Core Strength Testing: Developing Normative Data for Three Clinical Tests

Background/Purpose: Research suggests that core endurance is related to function and injury. Core endurance tests are commonly used in the clinic and yet limited data about normative values exist. This study aims to establish normative values and assess the effect of specific variables on these values in adults 18-55 years old for three clinical core endurance tests. Subjects/Methods: Fifty-five subjects, 20 male and 35 female with a mean age of 29 participated in this study. Subjects were required to complete a general health and exercise history questionnaire. Each subject was then randomly assigned a test order and tested by one of four student researchers. The core endurance tests performed were right side plank (RSP), left side plank (LSP), 60 degree flexion test (Fl) and trunk extensor (Ext) endurance test. Analyses/Results: Analyses included one-way ANOVA and multiple regression to determine where differences existed between groups and to understand what variables influenced test outcomes. Significant results existed for the following variables: gender M/F (RSP p=.002, LSP p=.003), exercise Y/N (Ext p=.02, Fl p=.003), active runners Y/N (RSP p=.03 Fl p=.0002), strength training Y/N (RSP p=.03, LSP p=.02), core exercise Y/N (LSP p=.02), previous and/or current competitive athletes Y/N (Ext p=.045, RSP p=.01, Fl p=.01) and lower extremity injury Y/N (Ext p=.03). Multiple regression revealed exercise time was the most significant predictor of RSP (p=.01) and core exercise time and overall exercise time were highest predictors of LSP (p=.001). Conclusion: Our results suggest that gender and exercise play a significant role in core endurance. Data suggests regular general exercise and strength training may have a stronger correlation with increased overall core endurance than participating in exercises specific to the core musculature. Implications: Normative values about these core endurance tests can be used in clinical practice to assess core endurance in the general population

Effects of Isolated Core Stability Training on Standing Static Postural Control, Recovery of Standing Postural Control and Kicking Velocity in Soccer Athletes

BACKGROUND: About 1/3 of injuries are non-contact in nature and half of these involve the LE’s. There are numerous anatomical and physiological mechanisms and systems involved in stabilizing the trunk for movement of the lower extremities. The ability of the trunk to maintain the position and motion of the trunk over the pelvis and LE’s is predominantly accomplished via quick postural responses to internal and external forces. These pre-programed postural responses are integrated within the neuromuscular system. It is theorized that poor core stability is a result of a failure in the neuromuscular system to support the trunk and pelvis over the lower extremities. Poor core stability has also been linked with an increased risk of lower extremity injuries. Poor core stability has also been linked to poor athletic performance via similar mechanisms. Current practice is to train the core in combination with the lower extremities. Improvements in athletic performance has been demonstrated. However, it is difficult to ascertain whether the improvements are due to changes in the trunk, the lower extremities or some combination thereof. Few studies have examined biomechanical measures of postural control following an integrated core stabilization training let alone an isolated approach to core stabilization. OBJECTIVE: To examine the reliability of the measurements and the effects of an 8-week isolated core stability program on trunk muscle activation, static and dynamic postural stability and kicking velocity in soccer athletes. DESIGN: Twenty division II and III soccer athletes (n=10 male, n=10 female) participated in a quasi-experimental randomized pre-post training study (n=10 control, n=10 experimental). The main outcomes were derivative of CoP and trunk muscle surface EMG normalized to %MVC for static postural control tasks TTS as a measure dynamic postural control and kicking velocity. STATISTICS: Reliability of the measures were assessed using ICC (2,K), MDC (95%CI) and SEM’s. Between and within group differences pre and post training were assessed using repeated measures MANOVA for static postural stability (CoP and EMG) and repeated measure ANOVA for dynamic recovery of balance and kicking velocity (p\u3c .05). RESULTS: Good to excellent ICC’s with relatively small MDC and SEM’s. Further, there was a reduction in CoP deviation and trunk muscle activation during postural control tasks, quicker TTS and increased kicking velocity following training as compared to controls. CONCLUSION: Static and dynamic postural control and kicking velocity improved in division II and III soccer athletes following an 8-week isolated core stabilization training. These results begin to elucidate to role of the core and the effects of core stabilization training on standing postural control and performance in athletes. These results have direct implications on clinical intervention for soccer athletes

Effects of Isolated Core Stability Training on Standing Static Postural Control, Recovery of Standing Postural Control and Kicking Velocity in Soccer Athletes

BACKGROUND: About 1/3 of injuries are non-contact in nature and half of these involve the LE’s. There are numerous anatomical and physiological mechanisms and systems involved in stabilizing the trunk for movement of the lower extremities. The ability of the trunk to maintain the position and motion of the trunk over the pelvis and LE’s is predominantly accomplished via quick postural responses to internal and external forces. These pre-programed postural responses are integrated within the neuromuscular system. It is theorized that poor core stability is a result of a failure in the neuromuscular system to support the trunk and pelvis over the lower extremities. Poor core stability has also been linked with an increased risk of lower extremity injuries. Poor core stability has also been linked to poor athletic performance via similar mechanisms. Current practice is to train the core in combination with the lower extremities. Improvements in athletic performance has been demonstrated. However, it is difficult to ascertain whether the improvements are due to changes in the trunk, the lower extremities or some combination thereof. Few studies have examined biomechanical measures of postural control following an integrated core stabilization training let alone an isolated approach to core stabilization. OBJECTIVE: To examine the reliability of the measurements and the effects of an 8-week isolated core stability program on trunk muscle activation, static and dynamic postural stability and kicking velocity in soccer athletes. DESIGN: Twenty division II and III soccer athletes (n=10 male, n=10 female) participated in a quasi-experimental randomized pre-post training study (n=10 control, n=10 experimental). The main outcomes were derivative of CoP and trunk muscle surface EMG normalized to %MVC for static postural control tasks TTS as a measure dynamic postural control and kicking velocity. STATISTICS: Reliability of the measures were assessed using ICC (2,K), MDC (95%CI) and SEM’s. Between and within group differences pre and post training were assessed using repeated measures MANOVA for static postural stability (CoP and EMG) and repeated measure ANOVA for dynamic recovery of balance and kicking velocity (p\u3c .05). RESULTS: Good to excellent ICC’s with relatively small MDC and SEM’s. Further, there was a reduction in CoP deviation and trunk muscle activation during postural control tasks, quicker TTS and increased kicking velocity following training as compared to controls. CONCLUSION: Static and dynamic postural control and kicking velocity improved in division II and III soccer athletes following an 8-week isolated core stabilization training. These results begin to elucidate to role of the core and the effects of core stabilization training on standing postural control and performance in athletes. These results have direct implications on clinical intervention for soccer athletes

Six weeks of core stability training improves landing kinetics among female capoeira athletes:a pilot study

Core stability training (CST) has increased in popularity among athletes and the general fitness population despite limited evidence CST programmes alone lead to improved athletic performance. In female athletes, neuromuscular training combining balance training and trunk and hip/pelvis dominant CST is suggested to reduce injury risk, and specifically peak vertical ground reaction forces (vGRF) in a drop jump landing task. However, the isolated effect of trunk dominant core stability training on vGRF during landing in female athletes had not been evaluated. Therefore, the objective of this study was to evaluate landing kinetics during a drop jump test following a CST intervention in female capoeira athletes. After giving their informed written consent, sixteen female capoeira athletes (mean ± SD age, stature, and body mass of 27.3 ± 3.7 years, 165.0 ± 4.0 cm, and 59.7 ± 6.3 kg, respectively) volunteered to participate in the training program which consisted of static and dynamic CST sessions, three times per week for six weeks. The repeated measures T-test revealed participants significantly reduced relative vGRF from pre- to post-intervention for the first (3.40 ± 0.78 vs. 2.85 ± 0.52 N·NBW-1, respectively [p<0.05, effect size = 0.60]), and second landing phase (5.09 ± 1.17 vs. 3.02 ± 0.41 N·NBW-1, respectively [p<0.001, effect size = 0.87]). The average loading rate was reduced from pre- to post-intervention during the second landing phase (30.96 ± 18.84 vs. 12.06 ± 9.83 N·NBW·s-1, respectively [p<0.01, effect size = 0.68]). The peak loading rate was reduced from pre- to post-intervention during the first (220.26 ± 111.51 vs. 120.27 ± 64.57 N·NBW·s-1 respectively [p<0.01, effect size = 0.64]), and second (99.52 ± 54.98 vs. 44.71 ± 30.34 N·NBW·s-1 respectively [p<0.01, effect size = 0.70]) landing phase. Body weight, average loading rate during the first landing phase, and jump height were not significantly different between week 0 and week 6 (p=0.528, p=0.261, and p=0.877, respectively). This study provides evidence that trunk dominant core stability training improves landing kinetics without improving jump height, and may reduce lower extremity injury risk in female athletes

EFFECTS OF PROXIMAL STABILITY TRAINING ON SPORT PERFORMANCE AND PROXIMAL STABILITY MEASURES

Proximal stability, or the ability to stabilize and actively control the spine, pelvis and trunk, has been reported to influence sport performance. Traditional training practices for the proximal segments have had little success improving sport performance. The purpose of this dissertation was to investigate the effects a sport specific proximal stability training program can have on throwing velocity and measures of muscular endurance and power which target the proximal segments of the pelvis, spine and trunk. A stratified randomized clinical trial was implemented with a pre- to post-intervention design. Forty-six healthy, Division III collegiate female softball (n=17) and male baseball (n=29) players were randomly assigned to one of two training groups for 7 weeks; a traditional endurance training group (ET) (n=21) or a power stability training group (PS) (n=25). The primary outcome measures were the change in peak throwing velocity/Kg of body weight in mph. Mean throwing velocity, power outputs from a one-repetition maximum chop test and lift test (watts/Kg body weight), and muscular endurance plank tests. Student’s independent t-tests were used to compare differences between change scores of all dependent variables. Peak throwing velocity change scores were significantly faster (ET= .21 ±.55 mph, PS= 3.4 ±1.1 mph, p\u3c .001) in the PS at post-intervention when compared to the ET group. Change scores were significantly greater in the PS group for mean throwing velocity, (ET= 1.1 ±1.6 mph vs. PS= 3.7 ±1.8 mph, p\u3c .001), chop (watts), (ET= 20 ±78 watts vs. PS= 105 ±68 watts, p\u3c .001), and lift, (ET= 49 ±62 watts vs. PS= 114 ±73 watts, p= .003). There were no change score differences for the side and prone plank endurance measures in seconds (p≥ .60). The PS group increased primary outcome measures over the ET program, indicating a more sport specific training regimen targeting the proximal segments is beneficial to both the power measures and throwing performance

Physiotherapy treatment of patient with chronic lumbar intervertebral disk herniation with radiculopathy

Thesis title: Physiotherapy treatment of a patient with diagnosis of lumbar intervertebral disk herniation with radiculopathy. Název práce: Fyzioterapie pacienta s diagnózou herniace bederní meziobratlové ploténky s radikulopatií. Work placement: Ustředni Vojenská Nemocnice , Prague, 1200/1, 16200, Praha 6. Summary: The objective of this thesis is to illustrate a case study of a conservative treated patient with intervertebral disc herniation of the L5 segment, in chronic stage. In my thesis I attempt to reveal the nature of this pathology, analyze the medical interventions and demonstrate the physiotherapeutic approaches, rehabilitation plan and all the conducted procedures. This thesis is divided in two parts. The first comprises the theoretical part which includes the anatomy, kinesiology, physiology and biomechanics of the lumbar spine as well the diagnostic and therapeutic procedures and approaches. The second contains a health chart which depicts the medical history of my patient and a detailed report that clarifies the clinical practices applied. Key words: Disk herniation, intervertebral disk, chronic state, physiotherapy, rehabilitation, lumbar spine conservative treatment, deep core, functional trainFyzioterapieFakulta tělesné výchovy a sportuFaculty of Physical Education and Spor

Métodos de entrenamiento de fuerza alternativos para incrementar la activación muscular en ejercicios de empuje

Introducción. Los movimientos en los que se empuja o presiona con los brazos a una resistencia externa constituyen un elemento clásico dentro de los programas de entrenamiento de la fuerza. Tradicionalmente se han empleado ejercicios convencionales con pesos libres y máquinas con los que se conseguía alcanzar intensidades de activación muscular altas. Sin embargo, tratando de incrementar en mayor medida la intensidad en este tipo de ejercicios, durante los últimos años se han comenzado a utilizar nuevos medios y métodos alternativos (por ejemplo utilizando dispositivos de suspensión, resistencia elástica o tratando de activar músculos de forma selectiva). No obstante, es escasa la evidencia científica que avala dichos recursos materiales y métodos alternativos para incrementar la activación muscular en extremidades superiores y tronco al compararlos con métodos más tradicionales. Los objetivos de la presente tesis fueron: 1) Comparar la activación muscular al realizar flexiones suspendidas con cuatro elementos de suspensión diferentes (Artículo I). 2) Evaluar la activación muscular durante diferentes variaciones de flexiones de brazos y comparar su activación con la del press de banca y el press polea en bipedestación, ambos realizados al 50%, 70% y 85% de 1 repetición máxima (RM) (Artículo II). 3) Evaluar la activación muscular en 6RM de press de banca y en 6RM de flexiones de brazos en el suelo realizadas con resistencia elástica añadida y a continuación evaluar las ganancias de fuerza tras utilizar un ejercicio u otro (Artículo III). 4) Evaluar si al focalizarse en el pectoral mayor o el tríceps braquial durante el press de banca se puede incrementar la activación de forma selectiva. Se presta especial atención a la relación entre la intensidad del ejercicio y la magnitud de la activación selectiva (Artículo IV). Métodos. Para investigar el primer objetivo de la tesis (Artículo I), 29 varones, estudiantes universitarios sanos participaron de manera voluntaria realizando 3 flexiones de brazos con cada uno de los 4 dispositivos de suspensión. La velocidad del ejercicio fue controlada utilizando un metrónomo y el orden de los ejercicios fue aleatorio. Los niveles de activación muscular fueron adquiridos utilizando electromiografía (EMG) en la porción larga del tríceps braquial, trapecio porción superior, porción anterior del deltoides, porción clavicular del pectoral mayor, recto anterior del abdomen, recto femoral y erector lumbar espinal. Para investigar el segundo objetivo (Artículo II), 29 varones, estudiantes universitarios y sanos participaron de manera voluntaria realizando 3 repeticiones en todas las condiciones bajo los mismos procedimientos estandarizados. Se analizó la señal de EMG de los músculos recto anterior del abdomen, oblícuo externo, porción esternocostal del pectoral mayor, porción anterior del deltoides, porción larga del tríceps braquial, trapecio porción superior, serrato anterior y la porción posterior del deltoides. Para abordar el tercer objetivo de la presente tesis (Artículo III), 30 estudiantes universitarios con experiencia de entrenamiento de fuerza participaron voluntariamente en un estudio de dos partes. Cada sujeto participó en 16 sesiones diferentes realizadas en el siguiente orden: dos sesiones de familiarización, evaluación de 1RM en el press de banca, dos test de 6RM con evaluación de EMG en la porción esternocostal del pectoral mayor y la porción anterior del deltoides, 10 sesiones de entrenamiento durante 5 semanas (usando las mismas cargas y variables que fueron usadas durante la evaluación EMG), medición de 1RM y 6RM en press de banca. Por último, un total de 18 adultos hombres con experiencia de entrenamiento de fuerza participaron voluntariamente para evaluar el cuarto objetivo de la tesis (Artículo IV). Los sujetos realizaron 3 repeticiones en 3 diferentes condiciones de press de banca (press de banca tradicional y press de banca tratando de utilizar de forma selectiva los músculos pectoral mayor o tríceps braquial) a intensidades del 20%, 40%, 50%, 60% y 80% de 1RM. Se evaluó la señal de EMG de los músculos mencionados. Resultados y conclusiones. En el Artículo I, las flexiones suspendidas con el dispositivo con polea generaron mayor actividad en el tríceps braquial, el trapecio porción superior, el recto femoral y el erector lumbar espinal que el resto de dispositivos de suspensión y que las flexiones tradicionales. El dispositivo con dos anclajes generó mayor activación del pectoral mayor que el resto de dispositivos y las flexiones tradicionales. Sin embargo, las flexiones tradicionales proporcionaron mayor activación muscular de la porción anterior del deltoides que el resto de dispositivos de suspensión, exceptuando el de dos anclajes. Todos los dispositivos de suspensión incrementaron de forma efectiva la activación muscular en el recto anterior del abdomen. En el Artículo II, las flexiones realizadas con resistencia elástica generaron similar activación muscular en los principales movilizadores que el press de banca realizado a alta intensidad, mientras que generaron mayor activación en la musculatura abdominal. Las flexiones suspendidas fueron muy efectivas para estimular la musculatura abdominal. La activación del pectoral mayor, porción anterior del deltoides y serrato anterior fue mayor durante condiciones más estables, mientras que los músculos del abdomen, el tríceps braquial y la porción posterior del deltoides se activaron más durante los ejercicios realizados en situación de inestabilidad. En el Artículo III, 6RM en press de banca y 6RM en flexiones con resistencia elástica generaron comparables valores de EMG durante la sesión de evaluación y también provocaron ganancias de fuerza similares después del periodo de intervención, mientras que el grupo control permaneció igual. Así, cuando los niveles de activación muscular son comparables y los ejercicios de empuje sean biomecánicamente y cinemáticamente similares, las ganancias de fuerza serán similares. En el Artículo IV, sujetos con experiencia de entrenamiento de fuerza fueron capaces de incrementar la activación del tríceps braquial o el pectoral mayor cuando se focalizaban en uno u otro músculo durante el press de banca realizado hasta intensidades del 60% de 1RM. Parece existir un umbral entre 60% y 80% de 1RM. En conclusión, existen cantidad de alternativas a los métodos convencionales para alcanzar niveles altos de actividad muscular (y por tanto ganancias de fuerza). Ello proporciona un mayor grado de variación en ejercicios para incrementar la fuerza muscular de lo que se pensaba.Introduction. Pushing or pressing movements with the arms against external resistance are classic elements of strength training programs. Traditionally, conventional strength exercises using free weights and machines have been used for achieving high intensities of muscle activity. However, new ways and alternative training methods (e.g. by using suspension training devices, elastic resistance or trying to selectively activate muscles) have increased during recent years. Nevertheless, scientific evidence supporting the use of such training methods and devices to achieve high intensities of upper-body muscle activity is scarce. The main purposes of this PhD thesis were: 1. To compare muscle activity during suspended push-ups using different suspension training systems (Paper I). 2. To compare muscle activity during push-up variations with the bench press exercise and the standing cable press exercise both performed at 50%, 70%, and 85% of the 1-repetition maximum (Paper II). 3. To compare muscle activity during 6 repetition maximum (6RM) bench press and added-resistance push-up, and subsequently to evaluate the strength gains after a training period with each of these exercises (Paper III). 4. To evaluate whether focusing on using the pectoralis major and triceps brachii muscles, respectively, during bench press can selectively activate these muscles. We were especially interested in measuring the relationship between exercise intensity and the magnitude of selective activation (Paper IV). Methods. To investigate the first purpose of the thesis (Paper I), 29 fit male university students voluntarily participated performing 3 push-ups each with 4 different suspension systems. Push-up speed was controlled using a metronome. Testing order was randomized. The level of muscle activity was recorded using electromyography (EMG) for the triceps brachii, upper trapezius, anterior deltoid, clavicular pectoralis, rectus abdominis, rectus femoris, and lumbar erector spinae. To investigate the second purpose (Paper II), 29 fit male students voluntarily participated performing 3 repetitions in all conditions under the same standardized procedures. EMG signals were recorded for the rectus abdominis, external oblique, sternocostal head of the pectoralis major, anterior deltoid, long head of the triceps brachii, upper trapezius, anterior serratus and posterior deltoid. To address the third aim of the present thesis (Paper III), 30 university students with resistance training experience voluntarily participated in a two-part study. Each participant took part in 16 sessions in the following order: two familiarization sessions, a 1RM bench press test session, two 6RM tests with EMG data collection on the sternocostal head of the pectoralis major and anterior deltoid, 10 training sessions during 5 weeks (using the same loads and variables that were used during the EMG data collection), a post-1RM bench press estimation session, and lastly a post-6RM bench press estimation session. Finally, to evaluate the fourth purpose of this thesis, 18 resistance-trained adult men voluntarily participated. Subjects performed 3 repetitions on 3 different bench press conditions with intensities of 20%, 40%, 50%, 60% and 80% of 1RM: regular bench press, and bench press focusing on selectively using the pectoralis major and triceps brachii, respectively. EMG signals were recorded for the triceps brachii and pectoralis major muscles. Results and conclusions. In Paper I, the suspended push-up with a pulley system provided greater triceps brachii, upper trapezius, rectus femoris and lumbar erector spinae muscle activity compared with the other suspension systems and the standard push-up. The twoanchor system provided greater pectoralis major activity than the other systems and the standard push-up. However, the standard push-up provided greater anterior deltoid activity than the other suspension systems except the two-anchor system. All the suspension systems effectively enhanced rectus abdominis activity.In Paper II, elastic-resisted push-ups induced similar levels of muscle activity the prime movers as the bench press performed at high load while also providing a greater core activity. Suspended push-ups were highly effective to induce high levels of abdominal muscle activity. Muscle activity of the pectoralis major, anterior deltoid and anterior serratus were higher during more stable pushing conditions, whereas abdominal muscles, triceps brachii, posterior deltoid and upper trapezius were more active during the unstable exercises. In Paper III, the 6RM bench press and the 6RM elastic-resisted push-ups induced comparable levels of muscle activity as assessed by EMG during the baseline session, and provided comparable muscle strength gains after the intervention period, whereas control group remained unchanged. Thus, when the levels of muscle activity are comparable and the kinematics and biomechanics of the push exercises are broadly similar, the gain in muscle strength will be similar. In Paper IV, resistance-trained participants were able to increase triceps brachii or pectoralis major muscle activity during the bench press when focusing on using either of these specific muscle at intensities up to 60% of 1RM. A threshold between 60% and 80% where selective activity no longer was possible appeared to exist. In conclusion, several alternatives to conventional methods for reaching high levels of muscle activity – and thus strength gains – appear to exist. This provides a larger degree of variability for exercises to increase muscle strength than previously thought