a whole! problem or weakness in one part of the chain can lead

to pain or injury in another part!

The e+ample of stepping on a rock as you throw applies to all the movements you

makeE your movements are all related to one another! #trengthening your trunk gives

greater stability and power to the whole kinetic chain as you move!

/'


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.ocusing on the core of the body as a way to promote strength and good health is an

ancient idea! Aoga, &ilates, and martial arts such as tai chi all use this concept! Aour

trunk, where the kinetic chains come together, is the foundation for your posture,

balance, and coordinated movement! The muscles of your trunkMyour coreMcan be

strengthened and trained to contract in the proper order to give you this stable

foundation for movement! The benefits include@

a)The strong, healthy feeling that comes from good posture!

b)1onfidence from strength and good balance!c)$reater strength and power for your activities!

d)/ess chance of injury!

e)*ecrease in, or prevention of, low back pain!

FUNCTIONS OF CORE06

i! t serves as a muscular corset that work as a unit to stabili6e body > spine with >

without limb movement!

ii! t serves as the centre of the functional kinetic chain!

PRINCIPLES OF CORE06

i! These e+ercises must not be done in the first hour after awakening due to increased

hydrostatic pressure in disk during that time!

ii! .irstly find neutral spine position > do all e+ercise in this position!

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ii! ctivate > develop neuromuscular control of spinal stabili6ation muscles to support

the spine during dynamic activities!

iii! *evelop strength > endurance in the postural > stabili6ing muscles of a+ial skeleton

for functional activities!

iv! *evelop control of balance in stable > unstable situation!

v! .or conditioning of low back muscles!

vi! To teach the proper contraction of muscles during an e+ercise so that injury can

prevent!

vii! To increase the fle+ibility of low back!viii! %odify trunk muscles activity could be important in the safety > efficacy of

rehabilitation!

STATEMENT OF THE STU'Y 06

To find out the effectiveness of the core stabili6ation e+ercises in strengthening the low

back muscles in younger females!

SIGNIFICANCE OF THE STU'Y 06

#ince there is a rush of daily activities, it places tremendous mechanical > physiological

demands upon the muscular system of an female! #ince the muscles of lower back are

more likely to get injured or weak during such activities! #o due to weak muscles,

females can not do their work properly > efficiently! f so, the implication for the

/2


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females are significant as or has already been demonstrated that core stabili6ation

e+ercises increases the muscles fle+ibility!

HYPOTHESIS

NULL HYPOTHESIS

1ore stabili6ation e+ercises are very effective method in strengthening the

lower back muscles!

ALTERNATIVE HYPOTHESIS

1ore stabili6ation e+ercises are very effective method in strengthening the

lower back muscles!

/3


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CHAPTER-2

0&


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REVIEWOFLITERATURE

! %c$ill, #!%! ::9! /ow back e+ercises@ evidence for improving e+ercise

regimens! &hysical Therapy 9 ')@ 5-75!

/ow back e+ercises need to be customi6ed for each person and their type of injury in

order to optimi6e the rehabilitation process! #tooping vs! #quatting when lifting objects!

%c$ill proposes that the emphasis on lifting should be about getting the load close to the

body to minimi6e joint forces and avoid spine fle+ion! /ow back e+ercise should be

performed daily!


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2! *eyo, ;!! and *iehl, !J! :97! &atient satisfaction with medical care for

low-back pain! #pine ')@ 29-30!

&atients with low-back pain are more satisfied with their doctor visits if they receive

adequate e+planations of their problem! The importance of patient satisfaction is

suggested by correlations with medication compliance and perceived adequacy of

diagnostic testing!

&erhaps our device should attempt to educate its users about back pain and how the

e+ercises are designed to help!

3! *i.abio, ;!&!, %ackey, $!, and 8olte, F!4! ::5! *isability and functional

status in patients with low back pain receiving workersH compensation@ a

descriptive study with implications for the efficacy of physical therapy!

&hysical Therapy 5 '3)@ 90-:2!

1ompliance, chronicity, and leg symptoms are all factors that can affect the outcome of

physical therapy! This study showed that physical therapy with multiple interventions may

decrease disability among patients receiving workersH compensation! ;ecovery for

patients with acute back-pain was faster than that of chronic symptoms!

Luantifying the compliance of patients to a back e+ercise regimen may help physicians

and physical therapists to give feedback to their patients! lso, giving feedback directly to

the patient from the device may help tremendously!

0)


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! "elson, 4!!, 1arpenter, *!%!, *reisinger, T!

and egner, F!! :::! 1an spinal surgery be prevented by aggressive

strengthening e+ercises prospective study of cervical and lumbar

patients! rch! &hys! %ed! nd ;ehabil! 90@ 20-25!

"elson et al! found that a large number of patients who were told they needed surgery

were able to avoid surgery in the short term by aggressive strengthening e+ercise!


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The objective of this study was to investigate the loading of the lumbar spine and trunk

muscle activity levels through various back e+ercises!


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group which received conventional treatments such as swimming, workouts and sit-ups!

t the 30 month follow-up, the improvement had been maintained!

s for the multifidus, it was found that in patients with back pain, the si6e of the muscle

was reduced at the segment and on the side of the pain! The studies found that when the

si6e of the lumbar multifidus had been increased through specific e+ercises, there was a

significantly lower incidence of recurrence of low back pain episodes!

;ichardsonBs research supports the idea that the back pain results more from inadequate

function of the stabili6er muscles than deficiency in the global muscles! (ne implication of

this is that many stabili6ation programs are not specific enough! #it-ups and lumbare+tension e+ercises most often do not differentiate between global and local muscle

involvement!


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n important part of rehabilitation is to re-establish the appropriate sequence of firing of

the muscles@ local stabili6ers first, global muscles after! The e+ercises that ;ichardson

used in the back pain e+periment have a component of kinesthetic education, learning to

feel the subtle sensation of the pre-movement! This appears to impact the connections

and timing in the nervous system and lead to improvement in stabili6er function

:! 200 line "ewton %!!, dvanced 1ertified ;olfer

n the past 5 years, the concept of spinal segmental stabili6ation has received

considerable attention from research science!QR #ometimes known as NcoreO stabili6ation,

this approach puts a focus on the role of the abdominal muscles in rehabilitation and

prevention of low back pain! lthough it seems a recent discovery in the western world,

the importance of the basic movement has been recogni6ed throughout history and in

many cultures@

n the practice of yoga, students learn to apply NbandhaO to seal the unified energy of

inhalation and e+halation! These subtle movements often precede the practice of a

specific pose or asana! The bandha NuddiyanaO is described thus, Nthe belly above and

below the navel should be pressed or drawn backwards toward the spine!O nd more

mysteriously@ Nuddiyana is so called because the great bird, &rana, tied to it, flies without

being fatigued!O The te+t is from :5, but of course the pose itself dates back centuries!

The bandha is described as having the potential to bring back youth and vigor, and the

author assures us that Nby practicing this for 7 months, one can undoubtedly conquer

death!

01


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N#lowly draw in the abdomen by contracting the lowest section of the bdominal muscle,

starting at the lowest point of the region below the navel!O

0! FK" $! #" FK", F%


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CHAPTER -302


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RESEARCHDESIGNMETHODOLOGY

NATURE OF THE STU'Y 06

This study is an e+perimental in nature in which effectiveness of core

stabili6ation e+ercises in strengthening the low back muscles will be seen!

RESEARCH SETTING 06

The study was performed in the *epartment of physiotherapy $aur 4rahman

yurvedic &hysiotherapy college! 4rahmanwas, ;ohtak, 8aryana!

#%&/"$ @- &urposive sampling

03


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The institute gave approval for this study! was certified that they are physically >

medically fit for this study! 1onsent was taken from all the subjects prior to the

study!

SELECTION CRITERIA 06

"1/K#=< 1;T doing e+ercises regularly >

abide by the instructions given for the purpose of the study!


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i+! Kncooperative patient

POPULATION 06

.emale subjects of $aur 4rahman nstitute of &hysiotherapy > ;ehabilitation 1entre,

4rahmanwas, ;ohtak formulated the population for this study!

SAMPLE ; METHO' OF SELECTION 06

;epresentative sample of 35 females subjects who volunterred to participate were

taken, out of whom 30 females were selected by randomi6ed sampling!

$roup '5)@


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1ore stability e+ercises

OPERATIONAL TOOLS 06

ll standardi6ed equipments of reputed brands were used @-

1alculator

#wiss 4all

1ouch

1lock atch

%at

METHO'OLOGY

&;(1


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&; &(#T T;


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&atients support themselves on the forearms, with the pelvis in the neutral position >

the body straight!

.ailure occurs when the athlete loses neutral pelvis > falls into a lordotic position with

anterior rotation of pelvis!

-3.LATERAL BRI'GE 06t assess the lateral core muscles!

.ailure occurs when the patient loses the straight

posture > the hip falls toward the table!

'1


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/egs are e+tended > the top foot placed in front of the lower foot for support! &atients

support themselves on one elbow > on their feet while lifting their hips off the floor to

create a straight line over their vody length! The uninvolved arm is held across the

chest with the hand placed on the opposite shoulder!

'


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-c.TORSO FLEXORS TESTING 06 t can be done by timing how long the

patient can hold a position of seated torso fle+ion at 70 degree!

.ailure occurs when the athletes torso falls

below 70 degree!

'2


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The athlete sits at 70 degree with both hips > knees at :0 degree, arms folded across

the chest with the hands placed on the opposite shoulder > toes secured under toe

straps or by the e+aminer!

-).TESTING OF EN'URANCE OF THE TORSO EXTENSORS 7

t can be assessed with athlete prone as shown in figure!

.ailure occurs when the upper body falls from a hori6ontal into a fle+ed position!

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The athlete is prone over the edge of couch with the pelvis , hips > knee secured! The

upper limbs are held across the chest with the hands resting on the opposite shoulder.

nalysis

nalysis of the result is by comparing it with the results of previous tests! t is e+pected

that, with appropriate training between each test, the analysis would indicate an

improvement!

f you were able to complete this test then it indicates you have good core strength! f you

are unable to complete the test then repeat the routine 3 or times a week until you can!

f core strength is poor then the torso will move unnecessarily during motion and waste

energy! $ood core strength indicates that the athlete can move with high efficiency!

"ormal values of test which identifies the normal strength of the low back muscles!

8olding the proper testing positions for all special test for 5 minutes!

"#T;K1T("# $=


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t is more important that you do core stabili6ation activities well than that you do a

lot of them! .or this reason, it is a good idea to have a physical therapist or

e+ercise physiologist with training in core stabili6ation check to sure you have

learned to use the right muscles > breathe normally while you do e+ercises!

Then he or she can help you learn more challenging e+ercises!

BREATHING 06

hen you e+ercise, you should breathe mostly with your diaphragm, the large

muscles that helps move air in > out of your lungs! To learn to breathe with your

stomach! hen you breathe in > out, your hand should move up > down! "oticehow it feels to breathe this way! hen you start to e+ercise, try to get the same

feeling of your chest > abdomen moving in > out as you breathe, rather than

your chest > shoulder moving up towards your neck > back down!

NEUTRAL SPINE 06

"eutral spine is the name for posture that maintains the three normal curves in

your spine D

(ne in your neck

(ne in your upper back

(ne in your lower back

These three curves help absorb stress > impact on your body, both while you are

sitting or standing still > when you move! t may seen more rela+ing to let your

self slump down, but when you loose the normal curves of a neutral spine, you

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actually put more stress on your body! Aour spine should be in the neutral

position when you do core stabili6ation e+ercises!

TO FIN' NEUTRAL SPINE 06

i) #tand normally in front of a mirror with your hands on your

hips, just below your waist!

ii) llow your low back to arch so your stomach juts forward >

your buttocks stick out@ notice how your hands rotateforward!

iii) Tighten the muscles around your stomach > buttocks so

your low back becomes very flat, notice how your hands

rotate backwards!

iv) "ow go halfway between the forward > backward positions!

v) Jeeping your pelvis in this neutral position,

vi) #tand with your tall ears > shoulders lined up over your hips!

vii) &ractice finding neutral spine in three positions @ standing,

sitting > lying on your back with your knees bent! (nce you

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can find neutral spine in each position, you can maintain

good posture for daily activities > for e+ercise!


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CURL UP 06

/ie flat on your back with your feet resting on an e+ercise ball with your knees bent at a

:0 degree angle! &lace your feet three to four inches apart and point your toes inward sothey touch! &lace your hands lightly on either side of your head keeping your elbows in!

*onHt lock your fingers behind your headU &ush the small of your back down in the floor to

isolate your ab muscles! 4egin to roll your shoulders off the floor! 1ontinue to push down

as hard as you can with your lower back! Aour shoulders should come up off the floor

only about four inches, and your lower back should remain on the floor! .ocus on slow,

controlled movement - donHt cheat yourself by using momentum!

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SI'E PLANK 06

/ie on one side, ensuring the top hip is above the bottom hip! &ush up until there is a

straight bodyline through feet, hips and head! Jeep the elbow under the shoulder! /ower

under control and repeat on opposite side! 8old this position for an increasing length of

time up to a ma+imum of one minute! &erform two to three sets!

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PUSH UP ; 'OWN 06

/ie flat on your back with your feet flat on the ground, or resting on a bench with your

knees bent at a :0 degree angle! f you are resting your feet on a bench, place them

three to four inches apart and point your toes inward so they touch! &lace your hands

lightly on either side of your head keeping your elbows in! *onHt lock your fingers behind

your headU &ush the small of your back down in the floor to isolate your ab muscles!

4egin to roll your shoulders off the floor! 1ontinue to push down as hard as you can with

your lower back! Aour shoulders should come up off the floor only about four inches, and

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your lower back should remain on the floor! .ocus on slow, controlled movement - donHt

cheat yourself by using momentumU

THE PLANK 06

8old a straight body position, supported on elbows and toes! 4race the abdominals and

set the low back in the neutral position! 8old this position for an increasing length of time

up to a ma+imum of one minute! &erform two to three sets!

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THE GLUTEAL BRI'GE 06

/ie on the floor with your knees bent! #quee6e your gluteals and then push your hips up

until there is a straight line through knee and hip to upper body! #houlders remain on the

floor! 4eware of rising too high or of flaring the ribs, which pushes the back into

hypere+tension! 8old this position for an increasing length of time up to a ma+imum of

one minute! &erform two to three sets!

BIR''OG OR SUPERMAN 06

#tart with hands below shoulders and knees below hips! #et your low back into neutral

and brace your abdominals slightly! #lowly slide back one leg and slide forward the

opposite arm!


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abdominals, gluteus medius, gluteus ma+imus and iliopsoas 'hip fle+or) muscles will be

evaluated! 1ore strength serves as a baseline for the design and implementation of a

complete 1ore strength training program!

There are many e+ercisesavailable for developing strong abs and building core strength,

but few methods offered for evaluating that strength! #ports 1oach, 4rian %acken6ie

offers the following 1ore %uscle #trength and #tability Test as a way to determine your

current core strength and gauge your progress over time!

ntroduction

Testing and measurement are the means of collecting information upon which

subsequent performance evaluations and decisions are made but in the analysis we need

to bear in mind the factors that may influence the results!

(bjective

The objective of the 1ore %uscle #trength > #tability Test is to monitor the development

of the athleteHs abdominal and lower back muscles!

1onducting the Test

The 1ore %uscle #trength > #tability Test is conducted as follows!

') The four basic test advocated!These are @-

-a. PRONE BRI'GE 06t is performed by supporting the body weight

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between the forearms > toes !

t primarily assess the anterior > posterior core muscles!

.ailure occurs when the athlete loses neutral pelvis > falls into a lordotic position with

anterior rotation of pelvis!

-3.LATERAL BRI'GE 06t assess the lateral core muscles!

.ailure occurs when the patient loses the straight posture > the hip falls toward the

table!

-c. TORSO FLEXORS TESTING 06 t can be done by timing how long the

patient can hold a position of seated torso fle+ion at 70 degree!

.ailure occurs when the athletes torso falls below 70 degree!

-).TESTING OF EN'URANCE OF THE TORSO EXTENSORS

t can be assessed with athlete prone as shown in figure!

.ailure occurs when the upper body falls from a hori6ontal into a fle+ed position!

nalysis

nalysis of the result is by comparing it with the results of previous tests! t is e+pected

that, with appropriate training between each test, the analysis would indicate an

improvement!

f you were able to complete this test then it indicates you have good core strength! f you

are unable to complete the test then repeat the routine 3 or times a week until you can!
http://sportsmedicine.about.com/od/bestabexercises/a/all_abs.htmhttp://sportsmedicine.about.com/od/bestabexercises/a/all_abs.htmhttp://sportsmedicine.about.com/cs/conditioning/a/aa052002a.htm


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f core strength is poor then the torso will move unnecessarily during motion and waste

energy! $ood core strength indicates that the athlete can move with high efficiency!

"ormal values of test which identifies the normal strength of the low back muscles!

8olding the proper testing positions for all special test for 5 minutes!

They are only under observation!

VALI'ITY ; RELIABILITY 06

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/


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CHAPTER 4OBSERVATION

DATA ANALYSIS

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OBSERVATION & ANALYSIS

'a%a A(al"#$#

This chapter deals with analysis, interpretation and discussion of the data collected on 30

subjects was put into several suitable statistical analysis in order to verify that

investigation of the study!

The characteristics of the data presided through tables!

&re and post test scores of pain free range of motion was analy6ed by using mean and

standard deviation presenting in table!

The VtB test was used to find out significant difference between pre and post test score of

pain free range of motion!

%ean W XdG"

#tandard


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Ta3le0 < %ean, #tandard

*al4e

?%> *al4e a%

@/@ le*el

?%> *al4e a%

@/@< le*el

! 1ore stability

e+ercise

0!2 !7 2!:9

Ta3le0 = %ean, #tandard


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S/ No/ Va$a3le# Pe %e#%

Mea(

Po#% %e#%

Mea(

S) SE)

! 1ore

stability

e+ercise

3!5 !3: 0!25 0! 075

Ta3le0 = &aired VtB test for the 1ore stability e+ercise

S/ No/ Va$a3le# O3%a$( >%>

*al4e

?%> *al4e a%

@/@ le*el

?%> *al4e a%

@/@< le*el

! 1ore stability

e+ercise

2! !7 2!:9


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CHAPTER -5RESULTSDISCUSSIO

N

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RESULT :

ncrease in core stability as per mean of pre test and post test!

#*d for e+perimental group is W 0!25

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e+ercised! hen collagen is heated, it undergoes a number of thermal transition!

These transitions cause increased e+tensibility > allow plastic deformation of the

tissue! #o, increased temperature also affect the strengthening of low back

muscle!

'ELIMITATION OF MY STU'Y 06

i! %y study is limited to $!4!&hysiotherapy > ;ehabilitation 1ollege!

ii! *uration of my project is only two > half months!

iii! The no! of samples are limited!

iv! Time for the e+ercise only morning!

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CHAPTER -6

CONCLUSION

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CONCLUSION

have taken 5 patients in two groups > for $roup given core stability e+ercises

> for $roup 4 not given any type of e+ercises! They are only under observation!

The results show that there is significant increase in strength of $roup patients!

(verall conclusion is that core stabili6ation e+ercises are very effective in

strengthening the lower back muscles!

The other conclusion drawn from this study is that there is clear need for the

development towards core stability e+ercises!

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FURTHER FUTURE STU'Y 06

i! t can be done on age below 5 years > above 30 years!

ii! t can be done on patients who are suffering from low back pain!

iii! &atients suffering from any type of metabolic disease can be included in the

core stability e+ercises program!

iv! &roject duration can be increased!

v! /arge number of areas can be surveyed for study!

vi!


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CHAPTER - 8

REFERENCES

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REFRENCES

QR Jisner 1arolyn, 1olby /ynn llen,OTherapeutic


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Q7R &andey #ureshwar, &anday nil, N1linical (rthopaedic *iagnosisO, Faypee

&ublications! 2nd


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Q3R Fournal of pplied &hysiology 5@-7,:9), /acote et al '1linical evaluation

of muscle function! 1hurchill /ivingstone,


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CHAPTER 9

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APPENDICES

APPEN'IX 7 A

ETHICAL 7CONSI'ERATIONS

! The identity of all subjects will be protected troughout the study and also

n any publication so made!

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3! decoding note will be made on the subjectsBs first appearance and will be retained

by me maintaining full secrecy!

! ll subjects would be briefed about this and about my legel obligations to observe any

act of data protection!

5! fter briefing only about their rights, will make them sign the consent form!

7! #ubjects will be free in any stage of the project to walk out of it, if they feel the need!

! ll the potential ha6ards of the research that can come are seriously being looked

upon by thorough literature review and pilot study! .ew potentially harmful effects of

mildest severities are being listed!

%uscular pain

hich will be told to the subjects and adequate precautions will be taken to

abide them!

9! ll information to be collected shall pertain to the study only!

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*ate of


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4ack .le+ion

4ack


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PLANE OF MOVEMENT06

1orrect body part moving in correct plane!

1orrect body part moving in incorrect plane! 0

ROM06


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ncorrect no! of timesGday 0

APPEN'IX 7 '

MASTER CHART

/ine $raph@ before and after treatment presentation of core strength of lower

back for controlled group!

S No/ A1e Pe

Tea%2e(%

Rea)$(1

Po#%

%ea%2e(%

Rea)$(1

< 23 3!5 3!5= 5 3!3 3!39 !9 !20

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D 9 2!59 2!5 23 !30 !30: 25 2!50 2!35 30 3!37 3!3 9 3!59 3!59

7 !2 !


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CONSENT FORM

Title

To find out the effectiveness of core stability e+ercises in strengthening

the lower back muscles in younger females!

nvitation to &articipate

The research is being undertaken to study the effect of core stability e+ercises

in strengthening the lower back muscles in younger females!

bout the &rocedure

#ubjects fitting the inclusion e+clusion criteria would be enrolled in the

study! The duration of the study is 3 months! Aou will be e+plained about the procedure!

The study will be conducted at the *epartment of &hysiotherapy,

$!4!!&!1ollege,4rafmanwas, ;ohtak!

;isks of &articipation in this study

s such there are no risks involvedas no medication or no drugs are being

used! t the most risks could be pain due to stretch given to the muscle!

;ight to ithdraw

Aou have a right to withdraw from research at any point of time without stating

any reasons for it!

1onfidentially

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ll the information about you will be kept strictly confidential and limited to the

research guide *r!#avita #ingh > *r! "erraimati and will not be shared with any person

without your consent!

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b.p.t project

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