Background: The presence of the lumbopelvic-hip neuromuscular chain is essential for dynamic spinal stabilization; its therapeutic effects on dynamic movements of the distal extremity segment and underpinning motor mechanism remain unknown and warrant further study on participants with low back pain (LBP). Objects: We aim to compare the effects of the broken chain exercise (BCE) and connected chain exercise (CCE) on electromyography (EMG) amplitude and onset time in participants with and without LBP. Methods: Randomized controlled clinical trial. A convenience sample of 40 nonathletic participants (mean age: 24.78 ± 1.70) with and without LBP participated in this study. All participants underwent CCE for 30 minutes, 30-minute daily. We measured EMG amplitude and onset times on bilateral erector spinae (ES), gluteus maximus (GM), hamstring (HAM), transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) during the prone hip extension (PHE) test before and after the BCE and CCE. We used multivariate analysis of variance (MANOVA) to analyze the amplitude and onset time difference between exercises (BCE and CCE) and Pearson's correlations to determine any synergistic relationship among the HAM, GM, bilateral TrA/IO, and ES muscles. The statistical analyses were used at p < 0.05. Results: MANOVA showed that CCE was more decreased on EMG amplitude in HAM and bilateral ES, while increased GM and contralateral TrA/IO than BCE (p < 0.05). MANOVA EMG onset time data analyses revealed that the main effect of the conditions was significant for all HAM, GM, and bilateral ES muscles, whereas the main effect for the group was significant only for GM and contralateral ES in healthy and LBP groups. Pearson's correlation coefficient was computed to assess the relationship between BCE and CCE on dependent variables. In most of the muscles, there was a strong, positive correlation between the two variables, and there was a significant relationship (p < 0.001). Conclusion: CCE produced more effective and coordinated core stabilization and motor control mechanism in the lumbopelvic-hip muscles in participants with and without LBP during PHE than BCE.
Objective : The purpose of this study was to evaluate the influence of a community based group exercise intervention on motor functional capacity. To evaluate the immediate(post-treatment) effects after 6-weeks exercise program on the group exercise intervention(PNF and Circuit exercise). Methods : Subjects-Included persons with stroke who were living in the community. Thirty-seven subjects were randomly assigned to the PNF, Circuit exercise and control group participated in a repeated measures design that evaluated the subjects with pre-treatment, post-treatment(6 weeks). Functional ability outcome measures assessed the motor assessment scale(MAS) and EMG. Both treatment groups participated in exercise cJass three times a week for 6 weeks. Group programs focused on balance, functional motor capacity and walking ability. The PNF program was modified PNF pattem and techniques with emphasis on functional tasks when possible, as well as stretching of the more affected limb particularly in the more affected shoulder. The Circuit program with subjects completing practice at a selies of work station as well as participating in walking races and relay with other members of the group. Results : Compared with the control group, the treatment group had larger improvements in the motor function ability after 6 weeks treatment and Post-treatment test scores were more significant than the pre-treatment score. 1. Motor function were assessed by using MAS, sit to stand, walking and upper function were assessed pre-treatment versus post-treatment measures revealed a statically significant(p<.05). There were significant differences between the groups. Compared with the control group, the treatment group had larger improvements. 2. In the treatment groups, demonstrated difference in the electromyographic activation of biceps, triceps, quadriceps and tibialis anterior muscles on the paretic side in the response to the reaching arm movement and stepping motion in stance. The difference in muscle activation improvement were not statically significant. Conclusion : The results of this study showed that the PNF and Circuit group exercise intervention can improve motor functional ability. This study suggests that the PNF and Circuit exercise programs is appropriate for community-based group exercise principles. It leads to gain and maintain potential function for disabled persons after stroke in the community.
Purpose: The purpose of this study was to determine the effect of symmetrical-reciprocal pattern of scapula and pelvis exercises using proprioceptive neuromuscular facilitation (PNF) on gait speed and balance in patients with hemiplegia. Methods: Among the adult patients with hemiplegia that were hospitalized at Michuhol Rehabilitation Center after being diagnosed with stroke, 10 that were capable of independent walking for more than five minutes and that understood and cooperated with the therapy and test methods of this research, were selected as subjects. The therapy was implemented based on the concept of PNF, and it was performed on a low mat and a height-adjustable mat, as proscribed by the fundamental procedure for PNF. Symmetrical-reciprocal pattern of scapula and pelvis exercises were applied to the patients in the decubitus position. The therapy scheme included stabilizing reversals, rhythmic stabilization, and a combination of isotonics, rhythmic initiation, and dynamic reversals. To investigate gait speed and body trunk mobility before and after the symmetrical-reciprocal pattern of scapula and pelvis exercises were applied, walking speed for a distance of 10 m was measured and balance was tested based on the Berg-Balance scale test table. The Berg-Balance scale test was performed by one therapist to minimize any error that could occur from the subjective evaluation method used by therapists. Results: Gait speed increased by 8.97 seconds after applying the symmetrical-reciprocal pattern of scapula and pelvis exercises using the concept of PNF, showing a significant difference (p<0.01). However, balance showed no significant difference after the therapy (p>0.14). Conclusion: Exercise therapy that uses the symmetrical-reciprocal pattern of scapula and pelvis with the concept of PNF can be said to be a useful therapeutic technique that can enhance the walking speed of patients with hemiplegia.
Noh, Dong-koog;Cha, Young-joo;Kim, Dae-hun;You, Joshua (Sung) H.
Physical Therapy Korea
/
v.25
no.4
/
pp.27-36
/
2018
Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contemporary spinal rehabilitation. Objects: The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques. Methods: patients with mechanical LBP (N = 40, 6 males; $35.1{\pm}7.6years$) were recruited and randomly assigned either to the combined LE and ADIM (experimental group) or the LE alone (control group). Outcome measures included the visual analog scale, the modified Oswestry Disability Index, muscle strength imbalance (MSI), and radiographic imaging. The lumbar intervertebral displacement (LID), intervertebral (IV) and total lumbar extension (TLE) angles were calculated to evaluate the lumbar segmental instability. Results: The experimental group showed significant differences in the L3-L4, L5-S1 LIDs, L4-L5 and L5-S1 IV angles, and TLE angle as compared to the controls (p<.05). Immediate pain reduction and muscle strength imbalance ratio were significantly different between the groups (p<.05). Conclusion: These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.
The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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v.13
no.1
/
pp.1-9
/
2007
Purpose: The purpose of this study was to evaluate the The Influence of contract-relax exercise of PNF on Equilibrium Ability. Methods: The subjects were consisted of thirty patients (14 females and 16 males). They were from 20 to 42 years old and the mean age was 25.03. All subjects were randomly assigned to two groups: contract-relax exercise of proprioceptive neuromuscular facilitation(PNF) group (n=15), control group (n=15). Contract-relax exercise group received contract-relax exercise for about 10 minutes along with therapeutic massage for about 15 minutes, 3 times per week during 4 weeks period. However, control group did not receive intervention during the same 4 weeks. The Balance performance monitor(BPM) was used to measure equilibrium ability. All measurements of each subjects were measured at pre-experiment, after 2 weeks, and post-experiment. Results: The results of this study were summarized below : 1. The sway area of contract-relax exercise group was significantly reduced according to within treatment period(p<.05), most significantly reduced between pre-test and post-test(p<.05). Contract-relax exercise group significantly more reduced than control group(p<.05). 2. The sway path length of contract-relax exercise group was significantly reduced according to within treatment period(p<.05), most significantly reduced between pre-test and post-test(p<.05). Contract-relax exercise group significantly more reduced than control group(p<.05). Conclusion : Contract-relax exercise applied with therapeutic massage can increased equilibrium ability. Additional randomized controlled trials to more fully investigate treatment effects and factors that may mediate these effects are needed.
Purpose : The purpose of this study was to investigate the effects of proprioceptive exercise (PE) using a trampoline and a balance board on a balance ability after stroke. Method : Sixteen chronic stroke patients participated. Participants were randomly assigned to the PE group or control group (8 experimental, 8 control). All of participants were in-patients at local rehabilitation centre and had been receiving a traditional rehabilitation program, five days a week. The PE group have additionally undergone for four weeks, three days a week, the PE using a trampoline and a balance board under supervision by a physical therapist but control group was not received any additional program except the traditional rehabilitation program. The position sense test used to assess a proprioceptive sense at a knee joint. The Berg Balance Scale (BBS) and the Timed Up & Go (TUG) test to measure the balance ability were carried out before and after the training. Result : After the training the error of position sense at knee joint of PE group significantly decreased compared to the control group. The PE group demonstrated a significant improvement in the scores of the BBS and TUG. Conclusion : The present study suggests that the PE program using a trampoline and balance board may become a useful tool for enhancing a balance ability in chronic stroke patients through the ennced proprioceptive position senses.
Candace, Wong YH;Kennis, Cheung KW;Evelyn, Ko YC;Jeffrey, Tse HC;Margaret, Law YL;Hwang, Seong-Soo;Shirley, Ngai PC
Journal of the Korean Society of Physical Medicine
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v.12
no.4
/
pp.73-82
/
2017
PURPOSE: Proprioceptive Neuromuscular Facilitation (PNF) has been shown to improve body function and activity/participation in people with functional dysfunctions. This study evaluates if active exercise using theraband in PNF pattern may induce similar benefits as exercise using manual PNF pattern performed by physiotherapists on promoting mobility, balance and fear of fall in community-dwelling elderly. METHODS: Twenty-three community-dwelling elderly with independent activities of daily living were recruited and randomly allocated into either PNF group - exercise in PNF pattern by trained physiotherapists or Theraband-PNF (T-PNF) group - exercise using theraband in PNF pattern, for an hour, twice weekly for 4 weeks. Functional outcomes such as Timed Up and Go test, Elderly Mobility Scale, Berg balance scale, functional reach and subjective measures including fear of fall (FOF) scale, bodily pain in visual analogue scale were measured pre and post-program. RESULTS: Twenty-one participants completed the program. PNF group demonstrated significant within-group improvements in all subjective measures and objective measures. Similar within-group improvements were demonstrated in all outcome measures except FOFS in T-PNF group. However, no between-group differences were found in any of the outcome measures. CONCLUSION: Comparable improvements in functional outcomes in community dwelling elderly were demonstrated in both groups. As manual PNF exercise traditionally need clinicians' contact and feedback on patient which limit the training to be carried out extensively in community setting. The current findings suggest that exercise using theraband in PNF pattern is feasible to be adopted as self-practice exercise for community-dwelling elderly to induce beneficial effects on functional outcomes.
Purpose: We investigated the effects of multimodal vs. stabilization exercises on chronic low back pain. Methods: Study participants were randomly assigned to a multimodal exercise (n = 20) or a stabilization exercise group (n = 20). Participants in the multimodal exercise group performed stabilization, stretching, and endurance exercises, whereas those in the stabilization exercise group performed only stabilization exercises. Participants in both groups performed the exercises for 1 hour thrice a week for 5 weeks. The following outcomes were evaluated: pain intensity (numeric rating scale), disability (the Oswestry Disability Index [ODI] and the Roland-Morris Disability Questionnaire [RMDQ]), pain-induced fear (the Fear of Daily Activities Questionnaire [FDAQ], the Fear-Avoidance Belief Questionnaire [FABQ], and the Tampa scale for kinesiophobia-11 [TSK-11]). Outcome measures were evaluated at baseline and after intervention. Results: Significant post-intervention improvement was observed in pain intensity and the RMDQ and FDAQ scores in both groups (p < 0.01). The post-intervention ODI, FABQ, and TSK-11 scores were improved in the multimodal exercise group (p < 0.01). Additionally, significant differences were observed in pain intensity, as well as in the ODI, FDAQ, and FABQ scores in the multimodal exercise group compared with these findings in the stabilization exercise group (p < 0.01). Conclusion: The multimodal and stabilization exercise programs reduced pain intensity, disability, and pain-induced fear. Compared with stabilization exercises, multimodal exercises more effectively reduced pain intensity, disability, and pain-induced fear. This study highlights that musculoskeletal rehabilitation for people with chronic low back pain should include a multimodal exercise program.
The purpose of this study was to investigate the effects of pelvic and lower extremity exercise on the gait of 25 patients with hemiplegia. 11 men and 14 women were studied, with a mean age of 61.2 years and a means duration post-onset of 8.7 months. Each participant recieved a total of 15 sessions of PNF(five times per week), and each procedure lasting for 40 minutes with affected side pelvic anterior elevation and posterior depression pattern, lower extremity flexion adduction with knee flexion pattern had 20 minutes respectively. Results showed significant improvement in gait speed and cadence in after 1st, 2nd, 3rd week(5th, 10th, 15th session, respectively) compared with the before treatment(p<0.05). And improvement in gait speed and cadence accompanied with longer stride length.
Purpose: The aim of this study was to investigate the effects of trapezius and serratus anterior strengthening exercise on the shoulder pain and muscle activation of patients with spinal cord injury and functional shoulder impingement syndrome. Methods: The study consisted of 10 patients with spinal cord injury who were hospitalized in Rehabilitation Hospital U, Uijeongbu, South Korea. The exercise was implemented three times a week for 10 weeks. In each session, the subjects performed one of a total of five types of exercise at mid-level intensity. The shoulder pain and disability index (SPADI) was used to evaluate the patients before and after the intervention. The muscle activation of the upper trapezius, middle trapezius, lower trapezius, and anterior serratus muscle was assessed by surface electromyography (EMG) at the beginning of the experiment and 10 weeks later. Wilcoxon's singed-rank test was conducted to determine differences in the pain index and muscle activation before and after the exercise. The level of statistical significance was set at ${\alpha}=0.05$. Results: SPADI scores significantly decreased after the exercise (p<0.05). In comparisons of muscle activation, there was a significant improvement in the upper trapezius at $60^{\circ}$ shoulder joint flexion (p<0.05). There was no significant improvement at $90^{\circ}$ shoulder joint flexion. The middle trapezius showed a significant improvement at $120^{\circ}$ shoulder joint flexion (p<0.05). Conclusion: Trapezius and serratus anterior strengthening exercise reduced pain in spinal cord injury patients with functional shoulder impingement syndrome. The decreased muscle activation of upper trapezius and increased muscle activation of the anterior serratus muscle at $60^{\circ}$ shoulder joint flexion point to positive effects of the exercise on supraduction of the scapula.
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