• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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• pp.79-84
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• 2016

PURPOSE: The purpose of this study was to investigate effects of Horse riding simulator exercise on pain, dysfunction and dynamic balance in adults with nonspecific chronic low back pain. METHODS: In this study, total 19 college students usually complain of low back pain who were randomly divided into the horse riding simulator exercise group (n=10), lumbar strengthening exercise group (n=9) were recruited. Each group carried out for 30 minutes exercise three times a week for 4 weeks. Horse riding simulator exercise group carried out 15 minutes horse riding simulator exercise and 15 minutes lumbar strengthening exercise. Lumbar strengthening exercise group carried out 30 minutes lumbar strengthening exercise. Visual analogue scale (VAS) were measured for evaluation back pain. Korean oswestry disability index (KODI) were measured for dysfunction. Limits of stability (LOS) were measured for dynamic balance. RESULTS: VAS, KODI, LOS results showed a significant change within both horse riding simulator exercise group, lumbar strengthening exercise group. CONCLUSION: Present study suggested that the horse riding simulator exercise can improve back pain, dysfunction, dynamic balance. Horse riding simulator exercise provides more convenience, interest and motivation than conversional therapy and it could be a possible approach to adults with nonspecific chronic low back pain.

• The Journal of Korean Physical Therapy
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• v.24 no.6
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• pp.414-418
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• 2012

Purpose: Muscle fatigue affects proprioception, and it causes problems in spinal stability. The purpose of this study was to examine the effect on the accuracy of reproducing the lumbar angles before lumbar exercise and after fatiguing isokinetic lumbar exercise. Methods: Thirty healthy adults participated in this study. Before induction of fatigue by exercise, the proprioception was measured by Biodex. Lumbar positions were passively maintained on stimulation position ($25^{\circ}$ flexion and $25^{\circ}$ extension), and back to the starting position. Subjects actively repositioned the remembered stimulation position, and error degrees between the stimulation position and reposition were measured. Using an isokinetic device at $120^{\circ}$/sec of velocity of angle lumbar flexion/extension exercise resulted in muscle fatigue. The post-fatigue proprioceptive position sense was used in the same way as in pre-fatigue measurement. Results: Means of position sense of pre-fatigue were $2.19{\pm}1.97$ on flexion angle, and $5.04{\pm}2.84$ on extension angle. After exercise induced fatigue, means of position sense were $2.37{\pm}1.83$ on flexion angle, and $4.93{\pm}2.57$ on extension angle. Results of this study showed significant differences of lumbar proprioceptive position sense between pre- and post-fatigue. Conclusion: Lumbar proprioception sense in active repositioning in flexion and extension was affected in the presence of muscle fatigue. Therefore, it should be noted that therapeutic exercise for patients with abnormal proprioceptive sense or elderly people must be performed with care because muscle fatigue can cause secondary damage.

• Journal of Korean Physical Therapy Science
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• v.16 no.3
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• pp.11-17
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• 2009

Background: The purpose of this study was designed to find out the effectiveness of reposition sense, muscle fatigue response on lumbar spine after apply lumbosacral stabilization exercise program to 4 patients with chronic low back pain and for 12 weeks. Method: In this study the reposition sense was measured in 3 angle(60, 30, 12) of 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 Mattress 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. Result: The results of the present study were that the repositioning sense was appeared the most error in 12 angles of lumbar flexion and Men was appeared to decrease an error more than female in average value of 4 angles after 12 weeks. And average error of male was decrease more than female. Thus the effects of lumbosacral stabilization exercise was improved repositioning sense of prorioceptor. Fatigue response test(FRT) results, in male, was raised muscle fatigue rate during increase weight, on the other hand female appeared lower than male. Conclusion: As a results, lumbosacral stabilization exercise was aided to improvement of lumbar spine repositioning sense and vertebra segments stabilization. It was showed the rate of decrease in typically 12 degree angle point of each 3 angle(60, 36, 12). Especially, that spine instability patients will have a risk when in lifting a load or working with slight flexion posture around 12 degree 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 Neurosurgical Society
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• v.59 no.3
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• pp.276-281
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• 2016

Objective : Although trunk muscles in the lumbar spine preserve spinal stability and motility, little is known about the relationship between trunk muscles and spinal fusion rate. The aim of the present study is to evaluate the correlation between trunk muscles cross sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion (PLIF) using stand-alone cages. Methods : A total of 89 adult patients with degenerative lumbar disease who were performed PLIF using stand-alone cages at L4-5 were included in this study. The cross-sectional area of the psoas major (PS), erector spinae (ES), and multifidus (MF) muscles were quantitatively evaluated by preoperative lumbar magnetic resonance imaging at the L3-4, L4-5, and L5-S1 segments, and bone union was evaluated by dynamic lumbar X-rays. Results : Of the 89 patients, 68 had bone union and 21 did not. The MCSAs at all segments in both groups were significantly different (p<0.05) for the PS muscle, those at L3-4 and L4-5 segments between groups were significantly different (p=0.048, 0.021) for the ES and MF muscles. In the multivariate analysis, differences in the PS MCSA at the L4-5 and L5-S1 segments remained significant (p=0.048, 0.043 and odds ratio=1.098, 1.169). In comparison analysis between male and female patients, most MCSAs of male patients were larger than female's. Fusion rates of male patients (80.7%) were higher than female's (68.8%), too. Conclusion : For PLIF surgery, PS muscle function appears to be an important factor for bone union and preventing back muscle injury is essential for better fusion rate.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.4 no.1
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• pp.7-20
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• 1998

Activity of the trunk muscles is essential for maintaining stability of the lumbar spine because of the unstable structure of that portion of the spine. The central nervous system deals with stabilization of the spine by contraction of the abdominal and multifidus muscles in anticipations of reactive forces produced by limb movement. Recent evidence indicates that the lumbar multifidus muscle and transversus abdominis muscle may be involved in controlling spinal stability. Stabilization training in neutral spine is an integrated approach of education in proper posture and body mechanics along with exercise to improve strength, flexibility, muscular and cardiovascular endurance, and coordination of movement.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.2
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• pp.235-246
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• 2011

Purpose: The aim of this study is to compare and assess the effects of lumbar stabilization exercise on the balance ability of young college studets with low back pain after having performed spinal stabilization exercise by using 3-dimensional air-balance system and gym ball. Methods: The subjects of this study were 34 low back patients in their early twenties. They were divided into two groups: 3-dimensional lumbar stabilization exercise group(N=17) and gym ball lumbar stabilization exercise group(N=17). The period of the intervention was for five weeks. VAS(Visual Analogue Scale) for pain test, ODI(Oswestry Disability Index) for ADL limitation test, Tetrax system for static balance test, and Air-balance system 3D for dynamic balance test were used as evaluation tools for this study. Results: Pain showed significant decrease in both groups after having performed the experiment, but ADL limitation of the groups did not show any remarkable difference between before and after the experiment. Dynamic balance ability in the 8-directional angle comparison test significantly increased in all directions except for the backward, left-backward, and right-backward directions. As for dynamic balance ability in the 8-directional postural test, 3D exercise group showed statistically significant reduction in every direction while gym ball exercise group did not(p<.05). However, when it comes to static balance ability in the weight distribution and stability test, there was not significantly change between pre and post test in both groups. Conclusion: This study shows 3-dimensional lumbar stabilization exercise is more effective in the lumbar stabilization of coordinated movement than gym ball exercise, which may imply that 3D air-balance system can be used for the therapeutic treatment of body imbalance for patients with low back pain.

• Physical Therapy Korea
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• v.20 no.3
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• pp.81-88
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• 2013

Active straight-leg raise (ASLR) is a physical evaluation procedure to test lumbar spine stability. Several previous studies have reported various methods to control the activation of abdominal muscles during ASLR. We investigated the effects of three different hip positions in frontal plane on abdominal muscles to increase or decrease the difficulty level of lumbar spine stability exercise during ASLR in pain free subjects. Eleven young and healthy subjects voluntarily participated in this study (6 men, 5 women; mean age=$24.0{\pm}1.2$ years, height=$160.0{\pm}7.3cm$, weight=$55.0{\pm}10.6kg$, body mass index=$21.5{\pm}2.3kg/m^2$). The subjects had three trials on each ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction. Separate repeated-measures analysis of variance (ANOVA) and the post hoc Bonferroni tests (with ${\alpha}$=.05/3=.017) were performed for each muscle among the three different hip positions in frontal plane (ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction). The ipsilateral external oblique (EO), contralateral EO, ipsilateral internal oblique/transverse abdominis (IO/TrA), and contralateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with hip $10^{\circ}$ adduction. Also, the ipsilateral EO, contralateral EO, and ipsilateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with neutral hip. These results suggest that ASLR with hip $30^{\circ}$ abduction and neutral would be useful method to strengthen the EO and IO/TrA. And, ASLR with hip $10^{\circ}$ adduction would be effective in early stages of lumbar stabilization program due to low activation of EO and IO/TrA during maintaining of ASLR position with low load.

• Journal of the Korean Society for Precision Engineering
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• v.27 no.2
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• pp.130-136
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• 2010

For stability analysis of the lumbar spine, the hypothesis presented is that the disc has stress sensors driving feedback mechanism, which could react to the imposed loads by adjusting the contraction of the muscles. Fusion in the motion segment of the lumbar spinal column is believed to alter the stability of the spinal column. To identify this effect finite element (FE) models combined with optimization technique was applied and quantify the role of each muscle and reaction forces in the spinal column with respect to the fusion level. The musculoskeletal FE model was consisted with detailed whole lumbar spine, pelvis, sacrum, coccyx and simplified trunk model. Vertebral body and pelvis were modeled as a rigid body and the rib cage was constructed with rigid truss element for the computational efficiency. Spinal fusion model was applied to L3-L4, L4-L5, L5-S1 (single level) and L3-L5 (two levels) segments. Muscle architecture with 46 local muscles was used as acting directions. Minimization of the nucleus pressure deviation and annulus fiber average axial stress deviation was selected for cost function. As a result, spinal fusion produced reaction changes at each motion segment as well as contribution of each muscle. Longissimus thoracis and psoas major muscle showed dramatic changes for the cases of L5-S1 and L3-L5 level fusion. Muscle force change at each muscle also generated relatively high nucleus pressure not only at the adjacent level but at another level, which can explain disc degeneration pattern observed in clinical study.

• The Journal of Korean Physical Therapy
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• v.26 no.2
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• pp.97-103
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• 2014

Purpose: The aim of this study was to clarify the gender difference during standing balance in accordance with recruitment of abdominal muscles against sudden support surface translation. Methods: Twenty healthy males (n = 10, $26.50{\pm}3.54$ years, $170.60{\pm}6.30cm$, $72.80{\pm}5.69kg$) and females (n = 10, $24.40{\pm}2.63$ years, $163.00{\pm}4.97cm$, $52.10{\pm}4.41kg$) participated in the study. Each subject performed standing balance task on a platform, which moved in the anterior and posterior direction, with a total of 18 trials in three abdominal conditions (resting, hollowing, and bracing). We analyzed angular displacement of thoracic and lumbar spine and linear displacement of center of mass for evaluatione of spinal stability and standing balance, respectively. Results: Angular displacement of thoracic and lumbar spine and linear displacement of center of mass did not differ significantly between female and male in all conditions. Conclusion: Our results indicate that the ability to maintain spinal stability and standing balance were similar between male and female regardless of the abdominal contractile conditions and the direction of support surface translation.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.11 no.3
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• pp.207-214
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• 2017

The problem of trunk stability is a major factor in back pain.. Abdominal draw in maneuver(ADIM), One of the trunk stabilization exercises to relieve lumbar instability, is a method of inducing selective contraction of the transverse abdominis associated with anticipatory posture control among the abdominal stabilization muscles. ADIM is usually performed with a visual feedback by applying a pressure biofeedback unit(PBU) under the lumbar at the supine position, which is not functional compared to the sitting position. This study was conducted to investigate the effect of ADIM applied in supine and sitting position on 31 healthy men and women. In each posture, muscle activity was measured by rectal abdominis (RA), external oblique (EO), transverse abdominis (TrA)/internal obilique (IO) and erector spinae (ES) using wireless EMG. In the result, there was no significant difference between RA and EO between the two postures and there was a significant difference between TrA / IO and ES. In both postures, the activity of TrA/IO was higher than that of RA, and the effect of ADIM was shown to be the same, whereas TrA/IO and ES showed higher activity in sitting position. This means that the activity of the muscles involved in the postural stability and lumbar stability is increased further in the sitting position. Therefore, ADIM in sitting, which can be applied more easily in daily life, is useful for improving lumbar stability.