Panjabi11) reported that lumbar stabilization exercise, a muscle strengthening exercise for the deep muscle group, plays an important role in providing dynamic stabilization in the segments providing lumbar segmental stability, and is useful for decrease in spinal functional disorder. Richardson et al.12) proposed that lumbar stabilization exercise increased the stability of the spine and pelvis while performing functional postures and movements.
Critchley et al.13) evaluated the activation of the transversus abdominis muscle in a group of 20 patients with chronic low back pain and a group of 24 normal adults the normal group showed 49.71% of activation while the group of patients with chronic low back pain showed 19.15% of activation, significantly less activation than the normal group. Another study of patients with chronic low back pain showed that both a group segmental stabilization exercise and a group performing segmental stabilization exercise with bio-feedback using ultrasound double the activation of the transversus abdominis muscle14). The present study also found improvements in isokinetic low extremity muscle function after performing bridge exercise and leg lifts that strengthen the lower extremity muscles along with lumbar stabilization exercise for back strengthening, a results which is consistent with those of studies cited above.
Both internal oblique and transversus abdominis muscles are deep abdominal muscles, which contribute to lumbar stabilization with specific rules so that damage of motor control system to such muscles causes spinal instability. Furthermore, internal oblique and transversus abdominis muscles are poorly controlled in patients with low back pain15). In the present study, lumbar stabilization exercise decreased kyphotisis and lordosis in an SCI patient with kyphosis due to abdominal and low back muscle weakening.
The lat pull-down training for posture correction elicits a significant effect on spinal kyphosis. It is general common sense that exercise can improve muscle strength. A lumbar stabilization exercise is one that strengthens the core muscles, which are deep muscles. It improves internal and external lumbar stabilization through isometric contraction by the muscles of the abdomen. The muscles used for lumbar stabilization are divided into deep stabilizer muscles and superficial stabilizer muscles. The lumbar area can be greatly strengthened when the superficial stabilizer muscles, as a large muscle group, and deep stabilizer muscles, as a local muscles group, are strengthened16).
Lumbar stabilization exercises can solve the problem of deficiency of motor control in the trunk and instability of postural balance. They are effective at reducing of low back pain, increasing the range of motion of the trunk and pelvis, and improving body balance, neuromuscular control, and muscle strengthening methods17, 18). Furthermore, exercises on unstable surfaces make sensory motor training possible19). The stabilization exercise used in this study increased muscle strength in the lumbar area thereby improving postural balance and muscle strength in the lower extremity.
Shumway-Cook & Woolacott20) revealed that muscles pass through body segments generate co-contraction in order to maintain balance against superficial instability while muscle activation increases as instability of the lower extremities increases21). In the present study, after a lumbar stabilization exercise was performed according to lower extremity muscle strength of the subject increased in the unstable.
Hodges & Richardson21) reported that deep muscles and stabilizer muscles such as the internal oblique and transversus abdominis muscles acted more quickly than the other large muscles to contribute to spine stabilization, while Cholewicki & Van Vliet22) emphasized strengthening of the superficial stabilizer muscles to reduce the movements between injured spinal segments. Furthermore, Standaert, Weinstein, & Rumpeltes23) proposed that complex exercise methods should be conducted to strengthen both the large and small muscles. In this study, the core stability exercise for deep muscle training and lat pull-down exercise had a positive effect on lower extremity muscle strength and the spinal shape of a patient with SCI. According to the report by Huang et al.24), chronic low back pain can be improved by a combination of Pelvic floor muscle exercise and the neuromuscular joint facilitation pattern. According to the report by Ju et al.25), the exercise treatment program for rehabilitation patients after lumbar disc herniation surgery was effective at strengthening lumbar extensor muscles and reducing pain. Therefore, in the present study showed that consistent with the results of the SCI patient trunk muscle strengthening is a leading research through the rehabilitation training.