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Background Children with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS. Methodology 28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively. Results Children with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS. Discussion Children with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support. Conclusion Children with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.

Purpose: Respiratory muscles play a dual role in breathing and trunk stability during activities. The relationship between respiratory muscle functions and trunk stability has not yet been clarified. The aim of the study was to examine the effects of respiratory muscle functions on trunk muscle endurance in healthy young adults. Methods: McGill's trunk muscle endurance tests, which consist of trunk flexion endurance test (FE), Sorensen test (ST) and Side Bridge test (SB), were used to evaluate the participants' trunk muscle endurance. Respiratory muscle strength was evaluated by measuring intraoral maximal inspiratory and expiratory pressures using an intraoral pressure meter device. The respiratory muscle endurance test was performed with the incremental threshold load protocol using a threshold IMT device. Results: A total of 51 healthy young adults, with a mean age of 21.8 ± 3.2 years, were evaluated. The results of the linear regression models were significantly explained 46% of the variance in the SB and 38% in the FE, (for SB Adj R2=0.46, F=21.40, p< 0.001 and for FE Adj R2=0.38, F=15.65, p< 0.001). Respiratory muscle endurance contributed 30% to the endurance of the trunk flexor muscles, while respiratory muscle strength contributed only 8%. Similarly, respiratory muscle endurance contributed 38% to the endurance of the trunk lateral flexor muscles, while respiratory muscle strength contributed only 8%. Conclusion: Although respiratory muscle strength and respiratory muscle endurance were independent contributors to trunk muscle endurance, respiratory muscle endurance more affected trunk muscle endurance than respiratory muscle strength in healthy young adults.

This study investigated age-related changes in trunk muscle function in healthy men and the moderating effect of physical activity. Twelve older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) men performed isokinetic trunk flexion and extension tests across a range of angular velocities (15°/s–180°/s) and contractile modes (concentric and eccentric). For concentric trunk extension, mixed-effects analysis of covariance revealed a significant interaction between Angular velocity × Age group (p = .026) controlling for physical activity. Follow-up univariate analysis of covariance revealed that the younger group produced significantly greater peak torque for all concentric extension conditions. Eccentric trunk strength was somewhat preserved in the older group. Age-related changes in trunk strength were independent of physical activity. The normal loss of trunk muscle strength in older age is muscle- and contractile-mode specific. These findings provide guidance for effective intervention strategies to offset adverse health outcomes related to trunk strength loss in older adults.

Made available in DSpace on 2022-05-01T09:31:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). Design: Cross-sectional. Setting: Laboratory-based study. Participants: 110 females and 38 males with PFP, 61 females and 31males without PFP. Main outcome measures: Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. Results: Lower anterior and lateral trunk muscle endurance were identified in females (p

BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) requires complex medical care because of multiple consequences especially on daily activities. Muscular involvement is part of the problem and may be treatable. OBJECTIVE: To analyze trunk muscle strength using an isokinetic dynamometer in female adolescents with AIS one year after orthopedic treatment by brace and compare the findings to a matched group of an asymptomatic cohort. METHODS: The trunk flexors and extensors strength was measured using an isokinetic dynamometer at 60, 90 and 120∘/s. Peak Moment (PM), Mean Power (MP) and the flexor/extensor ratio in 100 patients aged 14 to 18 years old were compared to a control group (N= 32) of asymptomatic age-matched females. In the AIS group, correlation analyses were computed to search for contributing factors to isokinetic performances, including morphological characteristics of patients, as well as clinical and radiological characteristics of the scoliosis. RESULTS: The trunk flexors in the AIS group were significantly but moderately (15%) weaker across speeds compared to their control counterparts at all speeds. No parallel weakness was noted for the extensors. While the MP of AIS patients was significantly weaker than that of the controls, 33% for flexors and by 31% for extensors, no significant differences were observed for the F/E ratios. The correlational analyses has indicated that weight and BMI were contributing factors at all speeds. CONCLUSION: Adolescents with AIS had weaker trunk extensors and mostly flexors compared to healthy females. Within this AIS population, weight and BMI seem to have a negative impact on muscular performances, whereas clinical and radiological characteristics of the scoliosis do not seem to contribute.

Lateral trunk muscles may contribute to the excessive ipsilateral trunk lean, which is a mechanical alteration related to impairment in hip and knee kinematics. This study aimed to investigate if hip and knee kinematics, lateral abdominal muscle thickness, and trunk muscle endurance are associated differently in men and women. Forty-six participants (27 men and 19 women) completed the following assessments: (1) lateral abdominal muscles thickness [external oblique + internal oblique + transversus abdominis] measured with ultrasound; (2) hip adduction (HADD) and knee frontal plane projection angle (FPPA) during single-leg squat; (3) muscle endurance in the side plank test. We did not find significant associations between HADD and lateral abdominal muscle thickness (men: r = 0.205; p = 0.315; women: r = 0.358; p = 0.145) or side plank time (men: rs = − 0.102; p = 0.614; women: rs = 0.391; p = 0.098). Moreover, no significant associations were found between FPPA and lateral abdominal muscle thickness (men: r = 0.012, p = 0.953; women: r = 0.326, p = 0.186) or side plank time (men: rs = 0.087, p = 0.667; women: rs = 0.319, p = 0.184). A strong association between lateral abdominal muscle thickness and muscle endurance was found only in women (r = 0.683; p = 0.002). Hip and knee kinematics were not associated with lateral abdominal muscle structure or endurance in men and women. Muscle structure seems to be associated with time to exhaustion in a side plank test only in women.

Study design Numerical in-silico human spine stability finite element analysis. Objective The purpose of this study was to investigate the contribution of major torso tissues toward static spine stability, mainly the thoracolumbar fascia (TLF), abdominal wall with its intra-abdominal pressure (IAP), and spinal muscles inclusive of their intramuscular pressure. Summary of background data Given the numerous redundancies involved in the spine, current methodologies for assessing static spinal stability are limited to specific tissues and could lead to inconclusive results. A three-dimensional finite element model of the spine, with structured analysis of major torso tissues, allows for objective investigation of static spine stability. Methods A novel previously fully validated spine model was employed. Major torso tissues, mainly the muscles, TLF, and IAP were individually, and in combinations, activated under a 350N external spine perturbation. The stability contribution exerted by these tissues, or their ability to restore the spine to the unperturbed position, was assessed in different case-scenarios. Results Individual activations recorded significantly different stability contributions, with the highest being the TLF at 71%. Combined or synergistic activations showed an increase of up to 93% stability contribution when all tissues were simultaneously activated with a corresponding decrease in the tensile load exerted by the tissues themselves. Conclusion This investigation demonstrated torso tissues exhibiting different roles toward static spine stability. The TLF appeared able to dissipate and absorb excessive loads, the muscles acted as antagonistic to external perturbations, and the IAP played a role limiting movement. Furthermore, the different combinations explored suggested an optimized engagement and coordination between different tissues to achieve a specific task, while minimizing individual work.Level of Evidence: N/A.

Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%–20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤ .003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P P ≥ .790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity.

الملخص: أهداف البحث: تقييم ذروة عزم الدوران ومتوسط قوة العضلات القابضة والباسطة للعمود الفقري لدى المراهقين الذين تتراوح أعمارهم بين ١٢ ١٨ عاما ومعرفة ما إذا كان هناك اختلاف في أداء عضلات الجذع باختلاف نوع مؤشر كتلة الجسم. طرق البحث: تم قياس ذروة عزم الدوران ومتوسط قوة العضلات القابضة والباسطة للعمود الفقري لدى ١٨٠ شخصا (تتراوح أعمارهم من ١٢ إلى ١٨ عاما) تم تصنيفهم الى أربع مجموعات وفقا لمؤشر كتلة الجسم. كما تم إجراء التقييم باستخدام جهاز الايزوكينيتك حيث تم تقييم ذروة عزم الدوران ومتوسط قوة العضلات القابضة والباسطة للعمود الفقري بسرعات ٦٠ درجة و١٢٠ درجة / ثانية. وتم تحليل البيانات باستخدام تحليل التباين متعدد الاتجاهات لتحديد ما إذا كانت هناك أي فروق ذات دلالة إحصائية بين المجموعات الأربع. النتائج: أشارت نتائج تحليل التباين متعدد الاتجاهات إلى انخفاض في قوة عضلات الجذع مع زيادة مؤشر كتلة الجسم. وكذلك أوضحت النتائج ارتفاعا ملحوظا في عزم الدوران ومتوسط قوة عضلات الجذع في مجموعة الأشخاص ذوي الوزن الطبيعي مقارنة بالأشخاص الذين يعانون من نقص الوزن وزيادة الوزن والسمنة. وأيضا أظهرت نتائج معامل ارتباط بيرسون وجود ارتباطا معنويا سلبيا بين الوزن وعزم دوران الذروة للعضلات القابضة والباسطة للعمود الفقري. وكان هناك ارتباط سلبي ملحوظ بين الوزن ومتوسط قوة هذه العضلات. الاستنتاجات: خلصت هذه الدراسة إلى وجود علاقة سلبية بين مؤشر كتلة الجسم وعزم الدوران الأقصى ومتوسط قوة عضلات الجذع والعضلات القابضة والباسطة للظهر. وبالتالي يجب أن تتضمن برامج إعادة التأهيل للمراهقين الذين يعانون من زيادة الوزن والسمنة برنامج لتقوية عضلات الظهر بهدف تحسين فاعلية تلك التدخلات العلاجية وبالتالي تحسين نوعية حياة هؤلاء الأشخاص. Abstract: Objective: This study aims to evaluate the isokinetic performance for the peak torque and average power of the spinal flexor and extensor muscles in adolescents aged 12 to 18 years. The study also analyses the differences between the trunk muscle peak torque and average power with body mass index (BMI). Method: The peak torque and average power of the trunk flexor and extensor muscles were measured in 180 adolescents (aged 12–18 years). The participants were classified into four groups according to BMI. The Biodex isokinetic dynamometer in concentric mode at speeds of 60° and 120°/sec was used for assessment. Results: One-way multivariate analysis of variance MANOVA results demonstrated a significant difference in trunk muscle peak torque and average power with different BMI (F = 14.692, p = 0.0005). A Pearson's correlation analysis demonstrated a significantly negative correlation between weight and peak torque of trunk flexors and extensors (r = - 0.43, p = 0.0001; r = −0.31, p = 0.007, respectively). Finally, the results showed a negative correlation between weight and average power of trunk flexors and extensors (r = −0.54, p = 0.0001; r = −0.31, p = 0.007). Conclusion: In this study, overweight and obese adolescents are found to be correlated with decreased trunk muscle torque and power. Thus, therapeutic interventions for overweight and obese adolescents, along with exercise training programmes, may help improve muscle performance including peak torque and power. Finally, these measures may enhance the quality of life of such adolescents.

Background The active hip abduction test (AHAbd) is widely used to evaluate lumbopelvic stability, but the onset of trunk muscle activation during the test in individuals with recurrent low back pain (rLBP) has not been investigated so far. It is important to investigate the pattern of trunk muscle activation during the AHAbd test to provide insight into the interpretation of observation-based assessment results; this may help to create exercise therapy interventions, from a movement control perspective, for people seeking treatment for rLBP. The purpose of this study was to compare the timing of trunk muscle activation between individuals with and without rLBP and to assess potential differences. Methods Seventeen subjects in remission from rLBP and 17 subjects without rLBP were recruited. We performed surface electromyography of the transversus abdominis/internal abdominal oblique, external oblique, erector spinae, and gluteus medius muscles during the AHAbd test on both sides. The onset of trunk muscle activation was calculated relative to the prime mover gluteus medius. The independent-samples t- and Mann-Whitney U tests were used to compare the onset of trunk muscle activation between the two groups. Results The onset of transversus abdominis/internal abdominal oblique activation on the ipsilateral (right AHAbd: −3.0 ± 16.2 vs. 36.3 ± 20.0 msec, left AHAbd: −7.2 ± 18.6 vs. 29.6 ± 44.3 ms) and contralateral sides (right AHAbd: −11.5 ± 13.9 vs. 24.4 ± 32.3 ms, left AHAbd: −10.1 ± 12.5 vs. 23.3 ± 17.2 ms) and erector spinae on the contralateral side (right AHAbd: 76.1 ± 84.9 vs. 183.9 ± 114.6 ms, left AHAbd: 60.7 ± 70.5 vs. 133.9 ± 98.6 ms) occurred significantly later in individuals with rLBP than in individuals without rLBP (p 0.05). Conclusions Our results suggest that individuals with rLBP possess a trunk muscle activation pattern that is different from that of individuals without rLBP. These findings provide an insight into the underlying muscle activation patterns during the AHAbd test for people with rLBP and may support aggressive early intervention for neuromuscular control.

This study investigated whether artificial gravity (AG), induced by short-radius centrifugation, mitigated deterioration in standing balance and anticipatory postural adjustments (APAs) of trunk muscles following 60-day head-down tilt bed rest. Twenty-four participants were allocated to one of three groups: control group (N=8); 30 minutes continuous AG daily (N=8); intermittent 6x5 minutes AG daily (N=8). Before and immediately after bed rest, standing balance was assessed in four conditions: eyes open and closed on both stable and foam surfaces. Measures including sway path, root-mean-square, and peak sway velocity, sway area, sway frequency power, and sway density curve were extracted from the centre of pressure displacement. APAs were assessed during rapid arm movements using intramuscular or surface electromyography electrodes of the rectus abdominis, obliquus externus and internus abdominis, transversus abdominis, erector spinae at L1, L2, L3, and L4 vertebral levels, and deep lumbar multifidus muscles. The relative latency between the EMG onset of the deltoid and each of the trunk muscles was calculated. All three groups had poorer balance performance in most of the parameters (all P

This study aimed to investigate the effect of the load and bar position on trunk and lower extremity muscle activity during squat exercise. High bar back squats (HBBS) and low bar back squats (LBBS) were performed in random order at 50%, 60%, and 70% loads of one repetition maximum by 28 experienced healthy adult men who had been performing squats for at least one year. Before the experiment, the maximal voluntary contraction of the vastus medialis, vastus lateralis, rectus femoris, biceps femoris, rectus abdominis, transverse abdominis, external oblique, and erector spinae muscles was measured by means of surface electromyography. In addition, eccentric and concentric exercises were performed for 3 s each to measure the muscle activity. There was a significant difference in muscle activity according to the load for all muscles in the eccentric and concentric phases (p < 0.05), indicating that muscle activity increased as the load increased. In addition, in the comparison between HBBS and LBBS, significant differences were shown in all lower extremity muscles and all trunk muscles except for the external oblique in the concentric phase according to the bar position (p < 0.05). HBBS showed a higher muscle activity of the lower extremity in the eccentric and concentric phases than in LBBS, while LBBS showed a higher muscle activity of the trunk muscle in the eccentric and concentric phases than in HBBS (p < 0.05). HBBS requires more force in the lower extremity than LBBS and is particularly advantageous in strengthening the muscular strength of the quadriceps. In contrast, LBBS requires more muscle activity in the trunk than HBBS and is more effective in carrying heavier loads because of the advantage of body stability. This study suggests that rehabilitation experts apply the bar position and load as important variables affecting the intensity and method of training for target muscle strengthening of the lower extremities and trunk.

Objetivos: Verificar o comportamento da força muscular de extensores e flexores do tronco conforme a idade e o nível de atividade física, além de comparar jovens inativas vs. idosas ativas sobre a força muscular. Métodos: Participaram da pesquisa 28 jovens e 30 idosas inativas fisicamente, as quais posteriormente se tornaram ativas, com a inclusão de atividade física em suas rotinas. As participantes foram avaliadas quanto à força isométrica máxima dos músculos extensores e flexores do tronco, por meio da utilização de uma célula de carga conectada a um assento estável de madeira, que isolou musculatura do quadril de maneira a ativar a musculatura do tronco. Testes t para amostras dependentes e independentes foram utilizados para a análise em relação a idade e o nível de atividade física. O nível de significância adotado foi ≤ 5%. Resultados: Quanto à força dos extensores e flexores do tronco, mulheres jovens e idosas ativas fisicamente possuíam um maior nível de força quando comparadas à condição inativa. Com relação a comparação entre jovens inativas e idosas ativas, foi verificado que as idosas apresentaram níveis semelhantes de força dos músculos extensores quando comparadas com as jovens. Conclusão: A força de flexores e extensores do tronco é influenciada pelos fatores idade e nível de atividade física. Idosas ativas fisicamente possuem o mesmo nível de força dos músculos extensores do tronco que mulheres jovens inativas.

BACKGROUND: During one-leg standing (OLS), optimum activity of the gluteus medius (Gmed), multifidus (MF), and quadratus lumborum (QL) muscles relies upon maintaining neutral lumbopelvic alignment. However, no studies have examined how using pressure biofeedback during OLS affects the activity of these muscles and the concomitant alignment of the pelvis and trunk. OBJECTIVES: The purpose of this study was to investigate the effect of pressure biofeedback on the activity of the Gmed, MF, and QL and the femoropelvic and trunk lean angles during OLS. METHODS: Twenty-four healthy males performed OLS with (PB+) and without (PB-) pressure biofeedback. For all OLS conditions, a pressure sensor was placed between the lateral surface of the humerus on the non-supporting side and the wall. Under the PB- condition, participants performed preferred OLS while the examiner measured the maximum pressure caused by trunk lean. Under the PB+ condition, participants were asked to perform at a threshold of 50% of the maximal pressure (PB+ 1 condition) and with minimal change in pressure (PB+ 2 condition). Muscle activities of MF, QL, and Gmed as well as the femoropelvic and trunk lean angles were measured under various OLS conditions. RESULTS: The activity of the Gmed, MF, and QL was greater under both PB+ conditions than under the PB- condition (p< 0.05). Also, both PB+ conditions resulted in a greater femoropelvic angle and reduced trunk lean angle. There were no significant differences in muscle activity, femoropelvic angle, or trunk lean angle between PB+ 1 and PB+ 2 (p> 0.05). CONCLUSIONS: These results suggest that pressure biofeedback is a useful modality for increasing the activity of the Gmed and trunk muscles, especially the MF muscle on the non-supporting leg side, and for preventing compensatory movements such as trunk deviation and pelvic lateral deviation during OLS.

OBJECTIVES Relationships between stress urinary incontinence (SUI) and physical function and spinal alignment have not been fully elucidated; therefore, we examined these relationships in older women. METHODS The participants of this cross-sectional study comprised 21 women with SUI (SUI group) and 41 continent women (continent group) aged >65 years who participated in a community-based health-check survey from 2018 to 2019. We examined age, body mass index, number of deliveries, age at first childbirth, and medical histories as participants' characteristics. SUI was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). We also assessed spinal alignment and physical activity, grip strength, trunk and lower limb muscle mass, gait speed, and one-leg standing time as measures of participants' physical function. RESULTS Body mass index was significantly higher in the SUI group compared with continents (P = 0.04), and trunk muscle mass in the SUI group was significantly lower (P

BACKGROUND AND OBJECTIVE: This study investigated whether equine riding affects static or dynamic mechanical contractions on the thighs and trunk muscles in inactive women. METHODS: Participants consisted of 30 women with a mean (SD) age of 21.06 (0.44) years. They were randomly allotted as follows: equine group (EQG, n= 15) and control group (CON, n= 15). Two types of muscle contraction properties in their thighs and trunk were measured through a tensiomyography (static muscle tester) and an isokinetic device (dynamic muscle tester), respectively. Using the body weights of EQG and CON as covariates, a 2-way between-groups multivariate analysis of covariance was used to investigate group differences in the mechanical quantification of the thighs and trunk. RESULTS: The effectiveness of 8 weeks of equine riding was hardly observed in a static muscle test, whereas in the dynamic muscle test, the dominant and non-dominant hip extensor/flexor, the dominant hip abductor/adductor, and trunk extensor in the EQG showed a significant increase, compared to no changes in the CON. CONCLUSIONS: This study did not find any particular differences in a static muscle test in inactive women, but showed improvements in the dynamic mechanical properties of the thighs and trunk, which are major muscle groups related to spinal alignment.

[Purpose] Although lifting tasks has been recognized as a primary risk factor in low back pain, the concept of lifting asymmetry is relatively new subject. To address trunk function, biomechanical studies generally measure trunk muscle activity using surface electromyography (EMG). But so far, magnitude and similarity index (SI) obtained from EMG have not been studied as indicators of the motor control during lifting task. So, the purpose of this study is to compare the trunk muscles magnitude and SI during symmetric and asymmetric lifting. [Subjects and Methods] A total of 20 healthy male with no history of lumbar spine disorders participated. Surface electromyography data were recorded from the 7 trunk muscles while the participants performed symmetric and asymmetric lifting and lowering different loads. [Results] According to Multivariate ANOVAs the phase of motion (lifting, lowering) and condition (symmetry, asymmetry) have a significant effect on SI and magnitude (p≤0.05). Load changes have no effect on SI (p=0.969) but have a significant effect on magnitude (p≤0.05). The magnitude and SI value is higher in asymmetrical lifting and lowering compare to symmetrical condition. [Conclusion] The findings reveal the SI value is higher in asymmetric conditions. This means that the amount of muscles co-contracture increased during asymmetrical conditions. Increased muscles co-contracture reinforces the hypothesis of exerting more compression on the spine in asymmetrical movement. Keywords: Asymmetrical lifting, Motor control, Electromyography

Inspite of common lifting advice to maintain a lordotic posture, there is debate regarding optimal lumbar spine posture during lifting. To date, the influence of lumbar posture on trunk muscle recruitment, strength and efficiency during high intensity lifting has not been fully explored.How do differences in lumbar posture influence trunk extensor strength (moment), trunk muscle activity, and neuromuscular efficiency during maximal lifting?Twenty-six healthy participants adopted three lumbar postures (maximal extension (lordotic), mid-range (flat-back), and fully flexed) in a free lifting position. Motion analysis and force measurements were used to determine the back extensor, hip and knee moments. Surface electromyography (EMG) of three trunk extensors and the internal obliques were recorded. Neuromuscular efficiency (NME) was expressed as a ratio of normalised extensor moment to normalised EMG.Significantly higher back extensor moments were exerted when moving from an extended to mid-range, and from a mid-range to fully flexed lumbar posture. This was accompanied by a decrease in activity across all three back extensor muscles (P 0.001) resulting in a higher NME of these muscles in more flexed postures. Change in lumbar posture did not influence hip or knee moments or internal oblique activation.A flexed-back posture is associated with increased strength and efficiency of the back muscles compared to a lordotic posture. These findings further question the manual handling advice to lift with a lordotic lumbar spine.

The functional importance of trunk muscle strength for running movement is widely recognised, but the kinematic effects of undertaking specific training are unclear. This study investigated the change in joint angle and its variability during running following trunk muscle training. Eighteen young female and novice runners participated. Using Plug-in-gait model with infrared markers attached to the body surface, the lower limb and lumber angles during running were measured, and the variability was examined by calculating the coefficient variation and Lyapunov exponent. Measurements of trunk endurance were also performed. Over four weeks of training, the subjects performed trunk muscle endurance trainings three times a week. Following this intervention, trunk endurance was found to have significantly increased. The Lyapunov exponent of lumbar flexion-extension angle also significantly increased. Moreover, a decreased range of the ankle angle and increased range of the hip angle were observed following the training. These results demonstrate that the trunk training promoted adjustments to lumbar movement and altered the movement patterns of the participants' lower limbs during running.

Research examining the measurement of trunk muscle strength after stroke is limited and diverse. This review, therefore, was undertaken to summarize research addressing what is known about measurements of trunk muscle strength after stroke.Potentially relevant research was identified via 3 electronic database searches and a hand search. The research was examined for information on patients, measurement procedures and study findings. Findings regarding measurement properties (ie, validity, reliability, and responsiveness) were of particular interest.Searches identified 260 potentially relevant articles of which 28 met inclusion and exclusion criteria. Research involving diverse populations and measurement procedures demonstrates that trunk muscle strength is impaired after stroke. Many studies show that measurements of trunk muscle strength have known-groups/conditions and convergent validity with balance and performance of functional activities. The literature also supports the reliability of measurements of trunk strength after stroke. Little is known regarding the responsiveness of the measurements.Trunk strength is commonly impaired after stroke. As weakness of the trunk muscles can affect balance and function, it may warrant routine measurement.

Slackline challenges balance by walking on a tensioned strap, where the trunk muscles help to maintain or regain balance. This study aimed to compare a cohort of individuals who regularly practiced slackline and physically inactive individuals on core endurance (CE) and dynamic balance (DB) and to determine whether CE is associated with years of slackline practice. Nine individuals (7 men) who practiced slackline regularly (SG; age= 24.5±3.6 years) and nine physically inactive individuals (7 men) (CG; age= 23.2±3.3 years) were compared. CE was assessed with the McGill battery (trunk flexor, extensor, and side-bridge test) and the plank test. DB was measured with the modified star excursion balance test in stable and unstable conditions. The SG maintained a 36.2% and 45% longer time in left lateral bridge (p=.049) and plank (p=.031), respectively, compared to the CG. The distance achieved in the stable DB test was similar between groups, but in unstable condition was 37.8% greater (p=.016) in SG in both legs and 46.6% greater in the non-dominant leg (p=.039) compared to CG. The SG showed a correlation between years of slackline practice and flexor (r=.674; p=.046), right lateral (r=.765; p=.016) and left (r=.730; p=.026) trunk endurance. In conclusion, those who practice slackline maintain a longer time in the plank and left lateral bridge test and achieve a higher reach distance in unstable DB compared to physically inactive individuals who do not practice slackline. Resumen. El slackline desafía el equilibrio al caminar sobre una cinta en tensión, donde los músculos del tronco ayudan a mantener o recuperar el equilibrio. El objetivo de este estudio fue comparar individuos que practicaban slackline e individuos inactivos fisicamente (IF) en resistencia del core (RC) y equilibrio dinámico (ED), y conocer si la RC se asocia a los años de practica de slackline. Nueve individuos (7 hombres) que practicaban slackline regularmente (GS; edad= 24.5±3.6 años) y nueve individuos IF (7 hombres) (GC; edad= 23.2±3.3 años) fueron comparados. La RC se evaluó con la bateria de McGill (prueba de flexores y extensores de tronco y puente lateral) y la prueba de la plancha. El ED se midió con la prueba de excursión de la estrella modificada en condiciones estables e inestables. El GS mantuvo un tiempo 36.2% y 45% mayor en puente lateral izquierdo (p=.049) y plancha (p=.031) respectivamente comparado con el GC. La distancia alcanzada en la prueba de ED estable fue similar entre grupos, pero en condición inestable fue 37.8% mayor (p=.016) en GS en ambas piernas y 46.6% mayor en la pierna no dominante (p=.039) comparado al GC. El GS mostró una correlación entre años de práctica de slackline y resistencia flexora (r=.674; p=.046), lateral derecha (r=.765; p=.016) e izquierda (r=.730; p=.026) de tronco. En conclusión, quienes practican slackline mantienen un tiempo mayor la prueba de la plancha y puente lateral izquierdo y logran un mayor alcance en ED inestable comparados con individuos IF que no lo practican.

Background: At high level of competition, sports require long periods of hard physical work. Each athlete should be able to perform desired actions efficiently, which will not be possible without coordinated activation of muscles in the kinetic chain. EMG studies demonstrate that lumbar paraspinal muscles fatigue is associated with Quadriceps Inhibition (QI), leading to speculation that these changes may not only have adverse effect for athletic performance but also increase the risk of injury in long term. This contrasts the evidence about the influence of fatigue on trunk muscles reflex activity. Method: 37 athletes (men) were recruited from city soccer clubs. The participants performed sub maximal isometric exercise of lower back extensors (Ito’s test) to induce fatigue. The two protocols were a single bout and repeated bouts of Lumbar Extension Isometric Exercise (LEIE). The Agility scores recorded at baseline, after single bout and after repeated bouts of LEIE were compared. Conclusion: The two experimental interventions differently affected the agility performance in the sample. On one hand, single bout intervention led to improved performance, repeated bout intervention resulted in relative deterioration of performance.

Neck pain is one of the most common musculoskeletal complaints. Evidence suggests that increased activities of neck and trunk muscles are one of the mechanisms related to neck pain. Jaw clenching and sitting posture may modulate the muscle activity in neck and trunk muscles during typing. The present study aimed to assess the effects of different postural positions and clenching conditions on neck and trunk muscle activities. Thirteen healthy adults (39.8 ± 5.0 years) performed computer typing tasks in four conditions (two postural positions [upright vs slouched] and two jaw clenching conditions [clenching vs non-clenching]). Integrated surface electromyography (iEMG) was measured in sternocleidomastoid (SCM), upper trapezius (uTP) and middle trapezius (mTP) muscles and compared between conditions. The Friedman and Wilcoxon signed-rank tests with Bonferroni's corrections were used to estimate the condition-specific differences in the iEMG data. The statistical significance level was set at 5%. In both postural positions, iEMGSCM was significantly greater under the jaw clenching than under the non-clenching condition (χ2 = 21.700, P

[Purpose] This study aimed to clarify the required number of measurements to calculate trunk muscle thickness at each position. [Participants and Methods] The participants were 30 elderly males aged >65 years. The right lumbar multifidus (L2), lumbar multifidus (L5), erector spinae, transversus abdominis, internal oblique, and external oblique muscle thicknesses were measured on longitudinal images obtained using ultrasonography in the lying, sitting, and standing positions. Two measurement values for each muscle thickness was used to calculate the intraclass correlation coefficient (1.1–1.5). [Results] The intraclass correlation coefficients of the abdominal muscle thickness measurements with “great reliabilities” were as follows: 1.3–1.5 for the external oblique muscle and 1.2–1.5 for the internal oblique and transversus abdominis muscles in the lying position; 1.3–1.5 for the external oblique and transversus abdominis muscles and 1.2–1.5 for the internal oblique muscle in the sitting position; the intraclass correlation coefficient in the standing position was 1.5 for the external oblique muscle 1.1–1.5 for the internal oblique muscle and 1.3–1.5 for the transversus abdominis muscle. In all the positions, the intraclass correlation coefficient of the measurements of the back-muscle thicknesses ranged from 1.1 to 1.5 for the right lumbar multifidus (L2), lumbar multifidus (L5), and erector spinae. [Conclusion] Depending on the posture, the abdominal muscles require multiple measurements, whereas the back muscles only require a single measurement.

[Purpose] The external and internal abdominal muscles may be related to gait speed; however, this has not yet been elucidated. In this study, we aimed to clarify the relationship between gait speed and trunk muscle thickness in elderly individuals. [Participants and Methods] The participants were 12 elderly individuals (4 males and 8 females, mean age 83.4 years old, SD ± 0.5) that attend a day service center. We measured the 5 m free gait speed, the 5 m fastest gait speed, and the thickness of five trunk muscles (the rectus abdominis [divided into three parts: upper, central, and lower], external oblique, internal oblique, transverse abdominis, and iliopsoas muscles). [Results] There were positive correlations between the free gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. There were also positive correlations between the fastest gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. [Conclusion] Incorporating muscle strength training of the lower rectus abdominis, internal oblique, and transverse abdominis muscles into existing lower limb muscle training protocols is important to effectively maintain the gait speed of elderly individuals.

[Purpose] To clarify the effects of longitudinal changes in older adults by evaluating the relationship between changes in spinal kyphosis and respiratory function over time in patients with certified need of care in the long-term care insurance system. [Participants and Methods] We included 57 older adults (28 males and 29 females) aged ≥65 years who were identified as requiring long-term care or support. The participants were community-dwelling individuals undergoing ambulatory rehabilitation. We assessed the longitudinal changes in spinal kyphosis index, respiratory function and muscle strength, and body composition over 1 year. [Results] The spinal kyphosis index was 10.5 at the first measurement and 14.6 at 1 year after the first measurement, showing a significant increase. We did not detect any significant differences in respiratory function and muscle strength, or body composition. [Conclusion] This 1 year longitudinal comparison suggests that the spinal kyphosis indexes were high, and the respiratory function and trunk muscle mass remained unchanged. Therefore, the relationships were negligible.

[Purpose] This study aimed to compare the results of two questionnaires administered in 2013 and 2020, on the level of awareness and understanding of trunk muscle training. [Participants and Methods] In total, 238 soccer club members in high schools responded to our questionnaire regarding trunk muscle training. Two teams were recruited from the top (top 4), middle (top 16), and bottom levels (first-round losers), according to the prefectural tournament's results in 2019. This questionnaire comprised questions divided into four parts: 1. Prevalence of trunk muscle training; 2. Knowledge of the classification of trunk muscles (local and global); 3. Consciousness of local and global muscles during trunk muscle training; and 4. Knowledge of the role of each muscle. These results were compared to those obtained from the survey in 2013. [Results] A significant difference was observed only in the responses to question 2. Regarding question 2 in 2020, several student-athletes in the top-level teams were aware of muscle classification compared to those in the middle- and lower-level teams. [Conclusion] The number of athletes who understood the classification of trunk muscles increased significantly in 2020. Therefore, in the future, we would need to better educate young athletes concerning the purpose of trunk muscle training and the role of each muscle.

In recent years, several studies have investigated upper-limb motion in a variety of scenarios including motor control, physiology, rehabilitation and industry. Such applications assess people’s kinematics and muscular performances, focusing on typical movements that simulate daily-life tasks. However, often only a limited interpretation of the EMG patterns is provided. In fact, rarely the assessments separate phasic (movement-related) and tonic (postural) EMG components, as well as the EMG in the acceleration and deceleration phases. With this paper, we provide a comprehensive and detailed characterization of the activity of upper-limb and trunk muscles in healthy people point-to-point upper limb movements. Our analysis includes in-depth muscle activation magnitude assessment, separation of phasic (movement-related) and tonic (postural) EMG activations, directional tuning, distinction between activations in the acceleration and deceleration phases. Results from our study highlight a predominant postural activity with respect to movement related muscular activity. The analysis based on the acceleration phase sheds light on finer motor control strategies, highlighting the role of each muscle in the acceleration and deceleration phase. The results of this study are applicable to several research fields, including physiology, rehabilitation, design of robots and assistive solutions, exoskeletons., Graphical abstract Image 1, Highlights • Upper-limb motion is assessed with kinematics and EMG in many scenarios: motor control, physiology, rehabilitation, industry • Separation of phasic (movement-related) and tonic (postural) EMG, and of acceleration and deceleration phases • Comprehensive and detailed characterization of the EMG of upper-limb and trunk muscles in point-to-point upper limb movements • EMG magnitude assessment, phasic and tonic EMG activations, directional tuning, acceleration and deceleration phases

Background: Patients with low back pain (LBP) experience misalignments in the center of pressure (COP) and muscle imbalances due to frequent onesided posture adjustments to avoid pain.Objectives: To identify the effects of Squat Exercises with Vertical Whole-Body Vibration on the Center of Pressure and Trunk Muscle Activity.Design: Randomized controlled trial.Methods: Thirty LBP patients with an imbalance in the COP were sampled and randomly assigned to an experimental group of 15 patients who under went an intervention involving squat exercises with vertical WBV and a control group of 15 patients who were treated via a walking intervention. As pretests before the interventions, the subjects’ COP was identified by measuring their stability index (ST), and erector spinae, rectus abdominis, transverse abdominis, gluteus medius muscle activity was analyzed by determining the % reference voluntary contraction (%RVC) value using surface electromyography while sit to stand. After four weeks, a post test was conducted to remeasure the same variables using the same methods.Results: Statistically significant differences were found in the ST (P

Background A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL. Methods In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed. Results When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p p p Conclusions We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.

Exercise is the most common conservative intervention for chronic low back pain (CLBP). We have developed an innovative exercise device for the abdominal trunk muscles that also measures muscle strength in a sitting position. The device, which is easy for patients with CLBP to use, allows for lumbar stabilization exercise under pressure. This study aimed to examine the efficacy of abdominal trunk muscle strengthening using the device in improving CLBP. We conducted a two-group non-randomized controlled clinical trial. CLBP patients were allocated into two groups. The strengthening group underwent a 12-week exercise program that included abdominal trunk muscle strengthening using our device and stretching exercises, while the control group received a 12-week stretching exercise program. The outcome measures included the improvement of the abdominal trunk muscle strength measured by the device, pain intensity of CLBP, physical function, and quality of life (QOL). A total of 40 participants (20 in each group) were analyzed. The strengthening group showed better improvement in the abdominal trunk muscle strength, CLBP, physical function, and QOL than in the control group. In conclusion, the strengthening exercise using the device with easy stretching was effective in improving the strength of the abdominal trunk muscles, pain intensity of CLBP, physical function, and QOL.

Objective: In wheelchair rugby (WR) athletes with tetraplegia, wheelchair performance may be impaired due to (partial) loss of innervation of upper extremity and trunk muscles, and low blood pressure (BP). The objective was to assess the effects of electrical stimulation (ES)-induced co-contraction of trunk muscles on trunk stability, arm force/power, BP, and WR performance. Design: Cross-sectional study. Setting: Rehabilitation research laboratory and WR court. Participants: Eleven WR athletes with tetraplegia. Interventions: ES was applied to the rectus abdominis, obliquus externus abdominis and erector spinae muscles. For every test, the ES condition was compared to the non-ES condition. Outcome measures: Stability was assessed with reaching tasks, arm force/power with an isokinetic test on a dynamometer, BP during an ES protocol and WR skill performance with the USA Wheelchair Rugby Skill Assessment. Results: Overall reaching distance (ES 14.6 ± 7.5 cm, non-ES 13.4 ± 8.2 cm), and BP showed a significant increase with ES. Arm force (ES 154 ± 106 N, non-ES 148 ± 102 N) and power (ES 37 ± 26 W, non-ES 36 ± 25 W), and WR skills were not significantly improved. Conclusion: ES-induced trunk muscle activation positively affects trunk stability and BP, but not arm force/power. No effects were found in WR skill performance, probably due to abdominal strapping. More research is needed to assess different ES (training) protocols and longitudinal effects.

Purpose: Many studies have reported increased muscle activities in treatments using kinesio tape. However, most studies have focused on only muscles, so the effects of kinesio tape on structures other than the muscles are unknown. The purpose of this study is to explore the effect of kinesio tape for the fascia on trunk muscle activity during plank. Methods: Eighteen healthy participants took part in this study. The participants were asked to perform the plank in two conditions: on stable surface and unstable surface. Two kinesio tapes were attached along the spiral line introduced in the anatomy train. EMG was measured in each condition. EMG data were collected before and after attaching kinesio tape in each condition. Repeated analysis of variance (repeated ANOVA) was conducted to compare EMG activities levels between conditions. Results: EMG activities levels of trunk muscles, especially rectus abdominis and erector spinae activities were significantly increased dur ing the plank with KT on both stable and unstable surfaces. Conclusion: KT applying on the fascia of targeted muscle increases the muscle activity. Therefore, we can also focus on the fascia to in crease muscle activities not only on muscles.

Purpose: Functional disability, impaired balance, and trunk muscle endurance are among the major changes in patients with Non-specific Chronic Low Back Pain (NCLBP). Investigating the relationship between these factors and Functional Movement Screen (FMS) can facilitate effective pain management and functional problems in these patients. This study aimed to assess the relationships between FMS and pain, dynamic balance, and trunk muscle endurance in military personnel with NCLBP. Methods: The present study was of a correlational research design. The study subjects were 50 male military personnel with NCLBP (Mean±SD age=33.30±3.94 y, height= 175.32±5.50 cm, & weight=74.05±3.64 kg). FMS was evaluated by FMS tests and pain severity was assessed through Quebec Back Pain Disability Scale; the dynamic balance was evaluated by Y-Balance Test (YBT), and the trunk muscle endurance was measured by the ITO test. Statistical analysis was performed by SPSS. Pearson correlation coefficient at a significance level of P

EnglishIntroduction:Aging can cause physiological and functional changes, and these, in turn, can lead to a decline in functions and functional capacity, thus generating a compromise in autonomy and mobility, and increasing the risk of falls. Aging is also associated with biological changes that compromise inspiratory muscle function. There are studies that have shown that all trunk muscles work together with the function of protecting the spine and preserving postural control, including inspiratory muscles, however, the diaphragm's role in breathing always takes precedence over postural function. Objective:To verify the influence of the increase in inspiratory demand on postural stability in the elderly, through a case study. Methods:Three elderly people initially performedthe maximal inspiratory pressure (MIP) assessment, and then underwent a postural stability test. In the Biodex Balance System SD, they performed the protocol of the device called 'Postural Stability Test' (PST), in order to assess the instability index under two different conditions. In the first condition, the elderly performed the test and could breathe normally, without making efforts and trying to stay balanced on the equipment platform; in the second condition, the elderly were evaluated performing breathing using the Power Breathe® equipment and using a nasal clip. To achieve this condition of increased inspiratory demand, an overload of 50% of the MIP value was adopted, assessed at the beginning. Results:In the anterior-posterior oscillations, all the elderly individuals presented a higher rate of instability in the test with an increase in inspiratory demand and for the right-left oscillations, two of the evaluated elderly individuals presented a higher rate of instability in this condition. Conclusion:The increase in inspiratory demand provided by the Power Breathe® device was able to alter the balance of the elderly, increasing the postural instability of the individuals evaluated. We consider that for more clarifying results it is necessary to carry out a randomized controlled study with a larger sample. portuguesIntroducao: O envelhecimento provoca alteracoes fisiologicas e funcionais, declinio das funcoes e da capacidade funcional, compromentendo a autonomia e mobilidade, aumentando o risco de quedas; tambem esta associado a alteracoes biologicas que comprometem a funcao muscular inspiratoria. Existem estudos que mostraram que toda musculatura do tronco trabalha conjuntamente com a funcao de proteger a coluna e preservar o controle postural, incluindo os musculos inspiratorios, porem, o papel do diafragma na respiracao sempre toma precedencia sobre a funcao postural. Objetivo: Verificar a influencia dos musculos inspiratorios na estabilidade postural de idosos. Metodos: Tres idosos, realizaram avaliacao da pressao inspiratoria maxima (PImax), em seguida no Biodex Balance System SD realizaram o 'Postural Stability Test' (PST), nas condicoes de respiracao livre e com respiracao atraves do equipamento Power Breathe®, com sobrecarga de 50% do valor da PImax. Resultados: Nas oscilacoes anterior-posterior todos os idosos apresentaram maior indice de instabilidade no teste com aumento da demanda inspiratoria e para as oscilacoes direita-esquerda dois idosos apresentaram maior indice de instabilidade nessa condicao. Conclusao: O aumento na demanda inspiratoria fornecido pelo dispositivo Power Breathe® foi capaz de alterar a equilibrio de idosos, ainda que devemos considerar que para resultados mais esclarecedores seja necessario a realizacao de um estudo maior.

The first period of mature age (21-35 years) of women is characterized by the beginning of involutionary processes in the body and a decrease in the motor abilities of women, and the solution to this problem is possible by optimizing their motor activity. An important factor in training for mature women is to ensure a positive effect on the functional state of the muscles of the torso. Classes in dance types of health-improving motor activity (in particular, bellydance- fitness) have a positive effect on the psycho-emotional state of women and the state of their musculoskeletal system. The work is devoted to the research of the influence of the practice of bellydance-fitness (fitness with movements of oriental dance) on the functional state of the trunk muscles of women of the first period of mature age. Indicators of physical qualities such as static and dynamic strength endurance of torso muscles; spinal mobility in women engaged in bellydance-fitness were studied. Indicators of physical preparedness of women with less than 4 months of training and women with 2-3 years of training were compared. It was a positive effect of bellydance-fitness on the level of functional state of the torso muscles of women. Women with 2-3 years of training are characterized by a higher level of strength of the muscles of the torso and mobility of the spine than women with less than 4 months of training. The results of the research give grounds to recommend the use of bellydance-fitness as a means of improving the functional state of the torso muscles of women.

Background Abdominal draw-in maneuver (ADIM) has been recommended to achieve appropriate trunk muscle response for patients with non-specific chronic low back pain (CLBP). However, it has remained unclear whether the intervention with ADIM could change the trunk muscle response to sudden release from loading, which is considered to contribute mechanical circumstances to low back pain. The purpose of the present study was to investigate the effects of the intervention with ADIM on electromyography (EMG) activities of trunk muscles following sudden release from loading. Methods Seventeen subjects with non-specific CLBP participated. Subjects resisted trunk flexion or extension loading in semi-seated position, and then the loading was suddenly released. EMG recordings of 6 trunk muscles were acquired using a wireless surface EMG system. Onset and offset times were calculated from the EMG data. The intervention with ADIM was provided for 4 weeks. The onset and offset times were compared between pre- and post-intervention with ADIM. Results At the post-intervention, the onset of trunk flexors following release from trunk flexion loading became significantly earlier than pre-intervention (P = 0.028). The offset of flexors following release from trunk extension loading of post-intervention was significantly earlier than that of pre-intervention (P = 0.001). Conclusions We showed that the intervention with ADIM changed the EMG activity of trunk flexors in response to sudden release from loading. These results suggest a possibility that ADIM might be effective to improve the neuromuscular control of trunk flexors for the treatment of young patients with non-specific CLBP.