Академический Документы
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Atsushi Imai, MS1 • Koji Kaneoka, MD, PhD2 • Yu Okubo, PT, MS1 • Itsuo Shiina, MD1
Masaki Tatsumura, MD1 • Shigeki Izumi, PhD3 • Hitoshi Shiraki4
T
runk stability is believed to play an important role for transverse abdominis (TrA) and lum-
lumbar spine injury prevention and rehabilitation.8,9,20,21 bar multifidus (MF), have more direct
or indirect attachments to the lumbar
Therefore, exercises for improving trunk stability are
vertebrae. They are associated with the
performed widely in sports and rehabilitation. An especially segmental stability of the lumbar spine
Copyright © 2010 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
important function of muscles is their contribution to trunk during whole-body movements and pos-
stability, and it is thought that the coactivation of several trunk tural adjustments.4,11,12,19 So, the functions
muscles is needed to achieve a degree of spinal stability beneficial of local muscles are necessary to enhance
for both the prevention and the treatment of low back injury.3,6,14,22,23 segmental stability of the spine.7
Trunk stability has been defined in
From a functional anatomy perspec- minis (RA) and external obliques (EO), terms of a coactivation of global and lo-
tive, trunk muscles can be classified produce torque and transfer the load cal muscles. So, specific training that
as either global or local muscles.5 The directly between the thoracic cage and promotes the function of these muscles
global muscles, such as the rectus abdo- the pelvis. The local muscles, such as the is needed to achieve coactivation.14 Exer-
Journal of Orthopaedic & Sports Physical Therapy®
1
Graduate Student, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan. 2 Associate Professor, Faculty of Sports Science, Waseda
University, Tokorozawa, Saitama, Japan. 3 Assistant Professor, Faculty of Sports and Health Studies, Hosei University, Machida, Tokyo, Japan. 4 Professor, Graduate School of
Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan. This study was approved by the Institutional Review Board at the University of Tsukuba. Address
correspondence to Koji Kaneoka, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192, Japan. E-mail address: kaneoka@waseda.jp
journal of orthopaedic & sports physical therapy | volume 40 | number 6 | june 2010 | 369
contrast, trunk muscle activity increased of surface and intramuscular fine-wire surface. Instructors provided feedback
when performing a squat on an unstable electrodes. to ensure that a consistent spine and
surface.1 Intramuscular fine-wire electrodes lower limb posture was maintained dur-
From these findings, the influence were fabricated from 2 strands of ure- ing the exercises, for which the subjects
of surface stability on muscle activity thane-coated, stainless steel, 0.5-mm- were requested to hold their posture for
appears to be muscle and exercise de- diameter wire (Unique Medical Co, Ltd, 3 seconds.
pendent. The exercises increased the Japan), from which 2 mm of urethane Elbow-Toe The subject was instructed to
perturbation to the trunk when the body’s was removed from the end. The elec- maintain a prone plank position on the
center of mass was over an unstable sur- trodes were threaded through a 23-gauge floor, such that the elbows were beneath
face and further away from the stable (60-mm) hypodermic needle. The tips of the shoulders and the upper arms were
surface.17 Additionally, decrease of the the intramuscular fine-wire electrodes perpendicular to the floor. In this posi-
Copyright © 2010 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
contact area between the individual and were bent at 1 and 2 mm to form hooks. tion, only the toes and forearms were
the unstable surface increased the pertur- Electrodes were sterilized by autoclaving touching the floor. Subjects performed
bation of the trunk, as demonstrated by (HighClave HVE-50; Hirayama Manu- the elbow-toe on the floor for the stable
increased muscle activity.1,16,17 facturing Corp, Kasukabe-shi, Saitama, condition, and with forearms on a Swiss
However, previous researchers have Japan) at 121°C for 20 minutes. Using ball and toes on a balance disk for the un-
limited their measurement of muscle ultrasound imaging, the intramuscular stable condition (FIGURE 1A).
activity to the use of surface electrodes. electrodes were inserted bilaterally in Back Bridge The subject was supine on
There appears to be no published report the TrA, approximately midway between the floor, with feet flat on the ground,
describing the activity of local muscles the rib cage and the iliac crest,18 and in knees bent at 90°, toes facing forwards,
Journal of Orthopaedic & Sports Physical Therapy®
during lumbar stabilization exercises. It the MF, approximately 2 cm lateral to and hands on the floor by the sides, palms
is also not clear whether the advantage the L5 spinous process.26 After the elec- facing down. The subject raised the pel-
of performing an exercise on the unstable trodes reached the targeted muscles, ad- vis to achieve and maintain a neutral hip
surface is greater than that of performing equate location was confirmed through flexion angle. Subjects performed the
the same exercise on the stable surface. electric stimulation observed with ultra- back bridge on the floor (stable condi-
Therefore, the purpose of this study was sound imaging. tion) and with feet on a BOSU Balance
to clarify whether differences in surface Before attaching the surface elec- Trainer (unstable condition) (FIGURE 1B).
stability influence trunk muscle activ- trodes, the skin was rubbed with a skin Hand-Knee The subject assumed a quad-
ity, as measured using a combination abrasive and alcohol swabs to reduce ruped position and was asked to hold a
of surface and intramuscular fine-wire the skin impedance to below 2 kΩ. If the neutral pelvis position as well as to breathe
electrodes. measured impedance was greater than 2 normally. The subject then lifted the right
kΩ, the surface electrodes were removed upper extremity and held it straight, while
METHODS and the skin preparation repeated. simultaneously lifting the left lower ex-
Pairs of disposable Ag/AgCl (Vitrode tremity and holding it straight also. Sub-
Subjects F-150S; Nihon Kohden Co, Ltd, Tokyo, jects performed the hand-knee on the
N
ine healthy males participated Japan) surface electrodes were attached floor (stable condition) and with a BOSU
in this study. Their mean SD age, to the skin in an orientation parallel to (unstable condition) (FIGURE 1C).
height, and body mass were 24.1 the muscle fibers over 3 muscles on both Side Bridge The subject was positioned
0.8 years, 170.4 4.8 cm, and 62.2 4.6 sides of the body: for the RA, 3 cm lateral in right sidelying, with the right elbow
kg, respectively. None of the subjects had to the umbilicus; for the EO, midway be- directly beneath the shoulder and upper
consistently trained with stabilization tween the costal margin of the ribs and arm perpendicular to the ground. The
exercise previously. Exclusion criteria in- the iliac crest, approximately 45° to the subject raised the pelvis so that the spine
cluded a history of lumbar spine disorder, horizontal; for the erector spinae (ES), was straight, thereby achieving a position
neurological disorder, or spine surgery. 3 cm lateral to the L3 spinous process. supported only by the right elbow and the
370 | june 2010 | volume 40 | number 6 | journal of orthopaedic & sports physical therapy
FIGURE 1. Exercises performed for this experiment: (A) elbow-toe, (B) back bridge, (C) hand-knee, (D) side bridge,
activity.
and (E) curl-up.
Data Analysis
side of the right foot. Subjects performed trial was performed with each muscle of EMG data were collected during both the
the side bridge on the floor (stable con- interest while the EMG signal amplitude dynamic and isometric phases of exercise
dition) and with the elbow on a balance was recorded. The test positions were performance. The dynamic phase, lifting
disk and feet on a BOSU (unstable condi- consistent with those demonstrated in and lowering of the pelvis and/or the ex-
tion) (FIGURE 1D). manual muscle testing books commonly tremities, was performed at the subject’s
Curl-up The subject was supine, with used by physical therapists, but in some own pace. The isometric phase was main-
hips at 45° and knees at 90° and hands cases additional manual resistance was tained for 3 seconds.
behind the head. The subject tucked in applied. Manual resistance was applied Raw EMG signals were sampled at
chin and curled the upper trunk by lifting gradually, with the maximum amount 1000 Hz, amplified (MEG-6116; JB-640J
the thoracic spine off the floor. With the held for 3 seconds. Correct electrode Nihon Koden Co, Ltd, Japan), band-
exercise performed optimally, the curl- placement was further confirmed by ob- pass filtered (20-500 Hz), and full-wave
up was performed so that the scapulae serving the EMG signal amplitude during rectified using analysis software (Vital
were off the floor. Once in this position, the manual muscle tests. Recorder1 and Bimutus-Video; Kissei
the subject was asked to breathe deeply. For the RA, MVC was tested us- Comtec Co, Ltd, Japan).
The subjects performed the curl-up both ing a partial sit-up with knees flexed The root-mean-square of EMG ampli-
on the floor (stable condition) and with a and hands behind the head, and trunk tude was calculated for a 1-second period
BOSU (unstable condition) (FIGURE 1E). flexed, with resistance applied to the of the isometric phase of each exercise.
shoulder in the trunk extension direc- The mean root-mean-square of MVC tri-
Maximum Voluntary Contraction Trials tion. For the EO on the right side, the als was used for normalizing EMG ampli-
For normalization of the EMG data, a subject was in a supine position, with tudes obtained during the experimental
maximum voluntary contraction (MVC) knees flexed and hands behind the head, exercises (% MVC).
journal of orthopaedic & sports physical therapy | volume 40 | number 6 | june 2010 | 371
A
120
*
ll EMG data were expressed in
percent MVC and compared be-
100 tween the unstable and stable sur-
* * face for each muscle.
80 Muscle activity was significantly great-
* er when the elbow-toe exercise was per-
%MVC
*
Downloaded from www.jospt.org at McGill University on November 19, 2014. For personal use only. No other uses without permission.
FIGURE 2. Mean and standard deviations of muscle activity for each muscle for the elbow-toe exercise. stable surface, bilaterally for the RA and
Abbreviations: EO, external obliques; ES, erector spinae; L, left side; MF, lumbar multifidus; MVC, maximum EO, and for the side ipsilateral to the arm
voluntary contraction; R, right side; RA, rectus abdominis; TrA, transversus abdominis. *Significant difference
lifted for the ES (P.05) (FIGURE 4). With
between the stable and unstable conditions (P.05).
the side bridge exercise, only the activity
of the RA was significantly greater with
90
the unstable condition (P.05) (FIGURE 5).
During the curl-up exercise, the activity
80
of the EO was significantly higher when
70 performed on the unstable surface; how-
Journal of Orthopaedic & Sports Physical Therapy®
60
ever, activity of the TrA was significantly
lower (P.05) (FIGURE 6).
50
%MVC
40 DISCUSSION
T
30
he aim of the investigation was
20
to determine if differences in sur-
10 face stability influence trunk muscle
0
activity during performance of a selected
RA(R) RA(L) EO(R) EO(L) TrA(R) TrA(L) ES(R) ES(L) MF(R) MF(L)
set of stabilization exercises.
Compared to a stable surface, perform-
Stable Unstable ing the elbow-toe on an unstable surface
increased activity of all trunk muscles.
FIGURE 3. Mean and standard deviations of muscle activity for each muscle for the back bridge exercise. No This differs from the findings of a previ-
difference was noted between stable and unstable condition for any of the muscles (P.05). Abbreviations: EO, ous study that used surface electrodes,
external obliques; ES, erector spinae; L, left side; MF, lumbar multifidus; MVC, maximum voluntary contraction; R, in which greater activity was observed
right side; RA, rectus abdominis; TrA, transversus abdominis.
with the unstable surface only for the RA
and EO, with no difference observed for
Statistical Analysis unstable conditions. The level for statisti- the internal obliques (IOs)/TrA.15 This
As the data were not normally distribut- cal significance was set as α = .05. Adjust- difference between studies could be at-
ed, nonparametric statistics were used for ments for multiple comparisons were not tributed to a difference in the difficulty
the analysis. The Wilcoxon signed-rank performed. All analyses were performed of the exercise. In the study by Lehman
test was used to compare muscle activity using Dr SPSS II for Windows (SPSS Ja- et al,15 subjects placed their forearms on
for each exercise between the stable and pan Inc, Tokyo, Japan). a Swiss ball, while in the present study we
372 | june 2010 | volume 40 | number 6 | journal of orthopaedic & sports physical therapy
%MVC
120
bending, extension, and rotation torque
100 of the trunk, and that the increased mus-
cle activity is associated with controlling
%MVC
80
these movements.
60 * Compared to a stable surface, per-
* forming the curl-up exercise on an un-
40
stable surface resulted in greater activity
20 of the EO but less activity of the TrA.
0
These results differ from those of previ-
RA(I) RA(C) EO(I) EO(C) TrA(I) TrA(C) ES(I) ES(C) MF(I) MF(C) ous research, in which surface electrodes
revealed greater activity of the EO and of
Stable Unstable the lower portion of the RA when using
an unstable surface, but no change in the
FIGURE 5. Mean and standard deviations of muscle activity for each muscle for the side bridge exercise lying on IO/TrA activity level.28
the right side. Abbreviations: C, contralateral to arm used for support; EO, external obliques; ES, erector spinae; These differences may stem from the
I, ipsilateral to arm used for support; MF, lumbar multifidus; MVC, maximum voluntary contraction; RA, rectus difficulty level of the exercises between
abdominis; TrA, transversus abdominis. *Significant difference between the stable and unstable conditions (P.05).
studies. In the previous study, subjects
had their feet on the floor, as compared
also had the subjects place their toes on the ES and MF, but these were extremely to in the air in this study. Because the
a balance disk. The addition of the bal- small differences. The lack of influence feet were in the air, the unstable surface
ance disk may have increased perturba- exerted by the unstable surface for the generated extension and rotation torque.
tion of the trunk and thereby promoted ES and MF may be due to the fact that Therefore the activity of the EO, which
coactivation of global and local muscles. those muscles are not considered agonist acted on rotation and flexion of the trunk,
Significant differences were found for for this exercise. increased.
journal of orthopaedic & sports physical therapy | volume 40 | number 6 | june 2010 | 373
422.
40
5. Bergmark A. Stability of the lumbar spine. A
study in mechanical engineering. Acta Orthop
Scand Suppl. 1989;230:1-54.
20
6. Butcher SJ, Craven BR, Chilibeck PD, Spink
KS, Grona SL, Sprigings EJ. The effect of trunk
0
stability training on vertical takeoff velocity.
RA(R) RA(L) EO(R) EO(L) TrA(R) TrA(L) ES(R) ES(L) MF(R) MF(L)
J Orthop Sports Phys Ther. 2007;37:223-231.
http://dx.doi.org/10.2519/jospt.2007.2331
Stable Unstable 7. Cholewicki J, Panjabi MM, Khachatryan A. Stabi-
lizing function of trunk flexor-extensor muscles
FIGURE 6. Mean and standard deviations of muscle activity for each muscle for the curl-up exercise. around a neutral spine posture. Spine (Phila Pa
Abbreviations: EO, external obliques; ES, erector spinae; L, left side; MF, lumbar multifidus; MVC, maximum 1976). 1997;22:2207-2212.
Copyright © 2010 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
study, the increase in EO activity was the EO and RA, as compared to the TrA 10. Ekstrom RA, Osborn RW, Hauer PL. Surface
most notable, suggesting that an unsta- and MF, which are considered more lo- electromyographic analysis of the low back
ble surface increases the need to control cal stabilizers of the trunk. muscles during rehabilitation exercises. J Or-
thop Sports Phys Ther. 2008;38:736-745. http://
trunk rotation. From the results of the CAUTION: Further confirmation of these
dx.doi.org/10.2519/jospt.2008.2865
present study, there is greater participa- results is necessary in larger more diverse 11. Hodges P, Richardson C, Jull G. Evaluation of
tion of the global muscles for additional populations, including females, older in- the relationship between laboratory and clinical
trunk control than the local muscles. dividuals, and especially individuals with tests of transversus abdominis function. Physio-
ther Res Int. 1996;1:30-40.
chronic and acute low back pain.
12. Hodges PW, Richardson CA. Inefficient muscular
CONCLUSION stabilization of the lumbar spine associated with
ACKNOWLEDGEMENTS: This study was support- low back pain. A motor control evaluation of
T
he present study demonstrated ed by a Grant-in-Aid for Scientific Research transversus abdominis. Spine (Phila Pa 1976).
1996;21:2640-2650.
that muscle activity differs, depend- (B) from the Japan Society for the Promotion
13. K
oshida S, Urabe Y, Miyashita K, Iwai K,
ing on surface stability, except for of Science (grant 19300220). We would like to Kagimori A. Muscular outputs during dy-
back bridge exercise. In particular, the thank the contributions of Fuminari Kaneko namic bench press under stable versus
activity of the more global trunk muscles, for providing guidelines for the intramuscular unstable conditions. J Strength Cond Res.
2008;22:1584-1588. http://dx.doi.org/10.1519/
such as the EO, was greater with the un- electrodes.
stable surface. t
JSC.0b013e31817b03a1
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Davis IM. Core stability measures as risk factors
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The increase in EO activity was espe-
374 | june 2010 | volume 40 | number 6 | journal of orthopaedic & sports physical therapy
during submaximal flexion and extension Wikmar L. Graded exercise for recurrent abdominal muscle thickness during common
efforts but antagonist co-contraction re- low-back pain: a randomized, controlled trial trunk-strengthening exercises using ultra-
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description to issues for performance and reha- PL, Vanderstraeten GG, Danneels LA. Trunk dominal muscle response during curl-ups on
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@ more information
Cond Res. 2008;22:95-102. http://dx.doi. 25. Stevens VK, Vleeming A, Bouche KG, Mahieu
org/10.1519/JSC.0b013e31815ef8cd NN, Vanderstraeten GG, Danneels LA. Electro-
www.jospt.org
Copyright © 2010 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
21. Oliver GD, Di Brezzo R. Functional balance myographic activity of trunk and hip muscles
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