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Sajad Bagherian, Khodayar Ghasempoor, Nader Rahnama and Erik A. Wikstrom

standard approach for assessing movement quality that would increase musculoskeletal injury risk. 4 , 5 Athletes need an adequate amount of balance, core stability, and neuromuscular control to safely and effectively perform the necessary movements of their sport. 6 A fundamental movement pattern is a

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Francisco J. Vera-Garcia, Diego López-Plaza, Casto Juan-Recio and David Barbado

Core stability is a popular concept attracting the interest of coaches, athletes, clinicians, and researchers in the last 20 years because of its potential benefits for injury prevention and athletic performance. 1 – 4 Consequently, many different tests have been used to assess core stability in

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David M. Werner and Joaquin A. Barrios

Core stability is considered fundamental for optimized whole-body movement. Functionally, core stability is partly reflected in the ability of the trunk to maintain or return the body to equilibrium when challenged by both expected and unexpected internal and external perturbations. 1 , 2 While no

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Tricia Majewski-Schrage, Todd A. Evans and Brian Ragan

Context:

Despite widespread acceptance, there is currently no consensus on the definition, components, and the specific techniques most appropriate to measure and quantify core stability.

Objective:

To develop a comprehensive core-stability model addressing its definition, components, and assessment techniques.

Design:

Delphi technique.

Setting:

University laboratory.

Participants:

15 content experts from United States and Canada, representing a variety of disciplines.

Main Outcome Measure:

The authors distributed an open-ended questionnaire pertaining to a core-stability definition, components, and assessment techniques specific to each expert. They collected data over 2 rounds of telephone interviews. They concluded data collection once a consensus was achieved that equated with 51% agreement among respondents.

Results:

The authors developed a working definition of core stability as the ability to achieve and sustain control of the trunk region at rest and during precise movement. Eighty-three percent of the experts considered the definition satisfactory. Therefore, the definition was accepted. Furthermore, the experts agreed that muscles (14/15 = 93.3%) and neuromuscular control (8/12 = 66.7%) were components of core stability. Assessment techniques were identified and inconsistencies were highlighted; however, no consensus was established.

Conclusions:

A consensus core-stability definition was created and 2 components were identified. However, of the initial definitions provided by the experts, no 2 were identical, which revealed the inconsistencies among experts and the importance of this study. Nonetheless, the goal of obtaining a consensus definition was obtained. Although a consensus for the assessment techniques of core stability could not be reached, it was a beneficial starting point to identify the inconsistencies that were discovered among the content experts.

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Athanasios Trampas, Anastasia Mpeneka, Vivian Malliou, George Godolias and Periklis Vlachakis

Context:

Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear.

Objective:

To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome.

Design:

Randomized, assessor-blind, test–retest.

Setting:

University research laboratory.

Patients:

10 physically active adults (5 men, 5 women).

Main Outcome Measures:

Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively.

Interventions:

The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP).

Results:

Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side.

Conclusion:

CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.

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Yi-Ju Tsai, Chieh-Chie Chia, Pei-Yun Lee, Li-Chuan Lin and Yi-Liang Kuo

participation in volleyball grows, it is necessary to have effective prevention programs for knee injuries in volleyball athletes. Core stability is defined as the ability to control the position and movement of the trunk over the pelvis. 5 Anatomically, the region between the diaphragm, abdominal muscles

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Marisa A. Colston

Edited by Monique Mokha

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Marisa A. Colston

Edited by Monique Mokha

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Barton E. Anderson and Kellie C. Huxel Bliven

Clinical Scenario:

Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.

Focused Clinical Question:

In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?

Summary of Key Findings:

Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.

Clinical Bottom Line:

Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.

Strength of Recommendation:

Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.