The validity and reliability of a dynamic neuromuscular stabilization-heel sliding test for core stability

Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

BACKGROUND

The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm.

OBJECTIVE

Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain.

METHODS

Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria.

RESULTS

Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001).

CONCLUSIONS

The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

NEUROMUSCULAR MECHANISMS AND EFFECTS OF CORE STABILIZATIONS ON TRUNK AND HIP MUSCLE ACTIVITY DURING LIFTING MOVEMENT

While the presence of lumbopelvic-hip stabilization has been provided as an importance component of the intra-abdominal pressure and dynamic spinal stabilization prior to movement, no previous study has investigated the effects in nonsymptomatic adults. This study investigated neuromuscular mechanisms and effects by comparing the natural core stabilization (NCS), abdominal bracing stabilization (ABS), and coordinated core stabilization (CCS) techniques in nonsymptomatic adults during lifting movement. A convenience sample of 40 nonsymptomatic adults (mean [Formula: see text] standard deviation, [Formula: see text]; 27 males, 13 females) were randomized into the NCS, ABS, and CCS techniques during lifting movement. The clinical outcomes included the deep and local (transverse abdominis (TrA), internal oblique (IO), and gluteus maximus (Gmax)) and superficial and global muscle (thoracic erector spinae (TES), lumbar erector spinae (LES), and external oblique (EO)) activation and balance ratios (IO/LES and Gmax/LES) and onset time co-activation ratios (IO/LES and Gmax/LES). One-way repeated-measures analysis of variance (ANOVA) and Bonferroni correction revealed that the IO/LES and Gmax/LES balance and activation ratios were greater in CCS than in NCS and ABS. The onset time co-activation ratio was improved in CCS as compared with NCS and ABS, and ABS dropped equally inversely to NCS. Our results provide novel therapeutic evidence that CCS-based lifting movement is more balanced or coordinated in terms of neuromuscular control than the other techniques and may be used as an alternative exercise for core stabilization.

THE EFFECTS OF DYNAMIC NEUROMUSCULAR STABILITY EXERCISE ON THE SCOLIOSIS AND PAIN CONTROL IN THE YOUTH BASEBALL PLAYERS

While the presence of dynamic neuromuscular stabilization (DNS) has been provided as an important component of the integrated spinal stabilization and associated abdominal stabilization prior to dynamic movement, no previous study has investigated the spinal mechanical effects scoliosis and pain control in youth baseball player with scoliosis. This study compared the effects of gymball exercise, with and without DNS core stability exercise, on spine kinematics and pain control in youth baseball player with scoliosis. A total of 28 participants with scoliosis were randomized into gymball exercise, with and without DNS core stability exercise. Clinical outcomes included the Cobb’s angle and visual analog scale (VAS). Two-way repeated analysis of variance (ANOVA) was conducted at p < 0.05. Two-way repeated ANOVA showed that gymball with DNS showed superior effects, compared to gymball without DNS, on Cobb’s angle (P < 0.001), but not on VAS (P < 0.837). Our results provide novel, promising clinical evidence that DNS improved scoliosis kinematics as well as pain control in youth baseball player with scoliosis.

EFFECTS OF CORE STABILIZATION EXERCISE ON MUSCLE ACTIVITY DURING HORIZONTAL SHOULDER ADDUCTION WITH LOADS IN HEALTHY ADULTS: A RANDOMIZED CONTROLLED STUDY

The importance of core stabilization exercises for extremities associated with dynamic spinal stabilization prior to movement has been demonstrated. However, no previous studies have investigated the muscle-coordinated effects on the upper trapezius (UT), anterior deltoid (AD), pectoralis major (PM), bilateral transverse abdominis (TrA), bilateral internal oblique (IO), and bilateral external oblique (EO) in healthy adults. The purpose of this study was to compare the effects of the dynamic neuromuscular stabilization (DNS) breathing technique and the abdominal bracing (AB) technique on UT, AD, PM, bilateral IO/TrA, and bilateral EO motor control in healthy participants during horizontal shoulder adduction. Thirty-six participants, eight of whom were female, were randomized into an AB and a DNS group and performed horizontal shoulder adduction with loads (8 and 17 lb). The clinical outcomes were UT, AD, and PM muscle activation and TrA/IO and EO muscle activation. Paired t-tests were used to analyze electromyography (EMG) data to determine statistically significant differences in muscle activity between the two techniques. For the EMG analysis, the maximal voluntary isometric contraction was measured for normalization and then divided by the EMG amplitude value. The results showed that UT, AD, and PM muscle amplitudes were lower and TrA/IO and EO muscle amplitudes were higher with DNS than with AB ([Formula: see text]). Our findings provide clinical evidence that core exercise with DNS is more effective in lessening UT, AD, and PM muscle activation and improving bilateral TrA/IO motor control than with AB.

Correlation between palpatory assessment and pressure sensors in response to postural trunk tests

BACKGROUND: The evaluation of postural trunk muscle function is a critical component of clinical assessment in patients with musculoskeletal pain and dysfunction. Postural activation of the trunk muscles has been evaluated by various methods. This study evaluates the correlation between subjective assessment of postural trunk muscle function with an objective measurement of abdominal wall expansion. METHODS: Twenty-five healthy participants (16 women, 9 men, age 22.4 years) were assessed. The subjective assessment was performed by two experienced Dynamic Neuromuscular Stabilization (DNS) clinicians evaluating the quality of trunk stabilization using five postural stability tests through palpation and observation. Interrater reliability was determined using an intraclass correlation coefficients (ICC). Objective measurement was performed using a new device (DNS Brace) which externally measures abdominal wall pressure. Spearman rank correlations were calculated for both palpation and observation measures with DNS Brace data. RESULTS: The interrater reliability (ICC2,k) estimates demonstrated moderate reliability in palpation measures for three DNS tests: Hip flexion test, Diaphragm test, & Intra-abdominal pressure regulation test (IAPRT) (ICC = 0.645–0.707). For observation measures, good reliability was found in IAPRT (ICC = 0.835), and three tests demonstrated moderate reliability: Hip flexion test, Diaphragm test, & Breathing Stereotype (ICC = 0.577–0.695). Correlation analysis demonstrated several moderate to strong correlations between palpation and DNS brace values (Assessor 1): IAPRT, rs= 0.580, p= 0.002, Diaphragm test, rs= 0.543, p= 0.005, (Assessor 2): IAPRT, rs= 0.776, p< 0.001, Breathing Stereotype, rs= 0.625, p= 0.001, Diaphragm test, rs= 0.519, p= 0.008, Hip Flexion test, rs= 0.536, p= 0.006, and Arm Elevation test, rs= 0.460, p= 0.021. For observation, several moderate correlations were demonstrated with DNS brace values (Assessor 1): Arm Elevation test, rs= 0.472, p= 0.017, (Assessor 2) Diaphragm test, rs= 0.540, p= 0.005, IAPRT rs= 0.475, p= 0.016, Hip Flexion test, rs= 0.485, p= 0.014, and Arm Elevation, rs= 0.451, p= 0.024. CONCLUSION: Based on inter-rater reliability and DNS brace correlations with trained DNS professionals, the IAPRT, Diaphragm test, and Hip Flexion test may prove useful when assessing asymptomatic individuals. More research is needed in order to establish the utility of DNS brace and clinical testing both in asymptomatic and back pain populations. DNS tests must be supplemented by further examinations for definitive clinical decision making.

Effectiveness of Abdominal and Gluteus Medius Training in Lumbo-Pelvic Stability and Adductor Strength in Female Soccer Players. A Randomized Controlled Study

BACKGROUND

Abdominal and lumbo-pelvic stability alterations may be the origin of lower limb injuries, such as adductor pathology in soccer players. Imbalance can be caused by both intrinsic and extrinsic factors.

METHODS

In this randomized controlled trial over 8 weeks, 25 female footballers were randomly allocated to an experimental group (isometric abdominal training and gluteus medius-specific training) or a control group (isometric abdominal training). Evaluations were performed at baseline, at the end of the intervention and after a 4-week follow-up period. The exercise protocol in common for both groups included three exercises: Plank, Lateral plank and Bird dog. Specific exercises for the gluteus medius were: Pelvic drop and Stabilization of the gluteus medius in knee valgus. Outcome measures were lumbar-pelvic stability and adductor strength.

RESULTS

After the intervention, there was an increase in lumbo-pelvic stability in both groups, being greater in the control group than in the experimental group (mean differences [MD]: 4.84 vs. MD: 9.58; p < 0.01) with differences in the analysis of repeated measures (p < 0.001), but not in group interaction (p = 0.26). Changes were found in adductor strength in the experimental group (MD: -2.48; p < 0.001 in the left adductor; MD: -1.48; p < 0.01 in right adductor) and control group (MD: -1.68; p < 0.001 in the left adductor; MD: -2.05; p < 0.001 in the right adductor) after the intervention, with differences in the analysis of repeated measures in left (p < 0.001) and right (p < 0.001) adductor strength.

CONCLUSIONS

An abdominal and gluteal training protocol shows no advantage over a protocol of abdominal training alone for lumbo-pelvic stability and adductor strength, while improvements in both variables are maintained at four weeks follow-up.