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: #$% SAVITA SINGH M.P.T. (Orthopae !"#$ Depart*e+t o, Ph-#!otherapSubmitted by: SHAMA GUPTA Ro%% No. &&'()( B.Ph.T. F!+a% Year

GAUR BRAHMAN INSTITUTE OF PHYSIOTHERAPY AN# REHABILITATION

.

BRAHMANVAS ROHTAK

CERTIFICATE

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"#$o%he a&" of the Maha #h$ '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

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 ' / Ne a$2a%$+ ' Sa%$#h Ba34 and *r Ra*$()e Sha 2a 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 / Na e#h Va#h$#% for his guidance and cooperation in statistical analysis of this project!

- am thankful to the &hysiotherapy *epartment La3o a%o " S%a!! of the Ga4 B ah2a( I(#%$%4%e o! Ph"#$o%he a&" a() Reha3$l$%a%$o(+ B ah2a(*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)

Dedicated
To My God And My Parents And All My Well Wishers

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CONTENTS

0cknowledgement *edication 1hapters 2! INTRO'UCTION 0natomy of core muscles 4iomechanics ,hat is 1ore %uscles which make the core 1ore stabili6ation -mportance of core stabili6ation .unctions of core stabili6ation &rinciples of core stabili6ation 0ims and purpose of the study $oal of study 35 35 37 37 33 33 33 25-32 32 &age "o! 20-22 22-23

#tatement of the study #ignificance of the study 8ypothesis

3 3 39 3:-37 3 - 0 39 39 39 39 39 39 39 39 3: 3: 3: 3: 50 50 50 52

2! REVIEW OF LITERATURE 3! RESEARCH 'ESIGN AN' METHO'OLOGY "ature of the #tudy ;esearch setting #ampling *esign "o! of samples *uration Time of e+ercise 0rea of study $roup 1onsent and ethical approval #election 1riteria -nclusion criteria <+clusion criteria &opulation #ample and %ethod of selection =ariables of the study

(perational tools %ethodology &rocedure =alidity > ;eliability 0dvice for younger females

52 52 52-7: 7: 0 2- 3 2- 3 57 7

3! OBSERVATION AN' 'ATA ANALYSIS *ata analysis

5! RESULTS AN' 'ISCUSSION ;esult *iscussion *elimitation of study

7! CONCLUSION ! FURTHER FUTURE STU'Y 9! REFERENCES :! APPEN'ICES 0ppendi+ 0 <thical consideration 0ppendi+ 4 0ssessment .orm 0ppendi+ 1 <+ercise assessment scale 0ppendi+ * %aster chart 0ppendi+ < 1onsent .orm

9- : 90-92 92-95 97-:5 9 -99 9:-:0 :2-:2 :3-:3 :5-:

CHAPTER -1
3

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! 0cc! to studies, almost 90? of person in modern society e+periences backache in their life!-t is a common reason for referral for &hysiotherapist! 0 need therefore arises for the strengthening of /ow back muscles to prevent the individuals from going to weakness! <very time we move, we depend on some muscles to hold us steady, and other muscles to actually move us! 1ore stabili6ation is the general term for how the muscles of your trunk keep your spine and body stable! This helps you stay

.&

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! <+ercises for core stabili6ation should be part of every conditioning program, along with fle+ibility, strength, and aerobic training! 1ore stability e+ercises improve the muscular strength of back muscles! 1ore stability is very important because @i! it strengthen the low back muscle in younger females because females are prone to low back pain due to weakening of muscles! ii! iii! iv! it aware the females about good postures! it improve the personBs balance > co-ordination! -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!

.)

(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) <+tension of lumbar vertebral column, with bilateral contraction

./

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 5thth

ribs > +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" 06 T D T22

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EXTERNAL OBLI5UE 06 <+ternal- closure to surface

(blique- fibres diagonal to midline

S% 4c%4 e 6 The e+ternal oblique is situated on the lateral and anterior parts of the abdomen! -t is broad, thin, and irregularly quadrilateral, its muscular portion occupying the side, its

aponeurosis the anterior wall of the abdomen! -n most humans 'especially males), the oblique is not visible, due to subcutaneous fat deposits and the small si6e of the muscle!

O $1$( 6 -t arises from eight fleshy digitations, each from the e+ternal surfaces and inferior borders of the fifth to twelfth ribs! These digitations are arranged in an oblique line which runs downward and backward, with the upper digitations being attached close to the cartilages .'

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 DT22 > -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 06 -nternal-farther from surface!

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O $1$(6

-t originates from iliac crest inguinal ligament > thoracolumbar fascia! -ts fibers run perpendicular to the e+ternal oblique muscle, beginning in the thoracolumbar fascia of the lower back, the anterior 2G3 of the iliac crest 'upper part of hip bone) and the lateral half of the inguinal ligament! The muscle fibers run from these points superiomedially 'up and towards midline) to the muscleHs insertion!

I(#e %$o( 7

-t inserts into cartilage of inferior 3rd or 3th ribs > linea alba! I((e *a%$o(

The internal oblique is innervated by the lower intercostal nerves, as well as the iliohypogastric nerve and the ilioinguinal nerve! .2

Ac%$o(#

The internal oblique performs two major functions! .irst, it acts as an antagonist 'opponent) to the diaphragm, helping to reduce the volume of the thoracic 'chest) cavity during e+halation! ,hen the diaphragm contracts, it pulls the lower wall of the chest cavity down, increasing the volume of the lungs which then fill with air! 1onversely, when the internal obliques contract they compress the organs of the abdomen, pushing them up into the diaphragm which intrudes back into the chest cavity reducing the volume of the air filled lungs, producing an e+halation!

#econdly, its contraction rotates and side-bends the trunk by pulling the rib cage and midline towards the hip and lower back, of the same side! -t acts with the e+ternal oblique muscle of the opposite side to achieve this torsional movement of the trunk! .or e+ample, the right internal oblique and the left e+ternal oblique contract as the torso fle+es and rotates to bring the left shoulder towards the right hip! .or this reason, the internal obliques are referred to as Isame side rotators!I

a) 1ompress abdomen b) 1ontraction of one side alone bends vertebral column laterally

Ne *e #4&&l" 7 T9 D T22 > -lliohypogastric nerve

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TRANSVERSUS AB'OMINIS 06

O $1$( 06 -t originates from the iliac crest,inguinal ligament,lumbar fascia > cartilage of inferior 7 ribs!

I(#e %$o( 6/

-t inserts into +iphoid process > linea alba > pubis -t imserts into +iphoid process > linea alba > pubis

Ac%$o( 6

)&

-t compresses the abdomen!

Ne *e #4&&l" 06 'a) 4ranches of thoracic T9 D T22 'b) -liohypogastric nerve 'c) -llioinguinal nerve

ERECTOR SPIN8 6

The <rector spinC 'or #acrospinalis in older te+ts), a bundle of muscles and tendons, and its prolongations in the thoracic and cervical regions, lie in the groove on the side of the vertebral column! They are covered in the lumbar and thoracic regions by the lumbodorsal fascia, and in the cervical region by the nuchal fascia! This large muscular and tendinous mass varies in si6e and structure at different parts of the vertebral column! -n the sacral region it is narrow and pointed, and at its origin chiefly tendinous in structure! -n the lumbar region it is larger, and forms a thick fleshy mass which, on being followed upward, is subdivided into three columnsE these gradually diminish in si6e as they ascend to be inserted into the vertebrC and ribs! a deep muscle of the backE it arises from a tendon attached to the crest along the centre of the sacrum 'the part of the backbone at the level of the pelvis, formed of five vertebrae fused together)! ,hen it reaches the level of the small of the back

).

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 region into three columns, vi6!, a lateral, the -liocostalis, an intermediate, the /ongissimus, and a medial, the #pinalis!

<ach of these consists from below upward, of three parts, as follows@ /ateral 1olumn -liocostalis -! lumborum -! dorsi -! cervicis -ntermediate 1olumn /ongissimus /! dorsi /! cervicis /! capitis #! capitis %edial 1olumn #pinalis #! dorsi #! cervicis

Il$oco#%al$# 6

O $1$( --iliac crest and sacrum!

)/

I(#e %$o( - 0ngles 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

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0ll 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 3 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

401J %(=<%<"T > .K"1T-(" @-

0ny back movement is a combination of the basic fle+ion,e+tension > rotation movements!

FLEXION 06
.le+ion is when the trunk bends forward > to side!

e!g! /eaning over a sink or sitting up in bed!

%K#1/<# &<;.(;%-"$ T8-# .K"1T-(" @- a) ;ectus abdominis

b) -nternal oblique c) <+ternal oblique

EXTENSION 06 <+tension is a when the back straightens from a bent

position or e+tends from an erect position!

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

%K#1/<# &<;.(;%-"$ T8-# .K"1T-(" @- a) <rrector spinae

b) Luadratus lumborum c) $luteus ma+imus d) 8amstrings

ROTATION 06
;otation is twisting of the trunk about the waist! e!g! Turning to one side while sitting down!

%K#1/<# &<;.(;%-"$ T8-# .K"1T-(" @- a) ;ectus abdominis

b) (bliques

These are basic three movements, but the back can move in any combination of these! e!g! a) The down swing of a self goal shot is a combination of rotation > 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

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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 to e+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 <ngagement of rectus abdominis or the e+ternal obliques is likely to pull the chest and pelvis together! The direction of transversus fibers, in contrast, is parallel to the vertebrae! Transversus thus will be able to act very precisely on each vertebra, one at a time!

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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! '2) 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!

<+ercise to help low back strength

4ack musclesMlike any other muscle in the bodyMrequire adequate e+ercise to maintain strength and tone! ,hile muscles like the gluteals 'in the thighs) are used any time we walk or climb a step, deep back muscles and abdominal muscles are usually left inactive and unconditioned! Knless muscles are specifically e+ercised, back muscles and abdominal muscles tend to weaken with age! &hysical therapy and e+ercise regimens to treat low back pain usually focus on strengthening the fle+or, e+tensor and oblique muscles to help reinforce support of the spine and in turn, reducing low back pain and sometimes eliminating the need for surgery!

The role back muscles play in low back pain

,hen the facet joints or certain other structures in the spine become injured or inflamed, the large back muscles can spasm and cause low back pain and marked limitation in motion!

0n episode of low back pain that lasts for more than two weeks can lead to muscle weakness 'since using the muscles hurts, the tendency is to avoid using them)! This process leads to disuse atrophy 'muscle wasting), and subsequent weakening, which in turn causes more pain because the muscles are less able to help hold up the spine!

/.

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!

0nother 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 on strengthening 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! 0n 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!

/)

 WHAT IS CORE

1ore referred to as the &(,<;8(K#< ,the foundation or the engine of all limbs!

The core is the lumbopelvic-hip comple+, where a personBs center of gravity is located and all movement begins! There are 2: muscles that attach at the lumbopelvic-hip comple+! 0n efficient core allows the length-tension relationship of functional agonists and antagonists to remain normal, which in turn allows the force couple relationships in the lumbopelvic-hip comple+ to remain normal! %aintaining these relationships allows one to maintain optimal arthrokinematics in the lumbopelvic-hip comple+ during functional kinetic chain movements! This provides optimal neuromuscular efficiency in the entire kinetic chain, allowing for optimal acceleration, deceleration, and dynamic stabili6ation of the entire kinetic chain during functional movements! This provides pro+imal stability for efficient lower e+tremity movements! The core operates as an integrated functional unit whereby the entire kinetic chain works synergistically to produce force, reduce force, and dynamically stabili6e against abnormal force!3 -n an efficient state, each structural component distributes weight, absorbs force, and transfers ground reaction forces!3 This integrated, interdependent

//

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 04*(%-"0/#

401J

- by &0;0#&-"0/# > $/KT<0/#

;((.

- by *-0&8;0$%

4(TT(%- by &</=-1 ./((; > 8-& %K#1/<#

/0T<;0/-by 8-& 04*K1T(;# > ;(T0T(;

4ut for strengthening of low back ,main stress on the 04*(%-"0/# > <ST<"#(;#!

CORE STABILIZATION
The spine itself is just bones stacked on top of one another with small fluid-filled discs in between to cushion them! To make the spine more stable, the parts are all

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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

0ll 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! 0 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!

/'

.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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iii!

4efore going to individual muscle, firstly activate the core muscle by drawing in maneuver, 0bdominal bracing > pelvic tilt!

iv! v!

They must be done slowly-slowly, jerky movement must not be there! ,hen the athlete has first mastered proper activation, then he or she should progress from a stable surface to a labile surface

vi!

&roprioceptive training should be incorporated by balance board!

AIM OF STU'Y06
i! ii! iii! iv! v! vi! vii! viii! To strengthen the weak muscles! To improve the endurance of muscles! To stabili6e the hypermobile structure! To improve posture! To improve mobility > fle+ibility! To improve the fitness level! &revent low back injury! To maintain ;(%

PURPOSE OF THE STU'Y06

To conduct an e+perimental evaluation whether core stabili6ation e+ercises are effective or not in strengthening the low back muscles in younger females!

GOALS OF STU'Y 06
/(

ii!

0ctivate > 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

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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!

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CHAPTER-2

0&

REVIEW OF LITERATURE

2! %c$ill, #!%! 2::9! /ow back e+ercises@ evidence for improving e+ercise regimens! &hysical Therapy 9 ' )@ 53- 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! <ndurance and strength training may develop from low weight-high repetition e+ercises! &erhaps the e+ercise regimens of our device need to be able to be custom tailored to each patient! &atients should be able to choose the computer game they want to do!

0.

2! *eyo, ;!0! and *iehl, 0!J! 2:97! &atient satisfaction with medical care for low-back pain! #pine 22'2)@ 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! 2::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)@ 290-2:2!

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! 0lso, giving feedback directly to the patient from the device may help tremendously!

0)

3! "elson, 4!,!, 1arpenter, *!%!, *reisinger, T!<!, %itchell, %, Jelly, 1!<!, and ,egner, F!0! 2:::! 1an spinal surgery be prevented by aggressive strengthening e+ercisesT 0 prospective study of cervical and lumbar patients! 0rch! &hys! %ed! 0nd ;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! <+ercises were performed via a lumbar e+tension device and a cervical e+tension device 'usually found in weight rooms)!

5! Fones, #usan /!, ;", &h*, Fones, &aul J et al! 1ompliance for /ow 4ack &ain &atients in the <mergency *epartment

This article evaluated two forms of the 8ealth 4elief %odel '84%) intervention which focused on increasing the compliance of low-back pain '/4&) patients visiting an emergency department! The two types of compliance studied included adhering to a referral by scheduling an appointment and keeping the scheduled appointment! Knfortunately this article has very little application to our project! -t does however validate the need for a possible outpatient device to facilitate the la6y!

:! 1allaghan, Fack, $unning, Fennifer, and #tuart, %c$ill The ;elationship 4etween /umbar #pine /oad and %uscle 0ctivity *uring <+tensor <+ercises
0/

The objective of this study was to investigate the loading of the lumbar spine and trunk muscle activity levels through various back e+ercises! <+ercises involving back e+tensionGfle+ion produced the highest joint forces where as e+ercises involving simple leg and contralateral arm e+tension reduced loads on the spine! This is another incredibly useful document that not only validates the need for our device but gives insight into what truly must be quantified! 8ere the specific local supporting muscles 'listed above) can be retrained into co-contraction resulting in reducing /4&! Two e+ceptionally interesting points came up in this article! .irst, a digital inclinometer '1ybe+ <lectronics) was used to measure spinal curvature! %ore interestingly however, no significant difference in lumbar spine sagittal mobility was detected after intervention between the control and variable groups! Thus, is it possible that our design may was to focus on a different aspect of quantificationT ;ichardson, 1!0! %uscle 1ontrol-&ain 1ontrol! ,hat e+ercises should you prescribeT

! 1arolyn ;ichardson and her colleagues@-

The role of lumbar multifidus and transversus in low back pain rehabilitation in 0ustralia investigated the role of these muscles in back pain and healthy patients! Q2 R-n ;ichardsonBs e+periment, the researchers found that only 20? of those with a history of low back pain could activate the transversus abdominis, compared with 92? of the nonlow-back-pain subjects! They found that patients who performed e+ercises that specifically targeted the transversus abdominis over the course of 20 weeks e+perienced a significant decrease in pain and an increase in functional ability compared to the control

00

group which received conventional treatments such as swimming, workouts and sit-ups! 0t the 30 month follow-up, the improvement had been maintained! 0s 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 lumbar e+tension e+ercises most often do not differentiate between global and local muscle involvement! <ven programs calling themselves Ncore stabili6ationO may not make this distinction! This is problematic because too much development of global muscles was found actually to interfere with the action of the local stabili6er system!

9! ;ichardsonBs study also confirms the importance of the neurological component! #he reports@

The motor skill which was practiced with high repetition changed the si6e of the inhibited levels of the multifidus in acute back pain patients quite quickly, in some patients within a week! ,ith this time frame, it can be surmised that the e+ercise effect was not related to muscle hypertrophy, but perhaps to neurally related events in the muscle which reestablished its si6e as well as its control of the associated lumbar segments! Q29R

0'

0n 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

:! 2003 0line "ewton %!0!, 0dvanced 1ertified ;olfer

-n the past 5 years, the concept of spinal segmental stabili6ation has received considerable attention from research science!Q2R #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! 0lthough 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 0nd more mysteriously@ Nuddiyana is so called because the great bird, &rana, tied to it, flies without being fatigued!O The te+t is from 2:25, 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

N#lowly draw in the abdomen by contracting the lowest section of the 0bdominal muscle, starting at the lowest point of the region below the navel!O

20! FK" $! #0" FK0", F0%<# 0! A0$$-<, #K#0" /<=A, =<;T %(("<A, 4;-0" K*<;%0"", 0"* F(8" %! %0A<;! !
<ffects of pelvic stabili6ation on lumbar muscle activity during dynamic e+ercise! F! #trength 1ond! ;es! 2:'3)@000D000! 2005!M

%any commonly utili6ed lowback e+ercise devices offer mechanisms to stabili6e the pelvis and to isolate the lumbar spine, but the value of these mechanisms remains unclear! The purpose of this study was to e+amine the effect of pelvic stabili6ation on the activity of the lumbar and hip e+tensor muscles during dynamic back e+tension e+ercise! .ifteen volunteers in good general health performed dynamic e+tension e+ercise in a seated upright position on a lumbar e+tension machine with and without pelvic stabili6ation! *uring e+ercise, surface electromyographic activity of the lumbar multifidus and biceps femoris was recorded! The activity of the multifidus was 52? greater during the stabili6ed condition, whereas there was no difference in the activity of the biceps femoris between conditions! This study demonstrates that pelvic stabili6ation enhances lumbar muscle recruitment during dynamic e+ercise on machines! <+ercise specialists can use these data when designing e+ercise programs to develop low back strength!

0(

CHAPTER -3
02

RESEARCH DESIGN & METHODOLOGY

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 0yurvedic &hysiotherapy college! 4rahmanwas, ;ohtak, 8aryana!

#0%&/-"$

@-

&urposive sampling 03

0ge 25 D 30 years $ender-female

*<#-$"

@-

4etween the subject design

"K%4<; (. #0%&/<# @-

30

*K;0T-("

@-

Two > half months

T-%< (. <S;1-#< @- (nly morning

0;<0 (. #TK*A

@- $aur 4rahman &hysiotherapy > ;ehabilitation 1entre

$;(K&

@-

i!

<S&<;-%<"T0/

@-

-n this no! of sample is 25 on which e+ercise are performed!

ii!

1("T;(//<*

@-

"o! of sample is 25 but no e+ercise are performed on them

CONSENT ETHICAL APPROVAL 06

'&

The institute gave approval for this study! <ach subject was e+amined by the institute %edical (fficer > 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<;-0

i! ii! iii! iv! v! .emale 0ge group-25-30yrs! .emales having weakness of low back muscles .emales who want to increase their fle+ibility for low back #ubjects who were willing to come regularly > doing e+ercises regularly > abide by the instructions given for the purpose of the study!

<S1/K#-=< 1;-T<;-0
ii! iii! iv! v! vi! vii! viii! 0ge group less than 25 > more than 30 yrs #pondylosis #pondylolisthesis (steoporosis (steomalacia %alignancy pregnant women '.

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 0 '25)@ <+perimental group receiving core stabili6ation e+ercises!

$roup 4 '25)@ 1ontrolled group not receiving core stabili6ation e+ercises!

VARIABLES OF THE STU'Y 06

A/

'EPEN'ENT VARIABLES

Test values %%T

B/

IN'EPEN'ENT VARIABLES

')

1ore stability e+ercises

OPERATIONAL TOOLS 06

0ll standardi6ed equipments of reputed brands were used @ 1alculator #wiss 4all 1ouch 1lock ,atch %at

METHO'OLOGY
&;(1<*K;< $roup 0
Step 1 &re treatment measurement of the lower back muscles were taken! Step 2 <+ercises were given to the lower back muscles for 25 minutes!

'/

&;<> &(#T T;<0T%<"T %<0#K;<%<"T# K#<* T( <=0/K0T< /(,<; 401J %K#1/<# @-

8ow to assess your core strength

1ore strength assessment evaluates the strength and quality of activation of the transversus abdominis muscle, which as mentioned in several articles on this site plays a key role in stabili6ing the lower back to not only reduce lower back pain, but also to increase performance in everyday functional activities and in all sports! -n addition, the strength and fle+ibility of other NcoreO muscles such as the lower abdominals, oblique 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+ercises available 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!

'0

(bjective
The objective of the 1ore %uscle #trength > #tability Test is to monitor the development of the athleteHs abdominal and lower back muscles!

4o+ 5"t!+6theTe#t
The 1ore %uscle #trength > #tability Test is conducted as follows! '2) The four basic test advocated!These are @ a) &rone 4ridge b) /ateral 4ridge c) Torso .le+or Testing d) Torso <+tensor Testing

-a. PRONE BRI'GE 06 -t is performed by supporting the body weight between the forearms > toes ! -t primarily assess the anterior > posterior core muscles!

''

&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 06 -t assess the lateral core muscles!

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

'1

/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!

'(

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

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

the

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

'2

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!

'3

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 .

0nalysis
0nalysis 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 3 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 3 special test for 5 minutes!

-"#T;K1T-("# $-=<" T( <S&<;-%<"T0/ $;(K& .<%0/<# ;<1<-=-"$ <S<;1-#<# @-

1&

-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! "otice how 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

1.

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)

0llow your low back to arch so your stomach juts forward > your buttocks stick out@ notice how your hands rotate forward!

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

1)

can find neutral spine in each position, you can maintain good posture for daily activities > for e+ercise!

<S<;1-#<# ,8-18 0;< $-=<" T( T8< <S&<;-%<"T0/ $;(K& .<%0/<# 0;< .(//(,-"$ @CRUNCH 06
/ie on your back and bend your knees about 70 degrees and keep your feet flat on the floor! &lace your hands loosely behind your head! 1url up and bring your right elbow and shoulder across your body while bring your left knee in toward your left shoulder at the same time! ;each with your elbow and try to touch your knee! *o one side for all your reps, then switch to the other side! Try to bring your shoulder up towards your knee rather than just your elbow!

1/

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 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 your lower back should remain on the floor! .ocus on slow, controlled movement - donHt cheat yourself by using momentum!

10

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!

1'

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

11

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!

1(

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! <nsure that the back does not slip into e+tension, and that the shoulders and pelvis do not tilt sideways! 8old for up to a ma+imum of 20 seconds! #lowly bring your leg and arm back and swap sides! &erform 5 to 20 sets!

12

$roup 4 '25) Step 1

&re treatment measurement of the low back muscles was taken!

Step 2
"othing is given to the $roup 4 females! They are on only observation!

&;<

>

&(#T

T;<0T%<"T

%<0#K;<%<"T

K#<*

T(

<=0/K0T< T8< #T;<"$T8<"-"$ (. /(, 401J %K#1/<#@-

8ow to assess your core strength

1ore strength assessment evaluates the strength and quality of activation of the transversus abdominis muscle, which as mentioned in several articles on this site plays a key role in stabili6ing the lower back to not only reduce lower back pain, but also to increase performance in everyday functional activities and in all sports! -n addition, the strength and fle+ibility of other NcoreO muscles such as the lower abdominals, oblique

13

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+ercises available 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! '2) The four basic test advocated!These are @-

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

(&

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 06 -t 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!

0nalysis
0nalysis 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 3 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 3 special test for 5 minutes! They are only under observation!

VALI'ITY ; RELIABILITY 06
T<#T<;# ;</-04-/-TA@&rocedures used for the measurement of the responses was conducted once > hence, this procedure intra-reliable!

&;(1<*K;< ;</-04-/-TA @&rocedure used in this study is reliable > was used previously by many researches!

A'VICE FOR YOUNGER FEMALES 06

i) ii) iii)

0void bad postures which causes discomfort to back! ;egular back e+ercises! 4elts can be used to support weak back!

()

(/

CHAPTER 4 OBSERVATION & DATA ANALYSIS

(0

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 <rror of *ifference

#*d W Y X+Z G"-2

#tandard <rror of %ean *ifference #<md W #*d G"

VtB value W *-0 G#tandard <rror of %ean *ifference

('

Ta3le0 < %ean, #tandard <rror of *ifference, #tandard <rror of %ean *ifference, and
%ean *ifference of the values of controlled group@-

S / No/

Va $a3le#

P e %e#% Mea(

Po#% %e#% Mea( 3!5

S)

SE)

2!

1ore stability e+ercise

3!57

0!05

0! 25

Ta3le0 = &aired VtB test for the training

S / No/

Va $a3le#

O3%a$( >%> *al4e

?%> *al4e a% @/@A le*el 2! 7

?%> *al4e a% @/@< le*el 2!:9

2!

1ore stability 0!23 e+ercise

Ta3le0 = %ean, #tandard <rror of *ifference, #tandard <rror of %ean *ifference, and
%ean *ifference of the values of e+perimental group group@-

(1

S / No/

Va $a3le#

P e %e#% Mea(

Po#% %e#% Mea( 3!3:

S)

SE)

2!

1ore stability e+ercise

3!5

0!25

0! 075

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

S / No/

Va $a3le#

O3%a$( >%> *al4e

?%> *al4e a% @/@A le*el 2! 7

?%> *al4e a% @/@< le*el 2!:9

2!

1ore stability 22! e+ercise

((

CHAPTER -5 RESULTS & DISCUSSIO N

(2

RESULT :&
-ncrease in core stability as per mean of pre test and post test! #*d for e+perimental group is W 0!25 #<md for e+perimental group is W 0!075 &aired VtB value is W 22! This shows that the result of study is highly significant!

GROUP A 06 $roup 0 receiving core stabili6ation e+ercises demonstrated increase in strength of lower back muscles!

GROUP B 06 $roup 4 females not receiving core stabili6ation e+ercises demonstrated that they have very very slight effect on their strengthening of lower back muscles! (nly with respect to time, they got only small effect on their strengthening of lower back muscles!

'ISCUSSION 06

(ur results support previous finding that core stabili6ation e+ercises are very effective in strengthening the lower back muscles! %uscles change under mechanical stress at temperature greater than 3 degree 1elsius! ,ith increased temperature, the microstructure of collagen changes such that stress-rela+ation property increases 'greater rela+ation), which permits deformation when

(3

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!

2&

CHAPTER -6

CONCLUSION

2.

CONCLUSION
- have taken 25 patients in two groups > for $roup 0 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 0 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!

2)

CHAPTER 7

FURTHER FUTURE STUDY

2/

FURTHER FUTURE STU'Y 06

i!

-t can be done on age below 25 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!

<%$ analysis in the study of core stability e+ercises in activation of core stability muscles!

vii!

.urther future study on individual core muscles!

20

CHAPTER - 8

REFERENCES
2'

REFRENCES
Q2R Jisner 1arolyn, 1olby /ynn 0llen,OTherapeutic <+ercise@ .oundations and

TechniquesO, Faypee &ublications, 3th <dition!

Q2R "orkin 1ynthia, ,hite *! Foyce, N%easurement of Foint %otion@ 0 $uide To $oniometryO,Faypee &ublications, 2nd <dition!

Q3R 8icks 1arolyn, O;easearch .or &hysiotheraphists-&rojet design and analysisO, 1hurchill /ivingstone, 2nd <dition!

Q3R *omholdt <li6abeth,O&hysical Therapy ;easearch D &rincipals and 0pplicationsO #aunders &ublications, 2nd <dition!

Q5R %agee *avid, O(rthopaedic &hysical 0ssessmentO, #aunders &ublications,3 th <dition!

21

Q7R &andey #ureshwar, &anday 0nil, N1linical (rthopaedic *iagnosisO, Faypee &ublications! 2nd <dition

Q R #nell ;ichard, N1linical 0namotyO, /ippincott ,illams and ,ilkins,

th

<dition!

Q9R Foshi Fayant, Jotwal &rakash, <ssential of (rtho and 0pplied &hysiotherapy,1hurchill /ivingstone,2st <dition!

Q:R [acha6ewski

Fames, %agee

*avid, Luillen ,illiam, 0thletic -njuries and

;ehabilitation,#aunders &ublications!

Q20R ;ichardson, 1arolyn, et al, Therapeutic <+ercise for #pinal #egmental #tabili6ation in /ow 4ack &ain! 1hurchill /ivingstone, <dinburgh, 2:::

Q22R /atey &enelope, Fournal of 4odywork and %ovement Therapies vol 5 '3) (ct!2002!pp!2 5-292

Q22R Jendall and %c1reary', %uscles! Testing and .unction, 3rd ed! ,illiams > ,ilkins, 4altimore, 2:93) attribute the drawing in of the abdominal wall to the e+ternal oblique muscles, but #trohl et al ';egional differences in abdominal muscle activity during various maneuvres in humans!

2(

Q23R Fournal of 0pplied &hysiology 52@23 2-23 7,2:92), /acote et al '1linical evaluation of muscle function! 1hurchill /ivingstone, <dinburgh, 2:9 )

Q23R *eTroyer et al 'Transversus abdominis muscle function in humans Fournal of 0pplied &hysiology 79@2020-2027, 2::0) say transversus abdominis predominates in pulling the belly in!

Q25R 4ergmark 0, #tability of the lumbar spine! 0 study in mechanical engineering! 0cta (rthopaedica #candinavica 230'suppl)@20-23!

Q27R [uluaga %aria, 4riggs 1hristopher, #ports &hysiotherapy 0pplied #cience and &ractice, 1hurchill /ivingstone!

Q2 R &orter #tuart, TidyBs &hysiotherapy, 4utterworth 8einemann, 23 th <dition!

Q29R "orris 1hristopher , #ports -njuries- *iagnosis and %anagement .or &hysiotherapists 4utterworth 8einemann!

22

CHAPTER 9

23

APPENDICES

APPEN'IX 7 A

ETHICAL 7CONSI'ERATIONS

2! The identity of all subjects will be protected -n any publication so made!

troughout the study and also

2! <ach subject randomly will be allocated a 3-digit secret code number throughout and after the study!

3&

3! 0 decoding note will be made on the subjectsBs first appearance and will be retained by me maintaining full secrecy!

3! 0ll subjects would be briefed about this and about my legel obligations to observe any act of data protection!

5! 0fter 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!

! 0ll 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! 0ll information to be collected shall pertain to the study only!

3.

APPEN'IX6B

A##e##2e(% !o 2

"ame@ 0ge@ $ender@ 0ddress@ (ccupation@

3)

*ate of <+amination@

8-#T(;A (. .(//(,-"$@

0ny relevant "euorological G (rthopedic conditions@ &yre+ia@ 0ny lower limb injury@ 0ny metal implants@

$<"<;0/ 0##<##%<"T@

8eight@ ,eight@ 4ody %ass -nde+@ &ulse@ 4ody Temperature@ =ital signs@ &osture of the patient@

<S0%-"0T-("@

;ange of %otion@

3/

 4ack .le+ion

4ack <+tension

4ack ;otation

/umbar vertebrae

%anual %uscle Testing@

#<"#(;A 0##<##%<"T@

&ain APPEN'IX 6 C

EXERCISE ASSESSMENT SCALE06

STARTING POSITION06 1orrect -ncorrect 30 2 0

PLANE OF MOVEMENT06 1orrect body part moving in correct plane! 1orrect body part moving in incorrect plane! 2 0

ROM06 <+ercise performed using correct ;om! <+ercise performed using partially correct ;om! <+ercise performed using incorrect ;om! 2 2 0

COMPENSATION06 "o compensatory movement Kse of compensatory movement 2 0

'URATION BSPEE' OF MOVEMENT06 Total time taken for e+ercise is correct Total time taken for e+ercise is incorrect 2 0

REPETITION06 1orrect no! of repetition -ncorrect no! of repetition 2 0

FRE5UENCY06 1orrect no! of timesGday 3' 2

-ncorrect no! of timesGday

APPEN'IX 7 ' MASTER CHART /ine $raph@ before and after treatment presentation of core strength of lower back for controlled group! S No/ A1e Pe T ea%2e(% < = C 23 25 2 Rea)$(1 3!25 3!3 3!29 Po#% % ea%2e(% Rea)$(1 3!25 3!39 3!20

31

D A : E F G <@ << <= <C <D <A

29 23 25 30 29 27 2 29 2: 29 23 22

2!59 3!30 2!50 3!37 3!59 3!32 3!29 2!59 3!27 3!32 3!32 3!23 MASTER CHART

2!53 3!30 2!35 3!3 3!59 3!32 3!25 2!50 3!27 3!50 3!32 3!23

/ine $raph@ before and after treatment presentation of core strength of lower back for e+perimental group! S No/ A1e Pe T ea%2e(% < = C D A : E F G <@ << <= <C <D <A 20 25 23 29 23 2: 30 27 25 2 29 2: 22 23 2: Rea)$(1 3 3 3 3 3!50 3!20 2!50 3!25 3!29 3!53 3!35 3 3!25 3!2 3!5 APPEN'IX 6 E Po#% % ea%2e(% Rea)$(1 3!90 3 3!35 3!20 3!50 5 3!50 5 3!27 3!3 3!35 3!50 3!25 3!59 3!50

3(

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!

0bout 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!0!&!1ollege,4rafmanwas, ;ohtak!

;isks of &articipation in this study 0s such there are no risks involvedas no medication or no drugs are being used! 0t 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

32

0ll 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!

1("#<"T

voluntarily consent to participate in the study! 0ll my

questions have been satisfactorily answered and the risks involved have been e+plained to me! - reserve my right to withdraw at any instant and - have the contact address of #hama $upta if - require any further information!

#ignature

1ontact 0ddress

#hama $upta

$aur 4rahman 0yurvedic and &hysiotherapy 1ollege,

4rahmanvas, ;ohtak, 8aryana!

33

.&&