• Journal of the Korean Society of Physical Medicine
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• v.8 no.1
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• pp.29-39
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• 2013

PURPOSE: The purpose of this study was to determine if the program focusing on gluteal muscle exercise combined lumbar stabilization had an effects on pain, functional disability and lumbar instability in chronic low back pain patients who had lumbar instability. METHODS: Thirty four patients were recruited in this study. The participants were randomly allocated stabilization exercise group (SEG) (n=17) and gluteal muscle exercise group (GEG) (n=17). The gluteal muscle exercise group conducted gluteal muscle exercises combined lumbar stabilization and stabilization exercise group did only lumbar stabilization exercise for 30 minutes three times a week for six weeks. Pre-exercise assessment tools, visual analogue scale (VAS) and Korean version Oswestry Disability Index level (KODI) were used for pain and functional disability each. Also, these were scored by the tool of lumbar instability. The pain, functional disability levels, and lumbar instability after six weeks with this exercise were re-evaluated. RESULTS: First, SEG showed a significant decrease in the lumbar pain, functional disability levels and lumbar instability. Second, GEG showed a significant decrease in the lumbar pain, functional disability levels and lumbar instability. The third, GEG showed even more significant decrease in the lumbar pain levels, functional disability levels and lumbar instability than SEG. CONCLUSION: Gluteal muscle exercises combined lumbar stabilization are more effective than only lumbar stabilization exercise in the pain levels, functional disability levels and lumbar instability for the chronic low back pain patients with lumbar instability.

• Journal of the Korean Society of Physical Medicine
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• v.18 no.2
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• pp.49-59
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• 2023

PURPOSE: This study examined the relationship between lumbar instability and shortening of the iliopsoas muscles in patients with chronic low back pain. METHODS: Forty-nine patients with chronic low back pain participated in this study. The modified Thomas test was used to examine the shortening state of the iliopsoas muscle. The length of the iliopsoas muscle was measured using the hip flexion angle, and those with a flexion angle of 10° or more were classified as positive. Five subtests were used for the lumbar instability test: testing for prone lumbar instability, passive lumbar extension, anterior-posterior mobility, passive straight leg raise, and age. Those who tested positive for at least three of these tests were classified as positive for the lumbar segment instability test. RESULTS: There was a significant association between the results of the lumbar instability test and the shortening of the iliopsoas test (p < .05). After analyzing the association between the iliopsoas length test and the five lumbar instability subtests, the results of the prone lumbar instability test (p < .001) and the anterior-posterior mobility test (p < .05) showed a significant association with the iliopsoas length test. CONCLUSION: The association between lumbar instability and shortening of the iliopsoas muscles was examined in 49 patients with chronic low back pain. Patients with shortened iliopsoas muscles tested positive in the lumbar instability tests more often. Hence, the length test of the iliopsoas muscle can be used to determine lumbar instability in patients with chronic low back pain.

• Physical Therapy Rehabilitation Science
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• v.11 no.3
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• pp.370-375
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• 2022

Objective: The purpose of this study was to compare the hip joint muscle strength of patients with chronic back pain with lumbar instability and normal subjects. Design: A case control study. Methods: Five types of lumbar instability test were conducted on forty young women with chronic low back pain for more than six months, and those who had 3 or more positive tests were selected as subjects. To select chronic back pain patients with lumbar instability group, aberrant movement patterns during lumbar flexion test (FMT), prone instability test (PIT), posterior-anterior mobility test (PAT), passive lumbar extension test (PLE), and pressure bio-feedback (PBF) were applied. In addition, a digital muscle strength meter was used to measure the hip flexor, extensor, adductor, and abductor muscles of chronic low back pain patients with lumbar instability group (n=20) and normal subject group (n=20). Results: As a result of comparing the hip joint muscle strength between the chronic back pain patient group with lumbar instability and the normal group, there were significant differences in the hip extensor, abductor, and adductor muscles (p<0.05). Conclusions: Patients of chronic back pain with lumbar instability were found to have weak hip joint muscle strength. Therefore, this study suggest that include hip joint strength exercise for functional recovery of chronic back pain patients.

• Journal of the Korean Society of Physical Medicine
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• v.10 no.4
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• pp.39-48
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• 2015

PURPOSE: This study aimed to compare the degree of lumbopelvic rotation during the active straight leg raise (ASLR) test in chronic low back pain with and without lumbar segmental instability. METHODS: A total of 71 patients with chronic low back pain were recruited for this study. The subjects who tested positive for more than three of the five lumbar segmental instability tests (prone lumbar instability, lumbar passive extension test, anterior posterior mobility test, passive straight leg raise, age) were categorized into the lumbar segmental instability positive group. Patients who tested positive for less than three of the five tests were categorized into the lumbar segmental instability negative group. The lumbopelvic rotation was measured three times during ASLR and a mean was determined. Subjective heaviness during the ASLR was measured on 6 point scale. RESULTS: There was a statistically significant difference in the lumbopelvic rotation angle between the groups with and without lumbar segmental instability (p<.01). There was no significant difference in the subjective heaviness during ASLR. The mean lumbopelvic rotation angle during ASLR was $13.54{\pm}2.86^{\circ}$, and $8.81{\pm}2.47^{\circ}$ in the positive and negative groups, respectively (p<.01). The cut-off value of the lumbopelvic rotation during was $10.5^{\circ}$, the sensitivity was 82.9%, and the specificity was 80.6%. CONCLUSION: These results suggest that lumbopelvic rotation is more prevalent in patients without lumbar segmental instability. Clinically, this important when diagnosing chronic low back pain with lumbar segmental instability, as the lumbopelvic rotation angle during the ASLR test can be used to aid in diagnosis.

• Journal of the Korean Society of Physical Medicine
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• v.19 no.2
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• pp.29-45
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• 2024

PURPOSE: This study aimed to compare the effects of pain level, lower back pain dysfunction level, psychosocial level, hip abductor strength (HAS), number of positive lumbar instability tests, and dynamic balance (DB) by applying lumbar stabilization exercises according to the presence or absence of gluteus medius muscle weakness in chronic lower back pain (CLBP) patients with lumbar instability. METHODS: Thirty-five CLBP patients with lumbar instability were divided into the gluteus medius weakness (n = 18) and gluteus medius non-weakened (n = 17) groups using the gluteus medius manual muscle test. Intervention applied conservative physical therapy and lumbar stabilization exercises to both groups that lasted three times a week for four weeks. To compare the intervention effects, the quadruple visual analog scale (QVAS), the Korean version of the Oswestry disability index (K-ODI), fear-avoidance beliefs questionnaire (FABQ), HAS, lumbar instability tests positive response counter (LIC), and DB were measured. RESULTS: Significant differences were shown for QVAS, K-ODI, FABQ, HAS, LIC, and DB for both groups pre- and post-intervention (p < .05). Compared to the gluteus medius weakness group, the gluteus medius non-weakened group showed a significant difference (p < .05) in the changes in QVAS, K-ODI, FABQ-W, FABQ-total, and HAS. CONCLUSION: In CLBP patients with lumbar instability, having gluteus medius weakness was less effective in improving lumbar stabilization exercise than gluteus medius non-weakness regarding pain level, lower back pain dysfunction level, psychosocial level excluding physical activity, and hip abductor strength. Therefore, additional gluteus medius strengthening exercises are necessary for patients with lumbar instability and gluteus medius muscle weakness.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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• pp.115-125
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• 2016

PURPOSE: This study aimed to compare the effects of lumbar stabilization exercise with those of the neurodynamic technique on low back pain in patients with lumbar instability. METHODS: The subjects included those with more than three tests with positive results for lumbar instability and those with a positive sign during the neurodynamic test, all of whom had low back pain. For the lumbar stabilization exercise group (n=15), lumbar stabilization exercise was performed using a sling system, while the neurodynamic technique group (n=15) performed the neurodynamic technique. The intervention was performed 5 days a week for 4 weeks. All measurement of each subject were measure at pre-intervention and post-intervention (after 4 weeks). SPSS/PC ver. 18.0 program was used to compile results. RESULTS: There was no significant difference in general characteristics of subjects between both groups (p>.05). Assessed items included the visual analog scale score (VAS), Korean version of the Oswestry Disability Index (KODI), lumbar instability test positive response counter (LIC) and Fear-Avoidance Beliefs Questionnaire score (FABQ), and a significant reduction was observed post-intervention compared to pre-intervention values in both groups (p<.01). Other assessed items such as trunk flexibility and lumbar extensor endurance and lumbar flexor endurance were significantly increased post-intervention in both groups compared to pre-intervention values (p<.01). There was no significant difference in all parameters between both groups (p>.05). CONCLUSION: Our results indicate that the neurodynamic technique may be useful for improving low back pain in patients with lumbar instability.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.2
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• pp.12-20
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• 2007

The purpose of this study was designed to find out the effectiveness of vertebral segment instability, muscle fatigue response on lumbar spine after apply lumbosacral stabilization exercise program to 4 patients with chronic low back pain and for 12 weeks. In this study, the lumbar spine motion with blind by MedX test machine and the difference of instability to lumbar vertebra segments in flexion, extension test of standing position and spinal load test(Matthiass Test) by Spinal Mouse. The stabilization exercise program was applied 2 times a week for 12 weeks in hospital and 2 times a day for 20 minutes at home. The results of the present study were as follows: 1. Instability test of lumbar vertebra segment is 2 type differential angle test between vertebrae segment and loading test of spine(matthiass) by Spinal Mouse. It appeared to improve stability of segments in sagittal plane after applying program. So lumbar spine curve increased lordosis toward anterior and was improved of the lumbar spine flexibility in flexion and extension. Specially, in matthiass test, (-) value was increased between lumbar vertebra segment when was the load on spine. And so applying stability improved after program. 2. Fatigue response test(FRT) results, in male, was raised muscle fatigue rate during increase weight, on the other hand female appeared lower than male. As a results, lumbosacral stabilization exercise was aided to improvement of lumbar spine vertebra segments stabilization. Spine instability patients will have a risk when in lifting a load or working with slight flexion posture during the daily of living life and it is probably to increase recurrence rate. Thus, not only lumbar extension muscle strength but also stability of vertebra segments in lumbar spine may be very important.

• Journal of Korean Physical Therapy Science
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• v.13 no.4
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• pp.7-16
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• 2006

The purpose of this study was designed to find out the effectiveness of vertebral segment instability, muscle fatigue response on lumbar spine after apply lumbosacral stabilization exercise program to 4 patients with chronic low back pain and for 12 weeks. In this study, the lumbar spine motion with blind by MedX test machine and the difference of instability to lumbar vertebra segments in flexion, extension test of standing position and spinal load test(Matthiass Test) by Spinal Mouse. The stabilization exercise program was applied 2 times a week for 12 weeks in hospital and 2 times a day for 20 minutes at home. The results of the present study were as follows: 1. Instability test of lumbar vertebra segment is 2 type differential angle test between vertebrae segment and loading test of spine(matthiass) by Spinal Mouse. It appeared to improve stability of segments in sagittal plane after program. So lumbar spine curve increased lordosis toward anterior and was improved of the lumbar spine flexibility in flexion and extension. Specially, in matthiass test, ( - ) value was increased between lumbar vertebra segment when was the load on spine. And so stability improved after program. 2. Fatigue response test(FRT) results, in male, was raised muscle fatigue rate during increase weight, on the other hand female appeared lower than male. As a results, lumbosacral stabilization exercise was aided to improvement of lumbar spine vertebra segments stabilization. Spine instability patients will have a risk when in lifting a load or working with slight flexion posture during the daily of living life and it is probably to increase recurrence rate. Thus, not only lumbar extension muscle strength but also stability of vertebra segments in lumbar spine may be very important.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.2
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• pp.73-83
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• 2022

Purpose : Low back pain (LBP) is reported as a risk of experiencing musculoskeletal disorders due to muscle stiffness and hypokinetics. The lumbar spine in an unstable state causes imbalance and lumbar instability. Therefore, This study examined the effects of lumbar stabilization exercise and self-complex exercise program on pain, function, psychosocial level, static balance ability, and transverse abdominal muscle (TrA) thickness and contraction ratio in patients with lumbar instability. Methods : The design of this is a randomized controlled trial (RCT). Twenty-six LBP patients participated in this study. Screening tests were performed and assigned to the experimental group (n=13) and control group (n=13) using a random allocation program. Both groups underwent a lumbar stabilization exercise program. In addition, the experimental group implemented the self-complex exercise program. All interventions were applied three times per week for four weeks. The quadruple visual analog (QVAS), the Korean version of the Oswestry disability index (K-ODI), Korean version of fear-avoidance belief questionnaire (FABQ), static balance ability, TrA thickness, and contraction ratio were compared to evaluate the effect on intervention. Statistical significance was set at 𝛼=.05. Results : Both groups showed significant differences before and after the intervention in QVAS, K-ODI, FABQ, static balance ability, and TrA thickness in contraction (p<.05). In addition, significant differences in K-ODI and FABQ were observed between the experimental group and control group (p<.05). Conclusion : A lumbar stabilization exercise and self-complex exercise program resulted in reduced dysfunctions, psychosocial stability in patients with lumbar instability. Therefore, Lumbar stabilization exercise and self-complex exercise program for patients with lumbar instability are effective method with clinical significance in improving the function and psychosocial stability.

• The Journal of Korean Physical Therapy
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• v.27 no.4
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• pp.207-213
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• 2015

Purpose: The aim of the current study was to investigate EMG activity on dynamic balance of subjects with functional lumbar instability following fatigue of low back. Methods: The subjects (24 university students) were divided into 2 groups; functional lumbar instability group (6 males and 6 females) and lumbar stable group (7 males and 5 females) who could complete a questionnaire and undergo a prone instability test. All participants were evaluated for distribution of muscle activity using the TeleMyo DTSTM system. Dynamic balance was tested by Y balance test. This study was conducted for measurement of EMG activity on dynamic balance with the difference between FLIG and control group following muscle fatigue. Results: The functional lumbar instability group (FLIG) showed a significantly lower YBT score (%) of anterior, posterolateral direction on Y-balance test (YBT) in dynamic balance than the lumbar stable group (LSG) (p<0.05). The FLIG was significantly lower than the LSG in anterior direction in EMG activity(%) of MF, RA, ES, GMX, GME, RF, and posteromedial direction in EMG activity(%) of IO, ES and then posterolateral direction in EMG activity(%) of IO, ES in dynamic balance (p<0.05). There was significant correlation of MF, RA, and GMX in anterior reach direction (p<0.05) and ES, GME (p<0.01) and IO, ES in posteromedial reach direction (p<0.05) and EO, ES, GMX in posterolateral reach direction (p<0.05) there was positive correlation. Conclusion: This study showed that FLIG effected EMG activity by dynamic balance following muscle fatigue. Further study is needed for measurement of various ages and work with lumbar instability for clinical application.