1Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
2Department of Rehabilitation Medicine, Yuseong Wellness Rehabilitation Hospital, Daejeon, Korea.
Corresponding author: Jun Ho Lim. Department of Rehabilitation Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-338-2460, Fax: +82-42-338-2461, ljh2434@cnuh.co.kr
• Received: May 9, 2013 • Accepted: October 12, 2013
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP).
Methods
Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined.
Results
Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence.
Conclusion
LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.
Low back pain (LBP) is common in the general population, affecting 60% individuals at some point in their lives, often causing appreciable disability [1]. Most episodes of back pain and associated symptoms resolve within several weeks [2]. However, LBP is a recurrent and chronic phenomenon, mostly associated with long-term disability and consequently is a significant socioeconomic burden [3]. These facts indicate that current interventions are being introduced too late and are not effective enough [4]. Early intervention before the first episode is the best method of prevention, but for this our understanding of the nature of LBP needs to improve.
The etiology of LBP and its natural course are important issues which remain to be poorly understood. An underlying specific pathology cannot be identified in most patients seeking primary care and approximately 90% of all low back problems are considered to have a non-specific origin [5]. It is essential to improve our understanding of its etiology and to analyze whether LBP has modifiable risk factors to decrease incidence and severity of LBP.
Although many studies on the etiopathogenesis of LBP exist, most of them have investigated the associations of exercise and muscle strength with chronic LBP [6,7]. Moreover, only few prospective studies have been conducted in individuals with asymptomatic spinal deformity and weakened trunk muscles.
The aim of this pilot study was to investigate the effects of asymptomatic back muscle weakness and spinal deformity on LBP incidence and the associations between asymptomatic trunk muscle weakness and LBP severity.
MATERIALS AND METHODS
We studied 60 healthy subjects without LBP (Fig. 1). The study population was recruited via poster notice at our hospital. All subjects provided written informed consent. Inclusion criteria were as follows: age 20-75 years; no previous history of spinal surgery and no history of lower extremity fracture (stress or traumatic). Exclusion criteria were as follows: subjects currently seeking medical care for LBP, pregnancy, poor general health, radicular pain, severe osteoporosis or severe psychological disturbances or psychiatric disease.
The baseline questionnaire included questions about age, gender, height and weight, and the body mass index (BMI) was calculated as well.
Standing anteroposterior and lateral views of the lumbar spine were obtained for the radiological evaluation. Then we measured the lumbar spine scoliosis angle using the Cobb angle method. We measured the lordosis angle between the upper border of L1 and the upper border of S1 on the lateral view radiographs. Scoliosis was considered to be present when the Cobb angle was greater than 10° [8].
The strength test included two isometric tests and two isokinetic tests. We used the Biodex System 4 (Biodex Medical Systems, New York, NY, USA) dynamometer to measure the torque of the trunk flexors and extensors (Fig. 2). Subjects were advised to wear comfortable, loose-fitting clothing on the day of testing. Both thighs and the back of subjects were fixed to the testing chair using straps. The axis of the dynamometer was located on the anterior superior iliac spine of the pelvis of the patient. Maximal isometric strength was measured of trunk flexors and extensors. The peak torque of three force measurements was recorded, for this the subjects held each contraction for 5 seconds. For the isokinetic strength test patients were instructed to perform flexion and extension of the back with maximum effort three times at an angular velocity of 120°/s. The peak torque was expressed in Newton meter (N·m) and was normalized to the body weight (N·m/kg×100%). Torque was proportional to power and the peak torque was the highest value within the range of motion.
Two years later, a follow-up survey was conducted. Forty-eight subjects visited the hospital again and answered questionnaires. These measures included the number of pain episodes, pain intensity with a numerical 0-10 rating scale and the Korean version of the Oswestry Low Back Pain Disability Questionnaire. The Korean version of the Oswestry Low Back Pain Disability Questionnaire was administered to every subject for measuring the Oswestry Disability Index (ODI). The questionnaire is a self-administered questionnaire divided into 10 sections designed to assess limitations of various activities of daily living [9].
Statistical analyses were performed using SPSS ver. 12.0 for Windows (SPSS Inc., Chicago, IL, USA). Associations were examined between sex, radiological abnormality and LBP incidence using chi-squared tests. Independent samples t-test was performed to analyze differences in age, BMI, isokinetic and isometric trunk torque between subjects with LBP and subjects without LBP. Associations were determined with correlation analyses between pain incidence and sex, age, BMI, isokinetic trunk torque, and isometric torque. A partial correlation analysis was developed in order to control the effect of sex and age. Variables with significant correlations with each were included in the multivariate model. The statistical significance level was fixed at 0.05.
RESULTS
There were 20 males and 28 females and 12 subjects were lost to follow-up. Of those responding to the surveys, 29 of the 48 subjects reported at least one episode of LBP at the 2-year follow-up (mean±standard deviation, 1.6±0.7) and there was no trauma history. The mean age was 56.93±17.94 years (range, 22-72 years) in the group without LBP and 45.63±14.84 years (range, 23-75 years) in the group with LBP; the ratio of men to women was 11:8 in the group without LBP and 6:23 in the group with LBP. The mean ODI was 5.0 (0-20). The mean Cobb angle of lumbar lordosis was 43.1°±11.1° in the group without LBP and 48.1°±11.1° in the group with LBP. The mean Cobb angle of lumbar scoliosis was 3.2°±3.0° in the group without LBP and 3.9°±3.5° in the group with LBP.
Sex and age were significantly different in both groups. Maximum isometric trunk flexor and extensor strength were significantly different. Also, maximum isokinetic trunk flexor and extensor strength were both significantly different. There were no significant differences of lumbar lordosis, scoliosis, and BMI between both groups (Tables 1, 2).
Sex and age were significantly and positively associated with LBP incidence (r=0.38, p<0.01 and r=0.32, p<0.05, respectively). After control of sex and age, maximum isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength were significantly and negatively associated with the incidence of LBP (Table 3).
DISCUSSION
In the prospective part of the study, the LBP incidence was found to be significantly and negatively associated with age, sex, maximum isokinetic trunk extensor and maximum isometric trunk extensor strength, and the LBP severity was significantly and negatively associated with the maximum isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength. BMI and lumbar spinal deformities had no association with LBP incidence and severity. The most interesting finding in this study was a strong association between paraspinal muscle strength and LBP incidence. Some strengths of this study were the recruitment of a cohort of subjects without a previous history of LBP and the measurement of the paraspinal muscle strength.
There are some longitudinal prospective studies about the development of LBP [10,11,12,13]. These studies were conducted for 10 to 24 months. Likewise, we collected the data over a period of 2 years.
Several risk factors are associated with LBP. As it was shown here, the association between age and LBP was also reported in several other studies [14]. Modern living increases the tendency to have a more sedentary lifestyle that involves prolonged periods of sitting [15]. The disadvantages from prolonged sitting include increased intradiscal load and weakened posterior lumbar structures [16,17]. Previous research suggested that the prolonged sitting could be a risk factor for the development of LBP [18]. In addition, increasing age results in degenerative changes in the spine.
Persistent overweight has been associated with disc degeneration upon magnetic resonance imaging studies [19]. A study has reported that the reported prevalence of LBP was 22% among 5,724 obese adults aged over 60 years with a linear correlation between LBP and BMI [20]. However, the present study results show no significant association between BMI and LBP incidence. This may be probably because the subjects in the present study were not severely obese. Moreover, BMI does not provide any information about body composition and might be influenced by muscle mass and fat tissue.
The prevalence of back pain in scoliotic adults is no greater than that in the population at large [21], and the severity of LBP (intensity and duration) in scoliotic patients was no greater than that in control patients [22]. Similarly, lumbar lordosis and scoliosis were not associated with LBP incidence or severity in the present study.
The relationship between LBP incidence and the decrease of trunk muscle strength was widely studied, but there is no study about the different effect of isometric and isokinetic strength of trunk muscles. A decreased isometric strength of trunk extensors was associated with LBP occurrence [23].
The paraspinal muscles of the back support the spine and maintain its stability and they consist of the multifidus and the erector spinae. The multifidus is attached to the spine at every segment to provide stability. Moreover, the multifidus muscle sectional areas have been well correlated with isometric peak torque in all directions of movements [24]. The erector spinae mostly acts as a trunk extensor [25]. The results of this study suggest that the weakened isometric and isokinetic trunk extensors may be related to the LBP incidence and we assumed that the LBP incidence may be related to multifidus and erector spinae muscles.
The goal of prevention is to decrease the overall number of LBP episodes experienced by a certain population. Effective strategies for preventing LBP remain elusive. Back schools, lumbar supports and ergonomic interventions have limited evidence regarding prevention [5,26]. Previous study suggested that lumbar stabilization exercises that strengthen the multifidus muscles decrease LBP incidence and recurrence [27]. Exercise for LBP has focused on lumbar stabilization and core strengthening [28].
Some limitations should be considered. First, only small numbers of patients were included and they were recruited from one hospital only. Because of those limitations, the patients may not adequately represent the general population. Therefore further studies must be conducted to validate our results. Second, there is no structural evaluation of paraspinal muscles and we could not analyze the effect of muscle or fat tissue composition on LBP. Third, the LBP episodes were dependent on the memory of subjects and the time of occurrence and duration of LBP was not assessed. Last, this study did not address occupation, lifestyle and psychosocial factors. This is relevant because other studies have shown a significant association between tobacco consumption and LBP as well as intervertebral disc herniation [29]. Moreover, LBP were reported to be more frequent among married or divorced employees [11]. Thus, future studies should also consider social and occupational factors.
In conclusion, this study was a pilot study which evaluated the risk factor for nonspecific LBP. Our results indicate that an incidence of LBP is associated with isometric and isokinetic trunk extensor weakness and LBP severity is associated with isokinetic trunk extensor and flexor weakness and isometric trunk extensor and flexor weakness. Paraspinal muscle weakness in asymptomatic subjects can lead to an increase of LBP incidence and severity. Age and sex are not modifiable risk factors, but the strength of the trunk muscles is modifiable and can be improved by exercise of the paraspinal muscles. Thus, early strengthening exercises of the paraspinal muscles are necessary to decrease the LBP incidences and severity.
ACKNOWLEDGMENTS
ACKNOWLEDGMENTS
This study was supported by Chungnam National University Hospital Research Fund, 2011.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
REFERENCES
1. Walsh K, Cruddas M, Coggon D. Low back pain in eight areas of Britain. J Epidemiol Community Health 1992;46:227-230.
4. van den Hoogen HJ, Koes BW, van Eijk JT, Bouter LM, Deville W. On the course of low back pain in general practice: a one year follow up study. Ann Rheum Dis 1998;57:13-19.
9. Jeon CH, Kim DJ, Kim SK, Kim DJ, Lee HM, Park HJ. Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci 2006;21:1092-1097.
10. George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, et al. Predictors of occurrence and severity of first time low back pain episodes: findings from a military inception cohort. PLoS One 2012;7:e30597.
11. Bejia I, Younes M, Jamila HB, Khalfallah T, Ben Salem K, Touzi M, et al. Prevalence and factors associated to low back pain among hospital staff. Joint Bone Spine 2005;72:254-259.
12. Evans K, Refshauge KM, Adams R, Aliprandi L. Predictors of low back pain in young elite golfers: a preliminary study. Phys Ther Sport 2005;6:122-130.
13. Burdorf A, Jansen JP. Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability. Occup Environ Med 2006;63:522-529.
14. Chon J, Kim SW, Kim SS, Kim YG, Choi HJ, Ahn KH, et al. Risk factors of low back pain in a general population. J Korean Acad Rehabil Med 2000;24:981-987.
15. Egger GJ, Vogels N, Westerterp KR. Estimating historical changes in physical activity levels. Med J Aust 2001;175:635-636.
19. Liuke M, Solovieva S, Lamminen A, Luoma K, Leino-Arjas P, Luukkonen R, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond) 2005;29:903-908.
20. Leboeuf-Yde C. Body weight and low back pain: a systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine (Phila Pa 1976) 2000;25:226-237.
22. Gremeaux V, Casillas JM, Fabbro-Peray P, Pelissier J, Herisson C, Perennou D. Analysis of low back pain in adults with scoliosis. Spine (Phila Pa 1976) 2008;33:402-405.
24. Han TR, Kim JH, Chung SG, Kwon BS, Lee KW. Correlation of ultrasonographic measure of lumbar multifidus muscles with isometric torque of low back. J Korean Acad Rehabil Med 1999;23:809-814.
26. Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J 2009;9:147-168.
27. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976) 2001;26:E243-E248.
29. Hestbaek L, Leboeuf-Yde C, Kyvik KO. Are lifestyle-factors in adolescence predictors for adult low back pain? A cross-sectional and prospective study of young twins. BMC Musculoskelet Disord 2006;7:27.
*p<0.05, **p<0.01, ***p<0.001 by partial correlation analysis.
Figure & Data
References
Citations
Citations to this article as recorded by
Risk Factors for Residual Back Pain After Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Retrospective Analysis Zhengao Huang, Hao Chen, Yi Ding, Liulong Zhu, Xuepeng Wang World Neurosurgery.2026; 205: 124694. CrossRef
Association of Muscle Strength, Psychological Factors, and Central Sensitization With Movement-Evoked Pain in Patients With Nonspecific Chronic Low Back Pain: The BACKFIT Project Víctor Segura-Jiménez, Gavriella Tsiarleston, Belén Donoso, Yolanda María Gil-Gutiérrez, Manuel Delgado-Fernández Sports Health: A Multidisciplinary Approach.2025; 17(2): 342. CrossRef
The role of muscle function and
pointe
shoe characteristics in
Arabesque
movement among ballet dancers with non-specific low back pain
Chia-Wei Lin, Cheng-Feng Lin, Amornthep Jankaew, Sirinad Chandee, Mayumi Kuno-Mizumura Sports Biomechanics.2025; 24(6): 1769. CrossRef
Responsiveness of hand-held dynamometry for measuring changes in trunk muscle strength in people with chronic low back pain Shouq Althobaiti, Janet A. Deane, Deborah Falla BMC Musculoskeletal Disorders.2025;[Epub] CrossRef
Influence of hip and lumbar extensor strength on lumbar moments during a squat lift: An evaluation of persons with and without low back pain Christopher S. Patterson, Skulpan Asavasopon, Lida Gharibvand, Christopher M. Powers Clinical Biomechanics.2025; 122: 106444. CrossRef
Explaining trunk strength variation and improvement following resistance training in people with chronic low back pain: clinical and performance-based outcomes analysis Shouq Althobaiti, David Jiménez‑Grande, Janet A. Deane, Deborah Falla Scientific Reports.2025;[Epub] CrossRef
Effect of backward walking versus home-based core program on pain and core function in non-specific low back pain: a randomized controlled trial Alaa Amr Ahmed, Salam Mohamed Elhafez, Ahmed Salamah Yamani, Yasmin Essam Mohamed, Ayman Gouda Matar Fizjoterapia Polska.2025; 25(1): 430. CrossRef
A comparison of Contractile properties of posterior chain muscles and trunk strength in females with non-specific chronic low back pain Hyungwoo Lee, Seungwon Lee, Chanki Kim, Kyoungkyu Jeon Journal of Back and Musculoskeletal Rehabilitation.2025; 38(4): 783. CrossRef
Comparison of Contraction Phase of Trunk and Lower Extremities Muscle Activity During Kneeling Squat in Individuals With Chronic Low Back Pain Yusung Park, Sae-hwa Kim, Ji-hyun Lee, Heon-seock Cynn Physical Therapy Korea.2025; 32(1): 28. CrossRef
Association between muscle strength and low back pain among middle-aged and older adults: a cross-sectional study Peng Wang, Xiangjun Lu, Mohan Wen, Xu Li, Qipeng Gao, Rujie Qin BMC Public Health.2025;[Epub] CrossRef
Knowledge, Attitudes and Beliefs about Chronic Low Back Pain among Final Year Physical Therapy Students in Universities of Islamabad Hafsah Arshad, Areej Fatima, Shafiullah Khan, Humna Imtiaz, Hafsah Gul Khattak, Kinza Anwar, Umm-e-Habiba, Zainab Rashid Bhatti The Healer Journal of Physiotherapy and Rehabilitation Sciences.2025; 5(2): 118. CrossRef
From strength to strain: How sarcopenia contributes to chronic low back pain Zening Zhang, Yaxing Guan, Shu Xie Experimental Gerontology.2025; 210: 112872. CrossRef
Effects of Exercise-Based Rehabilitation on Lumbar Degenerative Disc Disease: A Systematic Review Shirin Aali, Farhad Rezazadeh, Fariborz Imani, Mahsa Nabati Sefidekhan, Georgian Badicu, Luca Poli, Francesco Fischetti, Stefania Cataldi, Gianpiero Greco Healthcare.2025; 13(15): 1938. CrossRef
Beyond Body Composition, the Unexplored Sex Differences in Muscle Strength and Quality in Chronic Low Back Pain: A Cross‐Sectional Study Angela Rodríguez‐Perea, Luis Chirosa‐Ríos, Carlos Cristi‐Montero, Daniel Jerez‐Mayorga, Waleska Reyes‐Ferrada Physiotherapy Research International.2025;[Epub] CrossRef
Functional electromechanical dynamometer is a new, reliable, and safe tool to assess trunk muscle strength in young adults with non-specific chronic low back pain A. Rodríguez-Perea, P. Aragón-Aragón, J. Castro-Piñero, I. J. Chirosa-Rios, D. Jerez-Mayorga, W. Reyes-Ferrada Journal of Sports Sciences.2025; : 1. CrossRef
Characteristics of injuries among elite badminton players: a systematic review Muhammad Iqbal Shaharudin, Ahmad Munir Che Muhamed, Hazwani Ahmad Yusof Research in Sports Medicine.2025; : 1. CrossRef
Force capacity of trunk muscle extension and flexion in healthy inactive, endurance and strength-trained subjects—a pilot study Tim Schönau, Christoph Anders German Journal of Exercise and Sport Research.2024; 54(2): 213. CrossRef
Dose Weight loss and Core Exercise improve Oswestry disability index, Trunk Extensor and Flexor Muscle Strength in Obese Middle-Aged Women with Chronic Low Back Pain? Yun-Hwan Lee, Chul-Ho Kim, Jea-Kwang Lee, Ji-Eun Lee, Ho-Seong Lee The Asian Journal of Kinesiology.2024; 26(1): 76. CrossRef
The MedXFit-study – CrossFit as a workplace health intervention: a one-year, prospective, controlled, longitudinal, intervention study Tom Brandt, Elisabeth Heinz, Yannik Klaaßen, Selina Limbara, Marian Mörsdorf, Timo Schinköthe, Annette Schmidt Frontiers in Public Health.2024;[Epub] CrossRef
Isokinetische Krafttestung bei unterschiedlichen biomechanischen Anforderungen an die Rumpfkraft – Vergleich von militärischen Leistungssportlern und Soldaten mit dienstlich bedingt hoher körperlicher Beanspruchung Thomas Sanjay Weber-Spickschen, Daniel Geißler, Andreas Lison, Christoph Schulze Sportverletzung · Sportschaden.2024; 38(03): 140. CrossRef
Relationship between Respiratory Function and the Strength of the Abdominal Trunk Muscles Including the Diaphragm in Middle-Aged and Older Adult Patients Yuki Kurokawa, Satoshi Kato, Noriaki Yokogawa, Takaki Shimizu, Hidenori Matsubara, Tamon Kabata, Satoru Demura Journal of Functional Morphology and Kinesiology.2024; 9(4): 175. CrossRef
INVESTIGATION OF PSYCHOSOCIAL AND FUNCTIONAL DYNAMICS IN INDIVIDUALS WITH CHRONIC LOW BACK PAIN Tuba Yerlikaya, Alikemal Yazıcı, Adile Öniz Türk Fizyoterapi ve Rehabilitasyon Dergisi.2024; 35(3): 352. CrossRef
Effectiveness of Physical Activity in the Management of Nonspecific Low Back Pain: A Systematic Review Alexandra Alonso-Sal, José Luís Alonso-Perez, María Dolores Sosa-Reina, Juan Antonio García-Noblejas-Fernández, Viren Gul Balani-Balani, Giacomo Rossettini, Jorge Hugo Villafañe Medicina.2024; 60(12): 2065. CrossRef
Non-pharmacological Home Therapies for Subacute Low Back Pain in Active Duty Military Personnel: A Randomized Controlled Trial Laura A Talbot, Lee Webb, Vanessa J Ramirez, Christopher Morrell, Martina Bryndziar, Kayla Enochs, e.jeffrey Metter Military Medicine.2023; 188(1-2): 12. CrossRef
Effect of Trunk-Focused Exercises on Pain, Disability, Quality of Life, and Trunk Physical Fitness in Low Back Pain and How Potential Effect Modifiers Modulate Their Effects: A Systematic Review With Meta-analyses Amaya Prat-Luri, Javier de los Rios-Calonge, Pedro Moreno-Navarro, Agustín Manresa-Rocamora, Francisco J. Vera-Garcia, David Barbado Journal of Orthopaedic & Sports Physical Therapy.2023; 53(2): 64. CrossRef
Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain Khalid Alkhathami, Yousef Alshehre, Kelli Brizzolara, Mark Weber, Sharon Wang-Price International Journal of Sports Physical Therapy.2023;[Epub] CrossRef
Influence of Sex and Dominant Side on the Reliability of Two Trunk Rotator Exercises Angela Rodríguez-Perea, Daniel Jerez-Mayorga, María Dolores Morenas-Aguilar, Darío Martínez-García, Ignacio Jesús Chirosa-Ríos, Luis Javier Chirosa-Ríos, Waleska Reyes-Ferrada Applied Sciences.2023; 13(4): 2441. CrossRef
Prevalence and factors associated with low back pain in warehouse workers: A cross-sectional study Maryanne Martins Gomes, Sandra Raquel dos Santos Silva, Rosimeire Simprini Padula Journal of Back and Musculoskeletal Rehabilitation.2023; 36(4): 823. CrossRef
Comparison of the efficiency of core stabilization exercises and abdominal corset in the treatment of postpartum diastasis recti abdominis Ayse Kavasoglu Kaya, Merve Yilmaz Menek European Journal of Obstetrics & Gynecology and Reproductive Biology.2023; 285: 24. CrossRef
Isokinetic trunk training on pain, disability, and strength in non-specific low back pain patients: A systematic review and meta-analysis W. Reyes-Ferrada, L. Chirosa-Rios, D. Martinez-Garcia, A. Rodríguez-Perea, D. Jerez-Mayorga Journal of Back and Musculoskeletal Rehabilitation.2023; 36(6): 1237. CrossRef
Effect of Two Suspension Training Programs on Pain and Musculoskeletal Function in Chronic Low Back Pain: Study Protocol Francielle Joyce Fuckner Leonel, Lauana de Paula, Gustavo Cezar Raab Ferreira, Dariel Matheus dos Reis do Nascimento, Talita Gianello Gnoato Zotz, Julia Milena de Melo, Ana Carolina Brandt de Macedo Pain Management.2023; 13(5): 271. CrossRef
Effectiveness of Transcutaneous Neuromodulation on Abductor Muscles Electrical Activity in Subjects with Chronic Low Back Pain: A Randomized, Controlled, Crossover Clinical Trial Josep C Benítez-Martínez, Beatriz García-Haba, Samuel Fernández-Carnero, Daniel Pecos-Martin, Eleuterio A Sanchez Romero, Francisco Selva-Sarzo, Juan Nicolás Cuenca-Zaldívar Journal of Pain Research.2023; Volume 16: 2553. CrossRef
Rehabilitation therapy using the HUBER platform in chronic non-specific low back pain: a randomized controlled trial Vincent LE MOAL, Mélanie TANTOT, Éric MÉVELLEC, Isabelle NOUY-TROLLÉ, Emmanuelle LEMOINE-JOSSE, Florent BESNIER, Thibaut GUIRAUD European Journal of Physical and Rehabilitation Medicine.2023;[Epub] CrossRef
Reliability of a Trunk Flexion and Extensor Muscle Strength Test with Hand-Held and Isokinetic Dynamometers
in Female Athletes Casto Juan-Recio, Amaya Prat-Luri, David Barbado, Francisco J. Vera-Garcia, Víctor Moreno-Pérez Journal of Human Kinetics.2023; 92: 43. CrossRef
The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis Pincao Gao, Fang Tang, Weiguo Liu, Yu Mo Journal of Back and Musculoskeletal Rehabilitation.2022; 35(1): 21. CrossRef
Normative Reference Values for Trunk Range of Motion and Isometric Muscle Strength in Asymptomatic Young Indian Adults Gautam M. Shetty, Shikha Jain, Pratiksha Munje, Anita Bhan, C. S. Ram Indian Journal of Orthopaedics.2022; 56(1): 49. CrossRef
Isometric Trunk Strength Assessment of Athletes: Effects of Sex, Sport, and Low Back Pain History Darjan Spudić, Janez Vodičar, Miha Vodičar, Vedran Hadžić Journal of Sport Rehabilitation.2022; 31(1): 38. CrossRef
Is the novel suspension exercises superior to core stability exercises on some EMG coordinates, pain and range of motion of patients with disk herniation? Yasser Mohebbi Rad, Mohammad Reza Fadaei Chafy, Alireza Elmieh Sport Sciences for Health.2022; 18(2): 567. CrossRef
Variações baseadas em gênero no movimento e na força isométrica do tronco em jovens adultos com dor lombar: Um estudo de caso-controle prospectivo Shikha Jain, Gautam Shetty, Pratiksha Munje, Anita Bhan, Sanya Linjhara, CS Ram Revista Brasileira de Ortopedia.2022; 57(03): 392. CrossRef
The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift Christopher S. Patterson, Everett Lohman, Skulpan Asavasopon, Robert Dudley, Lida Gharibvand, Christopher M. Powers Musculoskeletal Science and Practice.2022; 58: 102501. CrossRef
Chronic low back pain is associated with impaired bed turning ability: Evaluation by a mobility detection system Chia-Huei Lin, Chueh-Ho Lin, Liang-Cheng Chen, Shun-Hwa Wei, Wen-Hsu Sung, Liang-Hsuan Lu, Shin-Tsu Chang, Yi-Hui Lin, Chun-Yi Lee, Shang-Lin Chiang Clinical Biomechanics.2022; 92: 105572. CrossRef
New comprehensive clinical tests to measure endurance of back muscles and their comparison with the Sorenson’s test Shashank Rousa, Ajay Gupta, Tarun Suri, Shashi Ranjan, Nishant Bhatia, Akash Goel Sport Sciences for Health.2022; 18(3): 957. CrossRef
Association between Dietary Protein Intake, Regular Exercise, and Low Back Pain among Middle-Aged and Older Korean Adults without Osteoarthritis of the Lumbar Spine Hye-Mi Noh, Yi Hwa Choi, Soo Kyung Lee, Hong Ji Song, Yong Soon Park, Namhyun Kim, Jeonghoon Cho Journal of Clinical Medicine.2022; 11(5): 1220. CrossRef
Reliability of trunk strength measurements with an isokinetic dynamometer in non-specific low back pain patients: A systematic review Waleska Reyes-Ferrada, Luis Chirosa-Rios, Darío Martinez-Garcia, Ángela Rodríguez-Perea, Daniel Jerez-Mayorga Journal of Back and Musculoskeletal Rehabilitation.2022; 35(5): 937. CrossRef
Effects of Core Stabilization Exercise Programs on Changes in Erector Spinae Contractile Properties and Isokinetic Muscle Function of Adult Females with a Sedentary Lifestyle Hyungwoo Lee, Chanki Kim, Seungho An, Kyoungkyu Jeon Applied Sciences.2022; 12(5): 2501. CrossRef
Investigation of the relationship between the clinical evaluation results of lumbar region muscles with cross-sectional area and fat infiltration Alikemal Yazici, Tuba Yerlikaya Journal of Back and Musculoskeletal Rehabilitation.2022; 35(6): 1277. CrossRef
Practicable performance-based outcome measures of trunk muscle strength and their measurement properties: A systematic review and narrative synthesis Shouq Althobaiti, Alison Rushton, Ahmad Aldahas, Deborah Falla, Nicola R. Heneghan, Fatih Özden PLOS ONE.2022; 17(6): e0270101. CrossRef
Effects of an Intensive 6-Week Rehabilitation Program with the HUBER Platform in the Treatment of Non-Specific Chronic Low Back Pain: A Pilot Study Mélanie Tantot, Vincent Le Moal, Éric Mévellec, Isabelle Nouy-Trollé, Emmanuelle Lemoine-Josse, Florent Besnier, Thibaut Guiraud Clinics and Practice.2022; 12(4): 609. CrossRef
The Japan Frailty Scale is a promising screening test for frailty and pre-frailty in Japanese elderly people Ryuichiro Egashira, Tomoharu Sato, Akimitsu Miyake, Mariko Takeuchi, Mai Nakano, Hitomi Saito, Misaki Moriguchi, Satoko Tonari, Keisuke Hagihara Gene.2022; 844: 146775. CrossRef
Surface Electromyographic Activity of the Rectus Abdominis and External Oblique during Isometric and Dynamic Exercises Athanasios Mandroukas, Yiannis Michailidis, Angelos E. Kyranoudis, Kosmas Christoulas, Thomas Metaxas Journal of Functional Morphology and Kinesiology.2022; 7(3): 67. CrossRef
The deer play in Wuqinxi and four-point hand−knee kneeling positions for training core muscle function and spinal mobility Xiao-Qian Chang, Xin-Peng Chen, Yi-Xin Shen, Kuan Wang, Shang-Jun Huang, Yan Qi, Wen-Xin Niu Frontiers in Bioengineering and Biotechnology.2022;[Epub] CrossRef
Relationship between Respiratory Function and Strength of the Abdominal Trunk Muscles, Including Diaphragm in Middle-Aged and Older Adult Patients Yuki Kurokawa, SATOSHI KATO, Satoru Demura, Kazuya Shinmura, Noriaki Yokogawa, Hidenori Matsubara, Tamon Kabata, Hiroyuki Tsuchiya SSRN Electronic Journal .2022;[Epub] CrossRef
The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial Nadia Keshwani, Sunita Mathur, Linda McLean Physiotherapy Theory and Practice.2021; 37(9): 1018. CrossRef
Muscular fitness is associated with spinal pain among young people: A cross-sectional exploratory study Diogo Henrique Constantino Coledam, Gustavo Aires de Arruda, Francys Paula Cantieri, Edineia Aparecida Gomes Ribeiro Journal of Bodywork and Movement Therapies.2021; 26: 174. CrossRef
The effect of aquatic exercise on functional disability, flexibility and function of trunk muscles in postmenopausal women with chronic non-specific low back pain: Randomized controlled trial S. Ansari, A. Elmieh, A. Alipour Science & Sports.2021; 36(3): e103. CrossRef
Association of low back pain with muscle weakness, decreased mobility function, and malnutrition in older women: A cross-sectional study Satoshi Kato, Satoru Demura, Kazuya Shinmura, Noriaki Yokogawa, Tamon Kabata, Hidenori Matsubara, Yoshitomo Kajino, Kentaro Igarashi, Daisuke Inoue, Yuki Kurokawa, Norihiro Oku, Hiroyuki Tsuchiya, Alison Rushton PLOS ONE.2021; 16(1): e0245879. CrossRef
Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study Soo Woong Jang, Hee Seung Yang, Young Bae Kim, Joo Chul Yang, Kyu Bok Kang, Tae Wan Kim, Kwan Ho Park, Kyung Soo Jeon, Hee Dong Shin, Ye Eun Kim, Han Na Cho, Yun Kyung Lee, Young Lee, Seul Bin Na Lee, Dong Young Ahn, Woo Sob Sim, Min Jo, Gyu Jik Jo, Dong Annals of Rehabilitation Medicine.2021; 45(1): 24. CrossRef
Isokinetic Trunk Strength in Acute Low Back Pain Patients Compared to Healthy Subjects: A Systematic Review Waleska Reyes-Ferrada, Luis Chirosa-Rios, Angela Rodriguez-Perea, Daniel Jerez-Mayorga, Ignacio Chirosa-Rios International Journal of Environmental Research and Public Health.2021; 18(5): 2576. CrossRef
Physical Abilities in Low Back Pain Patients: A Cross-Sectional Study with Exploratory Comparison of Patient Subgroups Nejc Šarabon, Nace Vreček, Christian Hofer, Stefan Löfler, Žiga Kozinc, Helmut Kern Life.2021; 11(3): 226. CrossRef
Age-Related Changes in Concentric and Eccentric Isokinetic Peak Torque of the Trunk Muscles in Healthy Older Versus Younger Men A. Dallaway, J. Hattersley, J. Tallis, D. Renshaw, C. Griffen, M. Duncan Journal of Aging and Physical Activity.2021; 29(6): 941. CrossRef
Altered Physical Performance Following Advanced Special Operations Tactical Training Joshua D. Winters, Nicholas R. Heebner, Alexa K. Johnson, Kathleen M. Poploski, Scott D. Royer, Takashi Nagai, Carson A. Randall, John P. Abt, Scott M. Lephart Journal of Strength & Conditioning Research.2021; 35(7): 1809. CrossRef
Exercise interventions can improve muscle strength, endurance, and electrical activity of lumbar extensors in individuals with non-specific low back pain: a systematic review with meta-analysis Sacha Clael, Lorrane Freitas Campos, Karina Lisboa Correia, Joana Marcela Sales de Lucena, Paulo Gentil, João Luiz Durigan, Alexandre Lima de Araújo Ribeiro, Wagner Rodrigues Martins Scientific Reports.2021;[Epub] CrossRef
The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis Antonio Cejudo, Josep María Centenera-Centenera, Fernando Santonja-Medina International Journal of Environmental Research and Public Health.2021; 18(16): 8654. CrossRef
Association between Relative Handgrip Strength and Chronic Lower Back Pain: A Nationwide Cross-Sectional Analysis of the Korea National Health and Nutrition Examination Survey Sungwoo Choi, Sangun Nah, Haedong Jang, Jieun Moon, Sangsoo Han International Journal of Environmental Research and Public Health.2021; 18(20): 10770. CrossRef
Trunk Muscle Activation Patterns Differ Between Those With Low and High Back Extensor Strength During a Controlled Dynamic Task D. Adam Quirk, Raymond D. Trudel, Cheryl L. Hubley-Kozey Frontiers in Sports and Active Living.2020;[Epub] CrossRef
Core Stability and Symmetry of Youth Female Volleyball Players: A Pilot Study on Anthropometric and Physiological Correlates Sophia D. Papadopoulou, Amalia Zorzou, Sotirios Drikos, Nikolaos Stavropoulos, Beat Knechtle, Pantelis T. Nikolaidis Symmetry.2020; 12(2): 249. CrossRef
Chronic Fatigue, Physical Impairments and Quality of Life in Women with Endometriosis: A Case-Control Study Francisco Álvarez-Salvago, Ana Lara-Ramos, Irene Cantarero-Villanueva, Maryna Mazheika, Antonio Mundo-López, Noelia Galiano-Castillo, Carolina Fernández-Lao, Manuel Arroyo-Morales, Olga Ocón-Hernández, Francisco Artacho-Cordón International Journal of Environmental Research and Public Health.2020; 17(10): 3610. CrossRef
Increased Liveliness of Trunk Muscle Responses in Elite Kayakers and Canoeists Andrej Kocjan, Nejc Šarabon Sports.2020; 8(6): 78. CrossRef
Evaluation isometric and isokinetic of trunk flexor and extensor muscles with isokinetic dynamometer: A systematic review Jaisson Agne Estrázulas, Jansen Atier Estrázulas, Kelly de Jesus, Karla de Jesus, Rubens A. da Silva, João Otacílio Libardoni dos Santos Physical Therapy in Sport.2020; 45: 93. CrossRef
Physical Performance, Anthropometrics and Functional Characteristics Influence the Intensity of Nonspecific Chronic Low Back Pain in Military Police Officers Janny M. A. Tavares, André L. F. Rodacki, Francielle Hoflinger, Alexandre dos Santos Cabral, Anderson C. Paulo, Cintia L. N. Rodacki International Journal of Environmental Research and Public Health.2020; 17(17): 6434. CrossRef
The Effect of Unicycle Riding Course on Trunk Strength and Trunk Stability Functions in Children Andrej Kocjan, Nejc Sarabon Journal of Strength and Conditioning Research.2020; 34(12): 3560. CrossRef
Do Older Adults and Those Recovered from Low Back Injury Share Common Muscle Activation Adaptations? D. Adam Quirk, Cheryl L. Hubley-Kozey Journal of Motor Behavior.2019; 51(2): 222. CrossRef
Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial Pattanasin Areeudomwong, Vitsarut Buttagat Brazilian Journal of Physical Therapy.2019; 23(5): 428. CrossRef
Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa Marie Doualla, Jeannine Aminde, Leopold Ndemnge Aminde, Fernando Kemta Lekpa, Felix Mangan Kwedi, Emmanuel Vubo Yenshu, Alain Mefire Chichom BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Response the letter to the editor: Incorrect use of PNF-techniques and principles, a response to: Areeudomwong P, Buttagat V. Braz J Phys Ther. 2018 Pattanasin Areeudomwong, Vitsarut Buttagat Brazilian Journal of Physical Therapy.2019; 23(3): 275. CrossRef
Which trunk exercise most effectively activates abdominal muscles? A comparative study of plank and isometric bilateral leg raise exercises Du-Jin Park, Se-Yeon Park Journal of Back and Musculoskeletal Rehabilitation.2019; 32(5): 797. CrossRef
Reliability and agreement of isometric functional trunk and isolated lumbar strength assessment in healthy persons and persons with chronic nonspecific low back pain Jonas Verbrugghe, Anouk Agten, Bert O. Eijnde, Frank Vandenabeele, Liesbet De Baets, Xavier Huybrechts, Annick Timmermans Physical Therapy in Sport.2019; 38: 1. CrossRef
Abdominal trunk muscle weakness and its association with chronic low back pain and risk of falling in older women Satoshi Kato, Hideki Murakami, Satoru Demura, Katsuhito Yoshioka, Kazuya Shinmura, Noriaki Yokogawa, Takashi Igarashi, Noritaka Yonezawa, Takaki Shimizu, Hiroyuki Tsuchiya BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Efficiency of vitamin D supplementation in patients with mechanical low back ache Maheshwar Lakkireddy, Madhu Latha Karra, Chandrasekhar Patnala, Raju Iyengar, Nagesh Cherukuri, K.S. Asif Hussain, Lalith Mohan Chodavarapu, Koppolu Kranthi Kiran Kumar, Sundeep Kund Aluka, Arvind Kumar Bodla, Raja Ramesh Badavath, Shravan Kumar Peddamady Journal of Clinical Orthopaedics and Trauma.2019; 10(6): 1101. CrossRef
Effets d’un programme de renforcement musculaire des extenseurs du rachis chez les triathlètes lombalgiques chroniques. Étude contrôlée randomisée chez 67 sportifs T. Raoul, J. Malfériot, N. Barizien, F.J. Lhuissier Journal de Traumatologie du Sport.2019; 36(3): 183. CrossRef
Can High-Intensity Functional Suspension Training over Eight Weeks Improve Resting Blood Pressure and Quality of Life in Young Adults? A Randomized Controlled Trial Florian A. Engel, Ludwig Rappelt, Steffen Held, Lars Donath International Journal of Environmental Research and Public Health.2019; 16(24): 5062. CrossRef
Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain? Paola Valdivieso, Martino V. Franchi, Christian Gerber, Martin Flück Frontiers in Medicine.2018;[Epub] CrossRef
Early Impact of Postoperative Bracing on Pain and Quality of Life After Posterior Instrumented Fusion for Lumbar Degenerative Conditions Hany A.G. Soliman, Soraya Barchi, Stefan Parent, Gilles Maurais, Alain Jodoin, Jean-Marc Mac-Thiong Spine.2018; 43(3): 155. CrossRef
Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population María Moreno Catalá, Arno Schroll, Gunnar Laube, Adamantios Arampatzis Frontiers in Neuroscience.2018;[Epub] CrossRef
Low handgrip strength is closely associated with chronic low back pain among women aged 50 years or older: A cross-sectional study using a national health survey Sang-Min Park, Gang-Un Kim, Ho-Joong Kim, Hyoungmin Kim, Bong-Soon Chang, Choon-Ki Lee, Jin S. Yeom, Gerardo M. Nava PLOS ONE.2018; 13(11): e0207759. CrossRef
Reliability and Validity of a New Method for Isometric Back Extensor Strength Evaluation Using A Hand-Held Dynamometer Hee-won Park, Sora Baek, Hong Young Kim, Jung-Gyoo Park, Eun Kyoung Kang Annals of Rehabilitation Medicine.2017; 41(5): 793. CrossRef
Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults Albatool H. Alnojeidi, Tammie M. Johnson, Michael R. Richardson, James R. Churilla Spine.2017; 42(16): 1220. CrossRef
Core Training in Low Back Disorders: Role of the Pilates Method Andrew A. Joyce, Dana H. Kotler Current Sports Medicine Reports.2017; 16(3): 156. CrossRef
Atrophy of gluteus maximus among women with a history of chronic low back pain Amy H. Amabile, John H. Bolte, Saskia D. Richter, Miklos S. Kellermayer PLOS ONE.2017; 12(7): e0177008. CrossRef
Effects of a Worksite Supervised Adapted Physical Activity Program on Trunk Muscle Endurance, Flexibility, and Pain Sensitivity Among Vineyard Workers Romain Balaguier, Pascal Madeleine, Kévin Rose-Dulcina, Nicolas Vuillerme Journal of Agromedicine.2017; 22(3): 200. CrossRef
Pelvic Compression Belt Convergence Impact on the Thickness of Multifidus and Erector Spinae Muscles In-Cheol Baek, Jae-Hun Shim Journal of the Korea Convergence Society.2016; 7(5): 51. CrossRef
Effect of Superimposed Electromyostimulation on Back Extensor Strengthening: A Pilot Study Jae Hyeon Park, Kwan Sik Seo, Shi-Uk Lee Journal of Strength and Conditioning Research.2016; 30(9): 2470. CrossRef
Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities Edward A. Shipton, Elspeth E. Shipton Pain Research and Treatment.2015; 2015: 1. CrossRef
Monochromatic Infrared Photo Energy Versus Low Level Laser Therapy in Chronic Low Back Pain Tarek Abdel Rahman Ali Ammar Journal of lasers in medical sciences.2015; 6(4): 157. CrossRef
Trunk extension exercises: How is trunk extensor muscle recruitment related to the exercise dosage? Eline De Ridder, Lieven Danneels, Andry Vleeming, Guy Vanderstraeten, Maarten Van Ranst, Jessica Van Oosterwijck Journal of Electromyography and Kinesiology.2015; 25(4): 681. CrossRef
