Background: Lumbar lordosis is a result of muscle shortening and may cause low back pain. Objective: To examine the effects of static and dynamic stretching on lumbar lordosis and low back pain in university students. Stretching is an intervention that can be applied to shortened muscles; however, very few studies have compared the effects of static and dynamic stretching on lumbar lordosis and low back pain. Design: Randomized controlled clinical trial (single-blind) Methods: The 12 selected subjects were randomly assigned static stretching and dynamic stretching groups each containing six students. The subjects in each group performed their respective stretching programs for 17 minutes, 3 times a week for 4 weeks. Lumbar lordotic angle, low back pain, and Oswestry Disability Index (ODI) were measured before and after the intervention. Results: Intragroup comparisons showed significant reductions in lumbar lordotic angle and low back pain in the static stretching group while the dynamic stretching group showed significant decreases in lumbar lordotic angle, low back pain, and ODI. The intergroup comparisons showed significantly greater differences between pre- and post-intervention in lumbar lordotic angle and low back pain in the dynamic stretching group compared to those in the static stretching group while ODI did not show any intergroup difference. Conclusions: The results of this study indicated that, while both static and dynamic stretching helped to reduce the lumbar lordotic angle and low back pain, dynamic stretching was more effective in alleviating lumbar lordotic angle and low back pain compared to static stretching.

Background: Lumbar disc herniation (LDH) causes neurological symptoms by compression of the dura mater and nerve roots. Due to the changed in proprioception inputs that can result in abnormal postural pattern, delayed reaction time, and changed in deep tendon reflex. Objective: To investigate the effects of lumbar stabilization exercises on motor neuron excitability and neurological symptoms in patients with LDH. Design: Randomized Controlled Trial (single blind) Methods: Thirty patients with LDH were recruited; they were randomly divided into the balance center stabilization resistance exercise group (n=15) and the Nordic walking group (n=15). Each group underwent their corresponding 20- minute intervention once a day, four times a week, for four weeks. Participants’ motor neuron excitability and low back pain were assessed before and after the four-week intervention. Results: There were significant differences in all variables within each group (p<.05). There were significant differences between the experimental and control groups in the changes of upper motor neuron excitability and pain (p<.05), but not in the changes of lower motor neuron excitability and Korean Oswestry Disability Index. Conclusion: Lumbar stabilization exercises utilizing concurrent contraction of deep and superficial muscles improved low back function in patients with LDH by lowering upper motor neuron excitability than compared to exercises actively moving the limbs. Lumbar stabilization exercises without pain have a positive impact on improving motor neuron excitability.

Background: Surgery has been known as an inefficient approach to reduce back pain in patients with lumbar spinal stenosis; therefore, non-surgical treatments are necessary. However, there has been little research to analyze the effect of non-surgical treatments on lumbar spinal stenosis pain. Objective: To identify the effectiveness of 2 physiotherapeutic treatment approaches to relieve pain due to lumbar spinal stenosis. Design: Randomized controlled trial Methods: The participants were 36 lumbar spinal stenosis patients who were randomized in the joint mobilization group (JMG) and transcutaneous electrical nerve stimulation group (TENSG). Joint mobilization (JM) was conducted at the posteroanterior joint in the spinous process of the lumbar spine with stenosis. Transcutaneous electrical nerve stimulation (TENS) was applied on the lumbar spine with stenosis at a high frequency and intensity. Results: Visual analog scale (VAS) pain score significantly decreased in both groups, and the VAS value decreased more after JMG than that after TENSG. The pain thresholds of both groups also significantly increased, and that of JMG increased more compared to TENSG. In both the groups, significant improvements in VAS and pain thresholds were found, and JMG showed better results than TENSG. Conclusions: JM and TENS showed significant relief in both pain threshold and painpain, and JM showed more advanced relief compared to TENS.

Background: In some clinical guidelines followed in clinical practice, nonsurgical treatments are recommended as the primary intervention for patients with lumbar disc herniation (LDH). However, the effect of a therapeutic exercise program based on stabilization of the lumbar spine for treatment of multilevel LDH has not been evaluated thoroughly. Objective: To investigate the effects of therapeutic exercise on pain, physical function, and magnetic resonance imaging (MRI) findings in a patient with multilevel LDH. Design: Case Report Methods: A 43-year-old female presented with low back pain, radicular pain and multilevel LDH (L3–L4, L4–L5, L5–S1). The therapeutic exercise program was conducted. in 40-min sessions, three times a week, for 12 weeks. Low back and radicular pain, lumbar disability, and physical function were measured before and after 6 and 12 weeks of the exercise program. MRI was performed before and after 12 weeks of the program. Results: After 6 and 12 weeks of the therapeutic exercise, low back and radicular pain and lumbar disability had decreased, and lumbar range of motion (ROM) was improvedbilaterally, compared with the initial values. Also improved at 6 and 12 weeks were isometric lumbar strength and endurance, and the functional movement screen score. The size of disc herniations was decreased on MRI obtained after 12 weeks of therapeutic exercise than on the pre-exercise images. Conclusions: We observed that therapeutic exercise program improved spinal ROM, muscle strength, functional capacity, and size of disc herniation in LDH patient.

Background: Previous researchers have investigated the mechanical and neurophysiological effects of manual mobilization, however little research has been done on muscle tone and muscle stiffness. Objective: To compare the effects of posterior-anterior (PA) mobilization with weight bearing on sling and conventional PA mobilization on the bed. Design: Randomized controlled trial (single blind) Methods: The subjects were 16 male university students and randomized to sling mobilization group (SMG, n=8) or conventional mobilization group (CMG, n=8). SMG received PA mobilization using a sling and CMG received traditional mobilization on the bed during lumbar mobilization. Results: Both left and right muscle tones of SMG increased, but left muscle tone of SMG were increased and right muscle tone was decreased after intervention. In addition, both left and right muscle stiffness of SMG were also increased, however left muscle stiffness of SMG was increased and right muscle stiffness was decreased. The muscle tone and muscle stiffness of SMG were higher than those of DMG, especially the right side was statistically significantly higher. Extension of SMG, extension and flexion of CMG were increased statistically significantly except for Flexion of SMG (p<.05). There were no significant differences between the groups in Extension and Flexion. Conclusions: This study suggests that lumbar spine PA mobilization using sling is beneficial in improving muscle tone, muscle stiffness, and trunk movement.

The purpose of this study was to investigate the short-term effects of lumbar rotational mobilization under the single-leg standing (SLS) position. Fifteen healthy individuals were recruited, and randomized to agroup of trunk rotational exercise (TRE) and lumbar rotational mobilization (LRM). Trunk twist rotational exercise was performed to the TRE group, and mobilization was applied to the LRM group on the lumbar spine. Velocity of the center of pressure (VCOP) and center of pressure (COP) for each participant were measured through SLS. COPs were not significantly increased or decreased after treatment in both groups. VCOPs also did not change considerably except on the right side when the eye was closed. There was no significant difference between COPs and VCOPs in two groups. This study suggests that trunk rotation exercise and lumbar rotation mobilization would have similar effects on balance ability.

Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contemporary spinal rehabilitation. Objects: The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques. Methods: patients with mechanical LBP (N = 40, 6 males; 35.1±7.6 years) were recruited and randomly assigned either to the combined LE and ADIM (experimental group) or the LE alone (control group). Outcome measures included the visual analog scale, the modified Oswestry Disability Index, muscle strength imbalance (MSI), and radiographic imaging. The lumbar intervertebral displacement (LID), intervertebral (IV) and total lumbar extension (TLE) angles were calculated to evaluate the lumbar segmental instability. Results: The experimental group showed significant differences in the L3-L4, L5-S1 LIDs, L4-L5 and L5-S1 IV angles, and TLE angle as compared to the controls (p<.05). Immediate pain reduction and muscle strength imbalance ratio were significantly different between the groups (p<.05). Conclusion: These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.

The original focus of this study was to investigate the immediate effects of lumbar rotational mobilization on the one-legged standing ability. Fifteen subjects (6 men and 9 women, mean age = 22.77 (SD = 1.21), mean height = 165.46cm (SD = 11.65), mean weight = 61.46kg (SD = 8.29) volunteers from healthy individuals were recruited and randomized to a lumbar rotational mobilization (LRM) group and a trunk rotational exercise (TRE) group. Mobilization (grade 3 or 4) was applied to the LRM group on the lumbar spine (L1 to L5) in a side-lying, and trunk twist exercise (left and right side) was applied the to the TRE group with lunge position. Center of pressure (COP) and the velocity of the center of pressure (VCOP) of each participant were measured as a balance ability through one leg standing position. Results are as follows. In within-group difference, the COP of the LRM group reduced during standing with the right foot, but the VCOP change of the LRM was not statistically significant. In between-groups difference, COP of TRE group was decreased compared with LRM group only during left leg standing in the eyes (p <.05). The results of this study suggest that LRM is more effective than TRE in improving balance ability.

This study aimed to determine the effect of McKenzie lumbar support on pulmonary function in Stroke patients. Twenty subjects (n=20) were divided into two groups: a McKenzie lumbar support group (MLS group=10), a control group (n=10). Pulmonary function was performed to assess its effectiveness. A spirometer was used to measure the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF). The intervention was conducted for four weeks. In the MLS group, FEV1, FVC, and PEF were increased after McKenzie lumbar support. (p<0.05), while no significant differences in the variables were found in the control group (p>0.05). There were no significant differences in variables between the MLS group and the control group (p>0.05). Our findings suggest that applying Mckenzie lumbar support may be an alternative maneuver to improve pulmonary function in stroke patients.

The main focus of this study was to investigate effects of lumbar central posteroanterior (PA) mobilization on isometric knee extension (IKE) ability and patellar tendon reflex amplitude (PTRA) in healthy university students. University students aged 19-26 (male; 10, female; 10) without any neurological disorders participated voluntarily and excluded the subjects with abnormal reflexes. The participation had an average body mass of 64.25±13.52 kg, an average height of 1.66±0.08m, and an average Body Mass Index (BMI) of 23.07±3.21. Every student was randomly assigned to be received squatting exercise and PA mobilization sequentially with 5 days of wash out period. IKE and PTRA were not significantly different between the two groups after the intervention. All the outcome measures were arranged into two data groups; PA mobilization and squatting exercise data group. In the PA mobilization data group, IKE and PTRA significantly increased after the intervention, however, these aspects were decreased in the squatting exercise group. These findings suggest that IKE and PTRA increase immediately after PA mobilization, therefore PA mobilization could be a valuable topic for controlled clinical trials.

The purpose of this study is to investigate the effect of pelvic, Lumbar spine and Cervical spine manipulation on the joint position sense in normal adults. Thirty normal adults were divided into an experimental group of 15 subjects and a control group of 15 subjects. The experimental group was treated with pelvic, Lumbar spine and Cervical spine manipulation with massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position errors (JPEs) using a digital dual clinometer before and after the experiment. The comparison of the JPEs of the experimental group and the control group before and after the experiment showed that the experimental group’s cervical spine results were significantly different in the flexion, left lateral flexion, and right rotation (p < .05) and lumbar spine results were significantly different in the flexion and extension (p < .05), but the control group’s results were not statistically significant in all items (p > .05). The pelvic, lumbar spine and cervical spine manipulation makes an effect on the joint position sense in normal adults. The findings of this study suggest that the pelvis, lumbar spine and cervical spine manipulation improve the motor ability in people with low joint position sense.

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at 90°. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs.

The purpose of this study was to measure the mean peak mobilization forces to the lumbar spine 1-3 with grade III and grade IV of posteroanterior (PA) mobilization. Twenty subjects with no history of Lumbar back pain (LBP) (10 female, 10 male) with a mean age of 24.1 years (SD = 6.0) were recruited for the study and PA mobilization were performed in each spine and the therapist took approximately 2.5s to complete mobilization. In the results, applied grade IV force showed no different according to each segment in LS1, LS2, LS3, however, there are distinct differences between LS1 and LS2, LS1 and LS3 during mobilization with grade III force. This study suggested that the mean peak force of the grade III and grade IV mobilization in the L1-L3 was almost similar each other.

Background: Abdominal bracing exercise (ABE) and abdominal hollowing exercise (AHE) improve the lumbar flexibility and pulmonary function in various patients, yet the efficacy of ABE or AHE have not yet been evaluated. Objects: The purpose of this study was to compare the lumbar flexibility and pulmonary function during both ABE and AHE in healthy adults. Methods: The study included 40 healthy adults, who were randomly divided into the experimental group and control group, each with 20 subjects. All subjects performed ABE (experimental group) and AHE (control group). The lumbar flexibility such as trunk flexion test (sitting and standing position) and schober test and pulmonary function such as the spirometer including forced vital capacity (FVC) and force expiratory volume in one second (FEV1) and chest circumference measurement (middle and lower chest) were measured, respectively. Two-way repeated analysis of variance was used to compare the lumbar flexibility and pulmonary function, respectively. Results: No significant effects of lumbar flexibility were observed on trunk flexion test from the sitting position (P=.478) and standing position (P=.096) in the ABE than in the AHE. However, the length of ABE was longer significantly than it of AHE (P=.024). No significant effects of lung function were observed on the FVC (P=.410) and FEV1 (P=.072) in the ABE group than in the AHE group. And also, no significant effects of chest circumference measurement were observed on the inspiration (P=.468) and expiration (P=.563) in middle chest circumference and inspiration (P=.104) and expiration (P=.346) in lower chest circumference. Conclusion: This study indicated that the ABE is only more effective in lumbar flexibility by lumbar length difference than AHE in healthy adults.

The purpose of this study was to investigate the effects of central posteroanterior mobilization on the pain, muscle tone, flexibility of trunk flexion, lumbar lordosis in patient with chronic back pain has been studied. The target subject was a 23 year old man, who had chronic back pain without surgical history within six months. The pain has been indicated by the pressure pain threshold, when the subject was pressed his spinous process of L3-L1 by the pressure of grade Ⅳ. The muscle tone, elasticity, and stiffness were measured by the MYOTONEⓇ PRO, and the flexibility of trunk flexion was evaluated by the distance from the figure tips to the floor, when subjects flexed their body. The lumbar lordosis was measured from the X-ray picture. The lumbar central posteroanterior mobilization of Maitland orthopedic physical therapy has been applied to the spinous process of L3-L1 in grade Ⅳ by five sets and 10 times for each set. According to the measurement result right after the intervention, the pain decreased from 2/10 to 1/10 based on the visual analogue scale. The flexibility of trunk flexion (distance from the finger tips to the floor) increased The muscle tone decreased from 15.3 to 14.65 and the muscle stiffness also decreased 53.5 from 310 to 256.5. However, the muscle elasticity increased from 0.89 to 1.04 and there was no changed on the lumbar lordosis as 25°. The results of the present study suggest that the central posteroanterior mobilization decrease the pain, muscle tone, and muscle stiffness of the lumbar area, however increase the muscle elasticity and flexibility of the trunk flexion.

The Purpose of this study was to determine the effects of sciatic nerve mobilization on pain and lower back muscle strength in female patients in their 40s who have been diagnosed with lumbar radiculopathy. Using a simple blinded method, 20 female patients with neuropathy in the nerve segments between L4-S1 were randomly divided into one group (n=10) that would undergo sciatic nerve mobilization, and another group (n=10) that would perform lower back segment stabilization exercises. The two groups attended 3 sessions per week, with each session taking 30 minutes, for a duration of 4 weeks. In the preliminary examinations, the pain index as well as the isometric muscle strength of the lower back extensor and flexor muscles were measured. After the passing of 4 weeks. The same method of measurement was used for the concluding examinations. Comparison of the pain indices in the two groups revealed that they both experienced a statistically significant decrease, and further inspection revealed that the there was a more substantial difference in the sciatic nerve mobilization group. Results of comparing changes in the Isometric Muscle Strength lower back muscle and bending muscle by group, In comparison between groups, the isometric strength of the lower back extensor showed a more significant difference in the sciatic nerve mobilization group (p <.05). Conclulsion, it can be inferred that application of sciatic nerve mobilization has a positive effect on the pain index and isometric muscle strength of the lower back in female patients with lumbar radiculopathy in their 40s.

The purpose of this study was to determine if a gentle form of manual lumbar traction could reduce painful lumbar motions associated with lumbar disc degeneration (LDD). This clinical trial incorporated 134 participants with painful active lumbar motion. Participants were randomly assigned to an experimental treatment or sham group. 67 participants received sidelying manual lumbar traction while the other 67 participants received a sham treatment. Pre and post treatment NPRS values for the painful active lumbar motion were recorded for each group. There was a statistically significant improvement (P=0.00) for decreased pain intensity during active lumbar motion in the experimental group as compared to the sham treatment group. The average percent decrease in numeric pain rating scale (NPRS) values was 52.1% for the experimental treatment group and 8.1% for the sham group. The results of the study suggest that side-lying manual lumbar traction can improve painful lumbar motion in patients with LDD.

Background: Lumbar stabilization (LS) improve the thickness of the quadratus lumborum (QL) muscle and muscle activity of the gluteus medius (GM) muscle during hip abduction in a side-lying position in patients with low back pain (LBP). Objects: The purpose of this study was to assess the effects of LS on muscle thickness of QL and muscle activity of GM during hip abduction in side-lying in patients with LBP. Methods: The study included 32 patients with LBP, who were randomly divided into the control group and experimental group, each with 16 patients. All subjects performed 35° preferred hip abduction (control group) and 35° hip abduction with LS (experimental group) during side-lying. An ultrasonography and a surface electromyography were used to measure the thickness of the QL muscle, and the muscle activities of the GM muscle respectively. Independent t-test was used to compare the muscle thickness of the QL and the muscle activity of the GM muscle, respectively. Results: Anterio-posterior diameter in the muscle thickness of QL muscle was decreased significantly in hip abduction with LS more than in preferred hip abduction (p<.001), but medio-lateral diameter in the muscle thickness of QL muscle was not significantly different between in preferred hip abduction and in hip abduction with LS (p=.06). The muscle activity of GM was increased significantly in hip abduction with LS more than in preferred hip abduction (p<.001). Conclusion: These findings suggest that hip abduction with LS could be recommended as a hip abduction for LS and a prevention unwanted compensatory pelvic lateral tilting movement.

목적 및 배경 : 본 연구의 목적은 Lumbar Spine Routine 자기공명영상에서 ProSet(Principles of the selective excitation technique)기법이 유용한 검사임에도 임상에서 많이 사용되지 않으며 2D영상만 주로 사용하고 3D영상으로 잘 분석되지 않고 있다. 이에 ProSet기법의 3D영상의 중요성과 요추 자기공명영상에서의 ProSet기법의 유용성을 알리고자 한다. 대상 및 방법 : 본원을 내원하여 2011~2014년 요추 자기공명영상 검사를 시행한 환자를 대상으로 ProSet 2D영상과 3D영상을 분석하였다. 연구에 이용한 실험 장비는 Philips사의 Gyroscan Intera 1.5Tesla로 Spine Array coil을 사용하였다. 결 과 : 요추 자기공명영상 검사의 ProSet 2D영상과 3D영상을 영상의학과 전문의 3명에게 보여주었다. 2D영상보다는 3D영상에서의 신경근 압박(Nerve root compression)정도와 신경근의 부종 등이 잘 묘사되어 3D영상의 진단적 가치가 더 높았다. 결 론 : 요추(Lumbar spine) 자기공명영상에서 ProSet의 2D영상보다 3D영상의 신경근 압박 및 부종 등의 진단적 가치가 높았다

Prolonged sitting can contribute to low back pain. The lumbar taping can be applied to correct the sitting posture. This study aimed to investigate the effect of lumbar taping on lumbar kinematics and the muscle activities of multifidus (MF) and internal oblique in the individuals with nonspecific chronic low back pain (NSCLBP) as they type for 30 minutes. Nineteen subjects with NSCLBP (9 people in non taping group and 10 people in taping group) were recruited. Lumbar taping was applied to the taping group before typing. Both groups started typing in a neutral sitting position with their feet on the floor. The change of posture and S2 posterior tilting (S2P) were measured to investigate kinematic data. Three sensors were attached on T12, L3, and S2 to identify the change of posture. Surface electromyography was used to measure the muscle activities. Palpation meter was used to standardize the angle of pelvic tilt in sagittal plane before typing. All instruments were used to measure each data before and after typing. Independent t-test was used to compare the changing values of lumbar kinematics and muscle activities before and after typing between both groups. The changing values of S2P and change of posture of L3 and S2 were significantly smaller in the taping group compared to the non taping group (p＜05). The changing value of muscle activities of MF between before and after typing was significantly smaller in the taping group compared to the non taping group (p＜05). In conclusion, the lumbar taping during the 30-minute typing task can be applied to maintain correct sitting posture in the lumbar and pelvis and to maintain activation of MF.