Journal of Korean Physical Therapy Science (대한물리치료과학회지)

Korean Physical Therapy Science (대한물리치료과학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Unstable Support Surface Plank Exercise on Flexibility, Abdominal Muscle Thickness and Pain in Chronic Low Back Pain

불안정한 지지면 위에서의 플랭크 운동이 만성허리통증환자의 유연성, 배 근육 두께 및 통증에 미치는 영향

  • Received : 2019.10.19
  • Accepted : 2019.12.03
  • Published : 2019.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The purpose of this study was to investigate the effect of Plank exercise on unstable support surfaces on flexibility, abdominal muscle thickness and pain in patients with chronic back pain. Design: Randomized controlled trial. Methods: This study was performed on 16 patients with chronic back pain of ◯◯ military unit. Sixteen subjects were randomly assigned into two groups, an upper extremity trainer group (group I, n=8) and a lower extremity trainer group (group II, n=8). The subjects in group I carried out Flank exercise applying the stability trainer to their upper extremities and ones in group II carried out the same exercise applying the stability trainer to their lower extremities for 4 weeks. In order to ascertain the difference between two groups, flexibility, abdominal muscle thickness and pain were measured before and after the exercise. The flexibility was measured by sit and reach test, the thickness of the abdominal muscle was measured by using ultrasonic imaging equipment, and the pain was measured by the visual analogue scale. A paired t-test was utilized to compare changes in pain, abdominal muscle thickness and flexibility before and after flank exercise on unstable support surfaces. Analysis of Covariance (ANCOVA) was performed for ascertaining the significant differences between groups. The significance level was set by α=.05. Results: 1) The flexibilities of two groups were increased after the exercise (p<0.05). 2) In both groups, the thicknesses of rectus abdominis, external oblique abdominis, internal oblique abdominis, and transverse abdominis were all increased after the exercise (p<0.05). 3) The pains in both groups were decreased after the exercise (p<0.05). 4) In the comparisons of two groups, there were no differences in the flexibility, thickness of external oblique abdominis, internal oblique abdominis and transverse abdominis and pain (p>0.05). Whereas only thickness of Rectus abdominis was larger in the group I than in the group II (p<0.05). Conclusion: Plank exercise on the unstable support surface for 4 weeks resulted in increased flexibility, abdominal muscle thickness and pain reduction in patients with chronic back pain. Therefore, it is considered that performing flank exercise on the unstable supporting surface is suitable for the reduction of the pain in patients with chronic back pain. However, in this study, it is considered that continuous and diverse studies are needed because there was not a large difference between the groups when the upper or lower limbs are provided unstable support surfaces.

Keywords

References

  1. 강명숙. 병사들의 근골격계 증상과 작업관련 및 사회심리적 특성과의 관계[석사학위논문]. 연세대학교 대학원; 2007.
  2. 고용노동부. 산업재해현황분석. 2013.
  3. 국군의무사령부(2005). 군 병원 통계연보
  4. 김수현. 등속성 및 등장성 재활트레이닝이 척추수술환자의 근기능 회복에 미치는 영향[석사학위논문]. 한국체육대학교 대학원; 1997.
  5. 노약우, 송재의, 변창세, 백창현. 요통에 관한 임상적 고찰. 대한 정형외과 학회지. 1985;20:445-453.
  6. 도용찬. 지면 유형별 플랭크 운동에서 초음파 영상을 통한 복횡근과 내복사근 두께 비교[석사학위논문]. 인제대학교 대학원; 2014.
  7. 박미애. 요부안정화 운동이 요통환자에게 미치는 영향[석사학위논문]. 삼육대학교 대학원; 2004.
  8. 박병문. 요통의 원인과 치료. 대한정형외과 학회지. 1977;12:1-8.
  9. 박지원. 교각운동 방법 차이에 의한 만성요통환자의 체간근 활성도, 근 두께 및 고유수용성감각에 미치는 영향[박사학위논문]. 대구가톨릭대학교대학원; 2014.
  10. 박재철. 지지면에 따른 안정화 운동이 근수행력에 미치는 영향[석사학위논문]. 남부대학교 보건경영대학원; 2012.
  11. 배성수, 김용천, 박홍기, 이현옥, 이현일, 장정훈. 물리치료학 개론. 서울: 도서출판 대학서림; 1989.
  12. 안명환. 만성요통환자의 건강 통제의 성격과 치료지시이행과의 관계연구[석사학위논문]. 고려대학교 대학원; 1997.
  13. 윤영애. 물리치료 환자의 통계적 고찰. 대한 군진 의학 학술지. 1975;6:20-26.
  14. 이강우. 요통의 운동치료. 대한 재활의학회지. 1995;19(2):203-208.
  15. 이다현. 매트와 짐볼 운동이 만성요통 환자의 유연성과 균형에 미치는 효과[석사학위논문]. 강원대학교 대학원; 2011.
  16. 이지현. 군 병사의 요통과 우울, 군 생활 적응간의 관계[석사학위논문]. 충남대학교 대학원; 2009.
  17. 이경희. 요통 유발 변인에 관한 탐색적 연구-군병원에 입원한 요통환자를 중심으로[석사학위논문]. 연세대학교 대학원; 1989.
  18. 이승재. 한국인 근로자 요통환자에 대한 임상적 연구. 인제의학. 1985;6(3):437-447.
  19. 정성수, 이종서, 정광훈, 이종열, 오일빈. 환축추간 경관절 고정시 후방 나사못 삽입을 위한 전산화 단층 촬영. 대한정형외과학회지. 2004;39(3):285-289. https://doi.org/10.4055/jkoa.2004.39.3.285
  20. 정은동. 만성요통환자에게 슬링에서의 교각운동이 통증 및 체간근 활성에 미치는 영향[석사학위논문]. 고려대학교 대학원; 2013.
  21. 최원제, 박범석, 유병국, 전재근, 손경현. 코어 프로그램 운동이 만성요통 환자의 균형에 미치는 영향. 대한물리치료과학회지. 2018;25(1):1-10. https://doi.org/10.26862/jkpts.2018.06.25.1.1
  22. Ainscough-Potts, A-M., Morrissey, M. C., & Critch ley, D. The response of the transverse abdominis and internal oblique muscles to different postures. Manual Therapy. 2006;11(1):54-60. https://doi.org/10.1016/j.math.2005.03.007
  23. Anderson G,B., Pope M,H., Frymoyer J, W. & Chaffin D, B. Occupation Low Back Pain: Assessment, Treatment and Prevention. St, Louis: Mosby. 1991;1(3):2-147.
  24. Anderson GBJ. Epidemilogic aspects on low back pain in industry. Spine. 1981;6(1):53-60. https://doi.org/10.1097/00007632-198101000-00013
  25. Costa, L. O. P., Maher, C. G., Latimer, J., & Smeets, R. J. Reproducibility of reh abilitative ultrasound imaging for the measurement of abdominal muscle acti vity: a systematic review. Phys Ther, 2009;89(8):756-769. https://doi.org/10.2522/ptj.20080331
  26. Czaprowski D, Afleltowicz A, Gbicka A, Pawlowska P, Kdra A, Barrios C, et al. Abdominal muscle EMG-activity during bridge exercises on stable and uns table surfaces. Physical Therapy in Sport 2014;15(3):162-8. https://doi.org/10.1016/j.ptsp.2013.09.003
  27. Deyo, R.A., & Tsui-Wu, Y.j. Descriptive epidermiology of low back pain and its related medial care in the United States, Spine. 1987;(12);264-267. https://doi.org/10.1097/00007632-198704000-00013
  28. Deyo RA. Acute low back pain: A new paradigm for management. BMJ, 1996;13 (3):1343-1344. https://doi.org/10.1136/bmj.313.7069.1343
  29. Frymoyer JW, Rosen J & Pope MH. Psychologic factors in lo back pain disability. Clinical Orthopedic Related Research 1985;195:178-184.
  30. Ferreira, P. H., Ferreira, M. L., & Hodges, P. W. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine, 2004;29(22):2560-2566. https://doi.org/10.1097/01.brs.0000144410.89182.f9
  31. Gottschall JS, Mills J, Hastings B. Integration core exercises elicit greater muscle activation than isolation exercise. Journal of Strength and Conditioning Research. 2013;27(3):590-6. https://doi.org/10.1519/JSC.0b013e31825c2cc7
  32. Gettman, L, R.(1988). Fitness testing. American College of Sports Medicine(Ed), Resource Manual for Guidelines for Exercise Testing & Prescription. Philadelphia; Lea & Febiger. 1988;161-170.
  33. Hodges, P. W., Pengel, L. H. M., Herbert, R. D., & Gandevia, S. C. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve, 2003;27(6):82 -692.
  34. Hides, J., Wilson, S., Stanton, W., McMahon, S., Keto, H., McMahon, K., et al. An MRI investigation into the function of the trans versus abdominis muscle during" drawing-in" of the abdominal wall. Spine, 2006;31(6):175-178. https://doi.org/10.1097/01.brs.0000202740.86338.df
  35. Hodges PW, Gandervia SC. Activation of the human diaphragm during a petitive postural task. J Physiol. 2000;522:165-75. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00165.xm
  36. Handzel TM. Core training for improved performance. NSCA's Performance Training Journal, 2003;2(6):26-30.
  37. Hodges, P. W., & Richardson, C. A. Altered trunk muscle recruitment in people with low back pain with upperlimb movement at different speeds. Archives of physical medicine and rehabilitation, 1999;80(9):1005-1012. https://doi.org/10.1016/S0003-9993(99)90052-7
  38. Hsieh, R.-L., & Lee, W.-C. One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain; comparison of terapeutic effects. American Journal of Physical Medicine and Rehabilitation, 2002;81(11):838-843. https://doi.org/10.1097/00002060-200211000-00006
  39. Imai A, Kaneoka K, Okubo Y, Shina I, Tatsumura M, Izumi S, et al. Trunk muscle activity during lumbar stabilization exercises on both a stable and unstable surface. Journal of Orthopaedic and Sports Physical Therapy, 2010;40(6):369-75. https://doi.org/10.2519/jospt.2010.3211
  40. Jenkins EM, Borenstein DG(1994). Exercise for the low back pain patient. Baillieres Clin Rheumatol, 1994;8(1):191-7. https://doi.org/10.1016/S0950-3579(05)80231-6
  41. John, E.K., &Beith, L.D. Can Activity within the External abdominal oblique be measured using real-time ultrasound imaginng? Clinical Biomechanics, 2007;22(9):972-979. https://doi.org/10.1016/j.clinbiomech.2007.07.005
  42. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther, 2005; 85(3):209-225. https://doi.org/10.1093/ptj/85.3.209
  43. Kiesel, K. B., Under wood, F. B., & Mattacola, C. G. A comparison of select tru nk muscle thickness change between subjects with low back pain classified in the treatment-based classification system and a symptomatic controls. J Orthop Sports Phys Ther, 2007;37:596-607. https://doi.org/10.2519/jospt.2007.2574
  44. Kankaanpaa M, Colier WN, Taimela S et al. Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion. Pathophysiology, 2005; Nov7.
  45. Kavcic, N., Grenier, S., & MeGill, S. M. Quantifying tissue loads and spine stability while performing commonly prescribed low back stabilization exercise. Spine, 2004;29(20),2319-2329. https://doi.org/10.1097/01.brs.0000142222.62203.67
  46. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther, 2006; 86(7):1001-12. https://doi.org/10.1093/ptj/86.7.1001
  47. Luoto S, Taimela S, Alaranta H et al. Psychomotor speed in chronic low back pain patients and healthy controls: construct validity and clinical significance of the measure. Percept Mot Skills, 1998; 87:1283-96. https://doi.org/10.2466/pms.1998.87.3f.1283
  48. Lindstrom I, Ohlund C, Eek C, Wallin L. Mobility, strength and fitness after a graded activity programme for patients with subacute low back pain : A randomized prospective clinical study with a behaviour a approach. Spine, 1992;17(6):641-652. https://doi.org/10.1097/00007632-199206000-00003
  49. Lehman, G. J., Hoda, W., & Oliver, S. Trunk muscle activity during bridging exercises on and off a Swiss ball. Chiropractic & osteopathy, 2005;13,14. https://doi.org/10.1186/1746-1340-13-14
  50. Marshall PW, Murphy BA. Corest ability exercises on and off a Swiss ball. Arch Phys Med Rehabil, 2005; 86(2):242-49. https://doi.org/10.1016/j.apmr.2004.05.004
  51. McMeeken, J., Beith, I., Newham, D., Milligan, P., & Critchley, D. The relationship between EMG and change in thickness of transversus abdominis. Clinical biomechanics, 2004;19(4):337-342. https://doi.org/10.1016/j.clinbiomech.2004.01.007
  52. Mauritis N. M., Bollen A. E., Windhausen A., De Jager A. E. & Van Der Hoeven J. H. Muscle ultrasound analysis: Normal values and differentiation between myopathies and 66 neuropathies. Ultrasound in Medicine and Biology, 2003;29(2):215-225. https://doi.org/10.1016/S0301-5629(02)00758-5
  53. Maigne R. Diagnosis and treatment of pain of vertebral origin. Boltimore : Williams & Wilkins. 1996.
  54. Mannion, A. F., Pulkovski, N., Gubler, D., Gorelick, M., O'Riodan, D., Loupas, T., et al. Muscle thickness changes during ab dominal hollowing: an assessment of between-day measurement error in c ontrols and patients with chronic low back pain. Eur Spine J, 2008;17,494-501. https://doi.org/10.1007/s00586-008-0589-x
  55. Mok NW, Yeung EW, Cho JC, Hui SC, Lin KC, Pang CH. Core muscle activity during suspension exercises. Science and Medicine in Sport In press, 2014.
  56. McGill SM. Low back stability: from formal description to issues for performance and rehabilitation. Exercise and Sports Sciences Review 2001;29(1):26-31. https://doi.org/10.1097/00003677-200101000-00006
  57. McGill, S. M., & Karpowicz, A. Exercises for spine stabilization: motion motor patterns, stability progressions, and clinical technique. [Clinical Trial Research Support, Non-U.S. Gov't]. Archives of physical medicine and rehabilitation, 2009;90(1):118-126. https://doi.org/10.1016/j.apmr.2008.06.026
  58. Melissa Ko, D., Kim Khauv, d., & Joel Alcantara, D. Resolution of Secondary Amenorrhea of 20 years in a Woman Undergoing Subluxation-Based Chiropractic Care. Journal of Pediatric, Maternal & Family Health, 2012;12(2):38 -42.
  59. O'Sullivan PB. Lumbar segmental' instability' : clinical presentation and specific stabilizing exercise management. Man Ther, 2000;5(1):2-12. https://doi.org/10.1054/math.1999.0213
  60. Panjabi, M. M. Clinical spinal instability and low back pain. J Electromyogr Kinesiol, 2003;13(4),371-379. https://doi.org/10.1016/S1050-6411(03)00044-0
  61. Patel AT, Ogle AA. Diagnosis and management of acute low back pain. Am Fam Physician, 2000;61:1779-1790.
  62. Roddey, T. S., Brizzolara, K. J., & Cook, K. F. A comparison of two methods of assessing transverse abdominal muscle thickness in participants using real-ti me ultrasound in a clinical setting. Orthop Phys Ther Pract, 2007;19,198-201.
  63. Scott, J. & Huskisson, E. C. Vertical or Horizontal visual analogue scales. Ann Rheum Dis, 1979;38(6):3-4967.
  64. Smith, L. A, Oldman, A. D, McQuay, H. J, & Moore, R. A. Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. Pain, 2000;86(1),119-132. https://doi.org/10.1016/S0304-3959(00)00234-7
  65. Teyhen D. S., Gill N. W., Whittaker Jackie L et al. Rehabilitative ultrasound imaging of the abdominal muscles. J Orthop Sports Phys Ther, 2007;38(8)450-466.
  66. Toma, V., Pulkovski, N., Sprott, H., Gubler, D., Gorelick, M., O'Riordan, D., et al. Reliability of measures of abdominal muscle thickness during abdominal hollowing asassessed with M -mode ultrasound. Eur J Pain, 2006;10(1),S109b-S109. https://doi.org/10.1016/S1090-3801(06)60411-4
  67. Unsgaard Tondel M, Fladmark AM, Salvesen O, Vasseljen O. Motor control exercise, sling exercises, and general exercises for patients with chronic low back pain : a randomized controlled trial with 1-year follow-up. Phys Ther, 2010;90(10):1426-1440. https://doi.org/10.2522/ptj.20090421
  68. Van der Pleog, J.D., Renting, H., Brunori, G., Knickel, K., Mannion, J., Marsden, T., et al. Rural development: from practices and policies towards theory. Sociologiaruralis, 2000;40(4), 391-408.
  69. Vera-Garcia, F. J., Grenier, S. G., & McGill, S. M. Abdominal muscle response during curl-ups on both stable and labile surfaces. [Research Support, Non-U.S. Gov't]. Physical therapy, 2000;80(6),564-569. https://doi.org/10.1093/ptj/80.6.564
  70. Waxman SE. Chronic low back pain and the impact on relationship satisfaction. Master's thesis, University of Queen's, Canada. 2006.
  71. Wheeler, A. H. Diagnosis and management of low back pain and sciatica. American family physician. 1995;52(5):1333-41.