||The effect of additional myofacial release to core stability training for football players with iliopsoas related back pain
||Department of Physical Therapy
core stability training
low back pain
Background: Lumbar segmental instability and iliopsoas tightness are recognized as contributing factors to identifiable subgroups of individuals among the heterogeneous LBP conditions. The lumbar segmental instability might be caused by the iliopsoas tightness that aggravated lumbar lordosis, indirectly resulting in low back pain, decreased muscle strength or flexibility around pelvic region, and over activities of lumbar muscles during lumbar flexion. In addition, high prevalence of iliopsoas tightness and back pain has been reported in football players. However, direct link between iliopsoas tightness and lumbar instability is still lacking. In addition, no studies have investigated the effects of core stability training in football players with iliopsoas related back pain, especially focusing on the improvement of sports performance. Purpose: This study aimed to investigate the effects of the core stabilization exercise (CSE) on sports performance in football players with or without iliopsoas tightness. The effect of additional myo-facial release techniques was also examined. Methods: Twenty-two high school football players were divided into 4 different groups, 7 with instability and iliopsoas tightness (LI-IT), 4 with iliopsoas tightness (nonLI-IT) and 4 with instability (LI-nonIT) with chronic low back pain, and 7 non-symptomatic controls, were recruited based on physical assessments and clinical tests in the beginning. All subjects participated in CSE training for 10 weeks. Subjects with iliopsoas muscle tightness (IT) were then arranged to take 4 additional weeks of myofascial release (MR) treatments and regular football training after completing post-CSE assessment. Meanwhile, subjects without iliopsoas muscle tightness (non-IT) and the 7 control subjects only took regular football training. A series of physical assessments focusing on the assessment of pain status, the flexibility and strength tests for trunk and hip muscles , muscle activation patterns for back extensors during prone hip extension and standing lumbar flexion movements, and sports performances were arranged at different stage points, including the initial assessments (Initial),the assessments two months (the control phase) prior to CSE (pre-CSE ), the assessments post CSE (post-CSE), and the 4th assessments after completing MR treatments(post-MR). Results: No significant differences were found between the first two assessments before and after the control phase for all sub-groups. After completing 10 weeks CSE training, significant improvements were only found in the LI-nonIT group, including the proportion of lumbar instability, pain intensity, paravertebral muscle activities at full lumbar flexion and the reversed phase, the flexibility of hip rotators and the strength of hip and trunk flexors and extensors, and sports performances. (p<0.05). However, after completing the MR treatment, the groups with IT also exhibited significant improvement in the proportion of lumbar instability, pain intensity, paravertebral muscle activities at full lumbar flexion and the reversed phase, the flexibility of hip rotators and the strength of hip and trunk flexors and extensors, and sports performances. (p<0.05). Conclusion: This study has confirmed the effect of CSE training for the football players with LI but without iliopsoas tightness. However, significant improvements were not found in subjects with iliopsoas tightness until completing additional MR treatment. The results have suggested a priority of treating iliopsoas tightness before CSE training is conducted for the young athletes with iliopsoas related back pain. These results might clearly imply the importance of iliopsoas associated with active system of lumbar stability in the treating young athletes with lower crossed syndrome. In conclusion, this study was the first research to provide evidence for supporting the effects of CSE training and MR treatment on iliopsoas for athletes with iliopsoas related back pain in reducing pain, improving lumbar stability, and especially promoting sports performances. Iliopsoas release treatment should be used as a routine maneuver prior to core stability training in treating young athletes that have non-specific backache accompanied with iliopsoas tightness or lumbar segmental instability.
Keyword: instability, iliopsoas tightness, core stability training, low back pain
中文摘要 ...... I
English abstract...... III
Table Contents ..... X
Figure Contents....... XI
Chapter 1. Literature review ..... 1
1.1 Introduction...... 1
1.2 Iliopsoas tightness and posture of lumbar pelvic region2
1.3 Lumbar segmental instability (LSI).... 4
1.3.1 Clinical test of Instability.... 4
18.104.22.168 Passive intervertebral motion test.. 5
22.214.171.124 The prone instability test.... 6
126.96.36.199 Passive Lumbar Extension.... 6
1.4 Lumbar segmental stability exercise... 7
1.4.1 Stage 1. Local Segmental Control.... 7
1.4.2 Stage 2. Closed Chain Segmental Control... 8
1.4.3 Stage 3. Open Chain Segmental Control... 8
1.5 Motivation...... 9
1.6 Purpose....... 9
1.7 Hypothesis...... 9
Chapter 2. Methods..... 10
2.1 Subjects............... 10
2.1.1 Inclusion criteria............ 10
2.1.2 Exclusion criteria ............ 10
2.2 Instruments.............. 12
2.2.1 Ultrasound-based motion analysis system......... 12
2.2.2Maximum isometric trunk muscle strength........ 12
2.2.3 Hand-held dynamometer............ 12
2.2.4 A digital Inclinometer........... 12
2.2.5 Inclinometer.............. 13
2.2.6 Stop watch and strap............ 13
2.3 Settings.............. 13
2.4 Experimental procedures........... 14
2.5 Measurements.............. 15
2.5.1 Demographic data............. 15
2.5.2 Pain condition............. 15
2.5.3 Physical Examination........... 15
2.5.4 Functional performance tests.......... 18
2.6 Core Stabilization exercise............ 20
2.6.1 Stage 1: Local Segmental Control.......... 20
2.6.2 Stage 2: Closed Chain Segmental Control ........ 21
2.6.3 Stage 3: Open Chain Segmental Control ......... 22
2.7 Manual therapy.............. 23
2.8 Data Processing............. 25
2.9 Statistics analysis............. 26
Chapter 3. Results.............. 27
3.1 Basic data.............. 27
3.2 The changes in the control phase before initiating core stabilization exercise .. 28
3.3 Proportion of Lumbar Instability........... 28
3.4 Flexibility of Iliopsoas............. 30
3.5 The intensity of Low Back Pain and VAS of Trigger Points..... 31
3.6 Flexibility............... 34
3.6.1 Flexibility of Hamstring and Rectus Femoris........ 34
3.6.2 ROM of Hip joint Rotators.......... 36
3.7 Muscle Strength............. 38
3.7.1 Hip Flexor and Extensor........... 38
3.7.2 Hip Abductors and Adductors.......... 39
3.7.3 Strength measurements of Trunk muscles........ 40
3.7.4 Trunk Muscle Strength ratio of Flexor/Extensor (F/E)...... 41
3.8 Maximum Range of Lumbar Spine Motion........ 43
3.9 Average EMG intensity............. 45
3.9.1 Full Flexion phase............ 45
3.9.2 Flexion Relaxation Phenomenon (FRP)......... 47
3.9.2 Reversed phase............. 48
3.10 Performance tests............ 51
Chapter 4. Discussions.............. 52
4.1 The comparisons of baseline data before training....... 52
4.2 Intensity of Low Back Pain........... 54
4.3 Lumbar Stability &Iliopsoas Tightness......... 55
4.4 VAS of Trigger Points............ 57
4.5 Flexibility............... 58
4.5.1 Flexibility of Iliopsoas............ 58
4.5.2 Flexibility of Hamstring and Rectus Femoris........ 59
4.6 Muscle Strength............. 60
4.6.1 Hip muscles.............. 60
4.6.2 Trunk Muscles............ 61
4.7 Maximum Range of Lumbar Spine Motion........ 62
4.8 Average EMG intensity............ 63
4.8.1 Full flexion phase............. 63
4.8.2 Flexion and Reversed phase........... 65
4.9 Performance tests.............. 66
Chapter 5. Conclusions............. 67
5.1 Clinical implications............. 67
5.2 Limitations.............. 68
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