Respond to the 5 post below.100-200 words
APA FORMAT (NO TITLE PAGE NEEDED)
Due Sunday January 26, 2020
- After selecting and reading two of the provided articles, I was able to notice some differences and similarities between the two studies. As I read the article by Grenier and McGill (2007), the focus seemed to be on explaining the methods of improving lumbar stability and determining which of these two methods was more efficient at providing stability to this region. Through this study, Grenier and McGill found that when comparing abdominal hollowing and abdominal bracing, major differences could be found. In fact, through this study, we are able to see that the strategy of abdominal bracing provided a 32% improvement in the observed stability of the lumbar spine. Although Okubo, et al. (2010) were also concerned with lumbar stability, their study focused more on specific exercises that maximize specific abdominal muscle activation. The information presented by Okubo, et al. shows that different exercises are necessary if our goal is to improve the overall stability of our lumbar spine.
The information gleaned from the two articles described above are both important when working with a patient/client who has need of improving their spinal stability. After reading these two articles, I feel instructing a patient/client to incorporate an abdominal brace can help prevent injury from occurring during the prescribed exercise program. McGill (2016) also claims that his studies have shown an instant reduction in pain levels in many of his patients when abdominal bracing is used. When abdominal bracing is used in combination with the exercises described by Okubo, et al. (2010), I believe we can help patients/clients avoid injury during exercise, while also improving the overall stability of the spine by strengthening the muscles associated with lumbar stability.
- I chose to review the articles by Ishida, Suehiro, Kurozumi, and Watanabe (2016) and Grenier and McGill (2007). Both studies made use of electromyography, which helped to quantify their data, rather than basing it on subjects’ perceptions of or description of what they felt during the study. The overarching purpose of both studies was to examine core stability and how different techniques contribute to core stability
Grenier and McGill (2007) examined abdominal hollowing and abdominal bracing. To test the two techniques, subjects were handed either a bilateral or asymmetrical weight in their hands. Electromyographic findings showed that the abdominal brace increased stability by 32%.
Ishida, Suehiro, Kurozumi, and Watanabe (2016) studied abdominal bracing and expiration in relation to sudden trunk loading. Subjects were loaded while at rest and while performing each of the stabilization techniques (expiration and bracing). The timing of when the loading would be applied was unknown to the subjects. There proved to be no difference between expiration and bracing, both of which promoted co-contraction of the torso musculature and increased spinal stability. The study also found that there is no rational behind the abdominal hollowing maneuver.
Both studies agree that abdominal bracing is superior to abdominal hollowing terms of increasing stability. I use the abdominal brace regularly in rehabbing my patients. The more I have come to learn about core stability, the more I have centered core training/strengthening/rehabbing around the abdominal brace. Exercises like “Bird dogs”, “Pallof press” and “Good mornings” are all great ways to first establish an abdominal brace and then proceed with the movement. However, the abdominal brace can and should be used in any exercise to provide a stable foundation on which to perform the movement.
- When addressing core stability issues, we should consider the results of these studies. Houglum (2016) confirms that “the use of both local and global muscles is needed for optimal core control, exercises for both groups should be used in a rehabilitation program.” Therefore, teaching proper bracing to enhance core stability issues would be one of the first things to do. McGill (2016) states “abdominal bracing, which activates the three layers of the abdominal wall (external oblique, internal oblique, transverse abdominis) with no drawing in, is much more effective than abdominal hollowing at enhancing spine stability.” Then, when the patient or athlete master the bracing technique, we can move ahead and start the stability exercise program. Exercises such as the curl up, bird dog, side bridge, supine stabilization arm/leg movement, dead bug, and the cat camel stretch are highly recommended at the beginning of the stability program as we have previously learned (Faries& Greenwood, 2007; Houglum, 2016; McGill, 2016). Considering that everyone is different, we should know when is the right time to progress our patient or athlete and if the exercises would fit his/her needs and abilities. Then, more complex and dynamic exercises could be incorporated, again, as we progress and the case allows us. Exercises such as planks, plank with hip extension, side bridge with abduction, side bridge with internal rotation, cable woodchop, exercises with a stability ball, single-leg exercises, and even glutes activation exercises would be ideal as this individual gets her/his core more stable and stronger.
- The other article on electromyography takes a different approach as they actually used electrodes, both in the muscle an on the surface of the skin to test multiple known core exercises, lumbar stabilizer exercises, and see which ones produce a contraction type best suited for rehab purposes. I thought this was the more interesting of the two as they were able to detect and quantify the strength level that each exercise produces in each targeted muscle. This can be quite useful for those clinicians who already have a general understanding of how to assess and program a low back pain rehab program but need further information on exact exercises for specific deficiencies. For instance Okubo, et al. (2010) “The highest bilateral symmetrical level of activation of the EO was seen during the elbow-toe exercises, with the highest levels when the contralateral arm and leg were lifted off the supporting surface, likely reflecting the role of the EO to help control trunk rotation.” I think this type of information is for the advanced practitioner but one who can use this type of knowledge to progress patients from a basic form of rehab to a more persoanlized and eventually specific rehab program suited to the patients’ needs. I’ve seen some clinicians in my Athletic Training profession use the same protocols for similar injuries, and although that is okay as it will help, being more patient-specific can help the patient return sooner and healthier.
- “ Quantification of lumbar stability by using 2 different abdominal activation strategies.”
The bracing strategy provided greater stability than hollowing. The potential of the transversus abdominis to enhance stability, on its own, appears to be very limited. It seems to be no mechanical rationale for using stabilization exercises to enhance a hollow for stabilization purposes; rather a brace creates patterns that better enhance stability. Hollowing strategy is unlikely to generate a greater intra-abdominal pressure than full bracing.
Core training- stabilizing the confusion
Core exercises do not aim to increase the stability of the musculature, but rather aim to enhance the muscles’ ability to stabilize the spine, particularly the lumbar spine. The main purposes of basic core strength training (training the local system) is to increase stability and to gain coordination and timing of the deep abdominal wall musculature, as well as to reduce and prevent injury. Training and exercise can lead to great increases in maximal dynamic strength through neural adaptations in all musculature, so the neuromuscular system then can specifically compensate and improve dynamic stability of spine.
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