A comparison study between core stability and trunk

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DEDICATION, It is with immense pleasure that I dedicate this dissertation to. My parents thank you for your continued sacrifice support and. encouragement Your undying love has been my pillar of strength and. inspiration and will continue to be my guiding light. Thank you to Gail for your unwavering love and belief in me. ACKNOWLEDGEMENTS, Supervisor Dr G Haswell I am eternally grateful to you for your supervision. Your assistance guidance and input in this dissertation are highly. appreciated, A special thank you to Pat Linda and Mrs Ireland for always being so helpful. and putting up with all the questions asked and errors made in this learning. experience, To all the lecturers and teachers who have led me through my academic. To Mrs T M Esterhuizen Biostatistician of Nelson R Mandela School of. Medicine for statistical support, To Miss Tasneem Paulus for your time and editorial input.
To my class for their friendship support and motivation through our years of. To all the field hockey players who participated in this study and who through. their contribution made this study possible, The Lord for his unconditional love and peace throughout my life. Objectives When we consider the body position of a field hockey player the. lumbar spine is always in a flexed position which combined with rotational. movements during various hitting and pushing techniques increases the. strain upon the spine and surrounding muscles thus leading to low back pain. To determine the relationship between core strength and trunk extensor. endurance relating to the incidence of acute low back pain in field hockey. Project Design The research project was in the form of a quantitative cross. sectional study using human subjects, Setting The research project occurred during the field hockey season 2008. with players who had acute low back pain The players were clinically. assessed and subdivided into necessary groups at the Chiropractic Day Clinic. at the Durban Institute of Technology, Subjects Adult male patients aged between 18 and 30 years of age. playing premier field hockey Out of the thirty players 12 players have played. in the National u 21 squad 7 players have played in a Junior National team. and 11 players have played senior provincial field hockey. Outcome measure This included three tests Firstly the absolute difference. of pressure from the reference value of 70mmHg prone and 40mmHg. supine was used as the outcome measure on a Pressure Biofeedback Unit. and length of time in seconds a correct contraction of the core stability. muscles was maintained Secondly the length of time in seconds for Trunk. Extensor Endurance Thirdly repeated measures for NRS 101 and Quebec. Back Pain Disability Scale for the duration of the research period. Results It was found that there was no statistical evidence or convincing. trend to show that the training programmes core stability and trunk extensor. endurance increased the subjects core strength or trunk extensor endurance. in the time allocated although there seemed to be a placebo effect in the. Trunk Extensor Group which showed improvement in some of the core. stability outcomes, There was statistical evidence that the intervention training programmes. reduced pain according to the Quebec Back Pain Disability Scale Quebec. score over time and a non significant trend suggested this according to the. Numerical Rating Scale 101 NRS Since both groups NRS and Quebec. scores were not significantly different at baseline the difference can be. attributed to the effect of the intervention,Conclusions.
The results of this study found that the Trunk Extensor Endurance Group that. performed the trunk extensor endurance training programme yielded better. results in core stability and trunk extensor endurance However the Core. Stability Group that performed the core stability training programme showed. a quicker reduction in pain levels during the three week intervention period. Therefore by combining both training programmes future rehabilitation of. athletes suffering from acute low back pain will be more successful Sport. performance of the athletes field hockey players through the proponents of. swiss ball training will also improve,TABLES OF CONTENTS. CHAPTER PAGE,CHAPTER 1 INTRODUCTION,1 1 Introduction 1. 1 2 Aim and Objectives 4,1 2 1 Objective 1 4,1 2 2 Objective 2 4. 1 3 Rationale for the study 4,CHAPTER 2 LITERATURE REVIEW. 2 1 Introduction 6, 2 2 To what extent does low back pain impact on us today 6.
2 3 Core stability 6,2 3 1 Anatomy 10,2 3 2 The role of core stabilization 16. 2 4 Athletes and Low Back Pain 20,2 5 Management of acute low back pain 24. CHAPTER 3 METHODOLOGY,3 1 Introduction 28,3 2 Study design 28. 3 3 Method 28,3 3 1 Sampling method 28,3 3 2 Sampling size 29. 3 4 Inclusion Criteria 30,3 5 Exclusion Criteria 31.
3 6 Assessment protocol 32,3 7 Assessment Instruments 36. 3 7 1 Subjective data 36,3 7 2 Objective data 37,3 8 Data collection 40. 3 8 1 Frequency 40,3 9 Statistical analysis 40,CHAPTER 4 STATISTICAL METHODS AND RESULTS. 4 1 Introduction 42,4 2 Demographics 43,4 2 1 Height Weight and Age 43. 4 2 2 Playing Position 45,4 2 3 Clubs 46,4 3 Low back pain 46.
4 3 1 Comparison of demographics and baseline values. between the treatment groups 46, 4 4 To assess the impact of core stability program on the. measurements of core stability 49,4 4 1 Difference in pressure prone 49. 4 4 2 Time prone 51,4 4 3 Difference in pressure prone 53. 4 4 4 Time supine 54,4 5 Trunk Extensor Endurance 55. 4 6 To assess the impact of core stability programme. on the intensity of low back pain in terms of,objective and subjective measurements 57.
4 6 1 NRS 101 57,4 6 2 Quebec Score 59,4 7 Summary and conclusion 61. CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS,5 1 Introduction 62. 5 2 Conclusions 62,5 3 Study limitations 62,5 4 Recommendations 63. REFERENCES 65,LIST OF TABLES,Table 1 Descriptive statistics for age weight. and height in study participants n 30 43,Table 2 Occupations of study participants n 30 44.
Table 3 Clubs that the study participants played for 46. Table 4 Comparison of age weight and height,between treatment groups 47. Table 5 Comparison of playing duration between,treatment groups 47. Table 6 Comparison of baseline outcomes between,treatment groups 48. Table 7 Between and within subjects effects for,difference in pressure prone 49. Table 8 Between and within subjects effects for,time prone 51.
Table 9 Between and within subjects effects for differences. In pressure supine 53, Table 10 Between and within subjects effects for time supine 54. Table 11 Between and within subjects for,trunk extensor endurance 55. Table 12 Between and within subjects effects for NRS 101 57. Table 13 Between and within subjects effects for Quebec score 59. LIST OF FIGURES,Figure 2 1 The Transversus Abdominus muscle 10. Figure 2 2 The Internal Oblique muscle 11,Figure 2 3 The Lumbar Multifidus muscle 12. Figure 2 4 The Iliocostalis Lumborum muscle 13,Figure 2 5 The Longissimus Thoracis muscle 14.
Figure 2 6 The Spinalis muscle 15, Figure 4 1 Position played by study participants n 30 45. Figure 4 2 Profile plot of mean difference in pressure. prone over time by group 50,Figure 4 3 Profile plot of mean time prone over. time by group 52,Figure 4 4 Profile plot of difference in pressure. supine over time by group 53, Figure 4 5 Profile plot of time supine over time by group 54. Figure 4 6 Profile plot of trunk endurance,over time by group 56.
Figure 4 7 Profile plot of mean NRS over time by group 58. Figure 4 8 Profile plot of mean Quebec score,over time by group 60. LIST OF APPENDICES,Appendix A Letter of Information. Appendix B Case History,Appendix C Physical Examination. Appendix D Lumbar Regional Examination,Appendix E SOAPE Note. Appendix F Numerical Rating Scale 101 Questionnaire. Appendix G The Quebec Back Pain Disability Scale, Appendix H Core Stability Swiss Ball Training Programme.
Appendix I Swiss Ball Training Card, Appendix J Trunk Extensor Endurance Swiss Ball Training Programme. Appendix K Trunk Extensor Endurance Training Card,Appendix L Data Sheet. Introduction,1 1 Introduction, Low back pain is one of the most common and costly musculo skeletal pain. syndromes affecting up to 80 of people at some point during their lifetime. The re occurrence rate of low back pain is high and these disorders often. develop into a chronic fluctuating problem with intermittent flares It has been. stated that caring for chronic low back pain is one of the most difficult and. unrewarding problems in clinical medicine as no approach to diagnose or any. form of treatment has been shown to be clearly definitive or effective One. possible explanation for the inability to identify effective treatment protocols is. the lack of success in defining groups of patients who are most likely to. respond to a specific treatment approach Dankaerts et al 2005 Estimates. of lifetime incidences of low back pain range from 60 80 and although most. low back pain episodes 80 90 subside within 2 3 months recurrence is. common The major concerns are the 5 10 of people who become disabled. with a chronic back pain condition and who account for up to 75 90 of the. increased burden on the health budget within the Western industrialized world. O Sullivian 2005, According to Krismer and van Tulder 2007 acute low back pain occurs. suddenly after a period of a minimum of six months without low back pain. and lasts for less than six weeks For most patients with acute low back pain. the etiology is thought to be a mechanical cause involving the spine and. surrounding structures A wide range of terms is used for non specific. mechanical causes including low back strain sprain facet joint syndrome. sacroiliac syndrome segmental dysfunction somatic dysfunction. ligamentous strain and myofascial strain Atlas and Richard 2001. A study by Cholewick and McGills 1992 suggests that biomechanics may be. altered due to low back pain or injury to the spine producing weakness and. loss of muscle control which leads to further injury because the joints are not. appropriately supported Again this may result in over compensation by the. pelvis or lower extremities which will increase the predisposition to chronic. injuries According to Hedrick 2000 well developed core stability allows for. improved force output increased neuromuscular efficiency and a decrease in. the incidence of overuse injuries, The normal function of the stabilization system is to provide sufficient stability.
to the spine to match instantaneous varying stability demands made by. changes in spinal posture static and dynamic load Panjabi 1992a Hicks et. al 2005 suggest that core stability system has a role in ensuring spinal. stability and according to van Dillin et al 2001 a decrease in spinal stability. places stress and excessive load on the spinal joints and tissues which. eventually results in low back pain Richardson and Jull 1995 suggest that. control of back pain and prevention of its occurrence can be assisted by. enhancing muscle control of the spinal segment through core stability. exercises Therefore exercise programmes which are based on active. rehabilitation can reduce low back pain intensity alleviate functional disability. and improve core stability and back extension strength mobility and. According to Liebensen 1997 endurance training of back extensor muscles. including the multifidus has long been recognised as a crucial preventative of. recurrent low back pain The function and coordination of the muscles that. stabilize the lumbar spine especially the lumbar extensor muscles are often. impaired in patients with low back pain Arokoski et al 2004 Trunk extensor. endurance training will prevent or delay fatigue which can affect the ability of. field hockey players to respond to the demands of an unexpected load lunge. combined with a reverse stick tackle According to Chok et al 1999 trunk. muscle endurance training will elevate fatigue thresholds and improve. performance thus reducing disability, Although athletes are in good general physical condition one cannot assume. that athletes have spent much time strengthening their own lower back core. and abdomen muscles From studies conducted on field hockey players. Murtaugh 2001 reported that 59 of the sample of female field hockey. players had low back pain during a season and Korporaal 2002 at the 6th All. Africa Games found that the most frequent injury reported was to the lower. back 36 6 In a study on Descriptive Epidemiology of Collegiate Women s. Field Hockey Injuries over a 15 year period Dick et al 2007 concluded that. trunk back was the second most commonly injured area that mainly occurred. during practices Execution of most field hockey ball handling skills requires a. combination of spinal flexion and rotation two movements known to increase. the work load of back extensor muscles Fenety and Kumar 1992 According. to Chok et al 1999 there is evidence that suggests that muscle endurance. is diminished in people with low back pain when compared with individuals. without low back pain Research conducted by Chok et al 1999 found that. endurance exercise is considered to expedite the recovery process for. the management of acute low back pain in field hockey players by Lloyed Clarke Dissertation submitted in partial compliance with the requirements for the Master s Degree in Technology Chiropractic at the Durban University of Technology I Lloyed Irwin Clarke do declare that this dissertation is representative of my own work in both conception and execution Lloyed I Clarke Date APPROVED

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