The Effect of Strength Training Programme in the Enhancement of Trunk and Hip Muscles Activations among Healthy Females Subject

Qais Gasibat^1*, Nordin Simbak^1*, Aniza Abd Aziz¹, Rabiu Muazu Musa²

¹Faculty of Medicine, Universiti Sultan Zainal Abidin, Kota Campus, 20400 Jalan Sultan Mahmud,

Kuala Terengganu

²Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin, 21300 Kuala Terengganu,

Terengganu, Malaysia

*Corresponding Author E-mail: nordinsimbak@unisza.edu.my

ABSTRACT:

Research has illustrated that the risk of lower back pain (LBP) among women population is signiﬁcantly higher owing to the hormonal and reproductive factors such as irregular or prolonged menstrual cycle and hysterectomy. The trunk and hip muscles are regarded as the most affected muscles in LBP patients and as such precise training of these muscles could be of value to the patients. Diverse exercises programmes exist, yet, the appropriate training that could be suitable in stimulating certain groups of muscles for a specified gender remains a challenge. As a result, this study aims to determine the efficacy of a strength training programme (STTP) in improving and stimulating the trunk and hips muscles of female’s subjects. 25 healthy females with normal BMI and ages range from 19 to 24 years performed five sets of strength exercises three times a week for five weeks. Electromyography (EMG) data were collected from 5 muscles of rectus abdominis, external oblique, multifidus, gluteus maximus and gluteus medius. The readings from the EMG were compared after the five weeks interventions (pre and post). An independent t-test was administered to the data collected to study the effectiveness of the STTP between pre and post on the trained muscles. A statistically significant difference of muscle activations between the pre and post on all the assessed muscles were obtained p < 0.05. The finding suggests that STTP intervention is effective in stimulating the females’ pelvic muscles activations. STTP could be a viable means for prevention and rehabilitation of LBP.

KEYWORDS: Strength training, Muscle activations, Pelvic muscles, Lower back pain

INTRODUCTION:

Muscle strength is a wide term that encompasses the capacity of the contractile tissue to generate force and resultant tension in relation to the demands placed upon the muscle. Strength training programme (STTP) is described as a systematic strategy of a tissue or muscle group to sustain its vigor when lifting, lowering, or controlling heavy loads (resistance) for a comparatively lowamount of repetitions or over a short time span¹.

Researchers have indicated that the deepfibres of the multifidus and transversus abdominis are among the preliminary muscles to become active when there is a postural change from rapid extremity movements². The rectus abdominis, external oblique, and internal oblique muscles are large, multi-segmental global muscles and are vital catalysts for supporting the spine against postural perturbations. The transversus abdominis is the deepest of the abdominal muscles and responds exclusively to postural perturbations. It has been demonstrated that activation and function of these muscles could substantially improve through the STTP interventions in patients with LBP². Moreover, some authors have similarly documented that STTP is useful in the improvement of postural control and stability for a long term benefit ^3,25.

Research has demonstrated that the prevalence of LBP among women population is signiﬁcantly higher due to the Hormonal and reproductive factors such as irregular or prolonged menstrual cycle and hysterectomy as compared to males⁴. In the other hand, it has been reported that to identify the effectiveness of a particular intervention programme, the first way to begin could be with healthy subjects after that the potential findings could be safely applied to the patient's^5,6. To this effect, the current study examined the effectiveness of STTP in improving the said targeted muscles activations of healthy female subjects. The study aims at drawing the attention of the physiotherapist, trainers and other stakeholders to determine the most appropriate training programme capable of given maximum effects in developing and stimulating the lumber muscles of female’s subjects which will consequently serve as a guide for application to the reduction and rehabilitations of LBP amongst female patients.

MATERIALS AND METHODS:

Participants:

A total of 25 healthy female subjects with normal BMI of 18.5 to 24.9 kg/m² and without any record for current or previous lower extremity or back problems with ages range of 19 to 24 years were recruited to participate in the study. The participants who volunteered to take part in this study were from the Faculty of Health Sciences of the Universiti Sultan Zainal Abidin. Written consent was obtained, and all the participants signed consent forms. All the exercises procedures, protocol, and equipment for this study were authorised by the Research Ethics Board of the Universiti Sultan Zainal Abidin with an approval number of UniSZAC/628-1jld2 (02).

Selected Exercises for the study:

The following stability based exercisewere selected and applied in the study. The selections of the exercises were carefully made based on their ability in strengthening the muscles under investigation.

Table 1: Selected exercises and the targeted muscles

Name of exercise	Muscle	How to perform	Reference
(a) Full crunches	Rectusabdominis	Lay on your back on a workout mat or bed. Flex both knees until the feet are flat on the ground. With your feet away from the ground, raise your upper body and shoulders to around 30 levels off the floor. Rise and stop whenever your elbows reach your upper thighs. The entire curl up should take around 30s.	6,7,25,26
(b) side crunches	External oblique	Begin by lying on your back again on the floor and turn both knees to the right. Slowly lift your shoulders off the floor and move your body straight up and then down again to the floor as if you had been doing a regular crunch. Ensure that you keep your knees turned to the best as you do the crunch.	8,9,25,26
(c) lumbar fullextension	Multifidus	Lie on your stomach and put your arms in front of your chest. Take your body up to a fully extended position. Your legs should be fully extended.	10,11,28
(d) hip extension	Gluteus maximus	Lie down; you can put your forehead on your hand or put a towel underneath your forehead. Lift your thigh off the ground and extend the leg.	12,27
(e) hip abduction	Gluteus medius	Lay on your side on an exercise pad or bed in a beginning position. With knees completely extended, slowly abduct while keeping the knees extended. Look at 30% of hip hold and slowly return.	13,27

Figure 1. The strength exercises used in the study (a) Full crunches; (b) Side crunches; (c) Prone lumbar extension; (d) Hip extension; (e) Hip abduction.

Experimental Protocol:

The participants were given a set of strength training as shown in Fig 1 for a period of five weeks. Before the beginning of the exercises, the initial measurement of the muscles activations was taken at a zero week (pre). Electromyography (EMG) data were collected from 5 muscles during the exercises performance (Rectus abdominis, External oblique, Multifidus, Gluteus maximus and medius), and the readings from the EMG were compared after the five weeks interventions (pre and post).

Data Collection Procedure:

Before electrode placement, each subject was familiarised with the procedures by being instructed, and by practising the muscle tests and exercises performed. The researchers taught all the participants on how to perform each exercise using explanations and pictures. Dual disposable silver chloride surface area recording electrodes were used. EMG data were gathered from the rectus abdominis, exterior oblique, lumbar multifidus, gluteus maximus and gluteus medius. For the rectus abdominis muscle, the electrodes were placed 3 cm horizontal and 3 cm above the umbilicus. The electrodes were positioned midway between the anterior fine iliac spine and the ribs cage for the exterior oblique abdominis muscle. Intended for the lumbar multifidus muscle mass, the electrodes were put 2 cm lateral towards the lumbosacral junction. The electrodes for the gluteus medius muscle were placed above the gluteus maximus muscle and closer to the iliac crest around the lateral side of the pelvis. For the gluteus maximus muscle, electrodes were placed in the centre from the muscle belly between the extensive edge of the sacrum as well as the posterosuperior edge of the higher trochanter. The reference electrode was located over the anterior superior iliac spine. All the procedures for the electrodes placement were conducted by the recommendations of the previous researchers^14,15. A detail description of the entire data collection procedure is provided in Figure 2.

Figure 2: A flow chart during the data collection process

Figure 2 projects the flow chart organisation during the data collection process. The time for the warm up, preparation of the sites attachment of the electrodes, the time taken for each exercise as well as the rest period interval are displayed. The procedures for all the steps were performed in accordance with the recommendations by the previous researchers^8,16.

Statistical Analysis:

An independent t-test analysis was employed in this study to determine whether there is a significant difference between the pre and post of the training modalities as well as to compare the efficacy of the interventions training in the improvement of the muscle activations between the pre and the post measurement. The periods (pre and post) were used as the independent variables while the average electrical activities of all the selected muscles were treated as the dependent variables. All the statistical analysis was conducted using XLSTAT add in software version 2014 for Windows at a confidence level of p ≤ 0.05.

RESULTS:

Table 2 demonstrates the descriptive statistics of the pre and post STTP on the muscles evaluated. The period of the intervention (pre and post) the number of the participants, the minimum, maximum scores, mean as well as the standard deviation of each variable is shown. It can be observed from the table that the mean of the post-intervention measurement is greater than the pre-measurement indicating that the mean muscle activations of the post are considerably higher as compared to the pre.

Table 2: Descriptive Statistics of the strength training intervention programme on the muscles.

Muscle type	Intervention Period	N	Min.	Max.	M	SD
Rectus abdominis	Pre	25.00	19.76	128.55	80.31	24.26
Rectus abdominis	Post	25.00	94.01	169.47	142.53	18.08
External oblique	Pre	25.00	35.14	119.30	76.51	23.94
External oblique	Post	25.00	93.31	178.56	141.79	24.99
Multifidus	Pre	25.00	53.48	122.26	83.79	17.37
Multifidus	Post	25.00	92.45	154.96	133.73	22.39
Gluteus maximus	Pre	25.00	12.32	130.58	83.61	21.07
Gluteus maximus	Post	25.00	99.05	174.78	134.74	23.29
Gluteus medius	Pre	25.00	18.34	126.32	83.12	23.00
Gluteus medius	Post	25.00	86.29	169.34	145.86	19.95

Table 3 reveals the inferential statistics of the pair wise comparison performed as a follow-up for the t-test. From the table t observed, t critical, the degree of freedom the difference between the pre and post evaluations as well as the significant levels are highlighted. It can be seenthat there is a statistically significant difference between the pre and post on the muscle activations in all the evaluated muscles of Rectus abdominis, External oblique, Multifidus, Gluteus maximus and Gluteus medius p < 0.001. This result suggests that STTP is intervention is effective in improving the said selected muscles activations of the participants examined in the study.

Table 3: Inferential Statistics of the strength training intervention programme on the muscles examined.

Muscle types	t(obs.)	t(crtcl)	DF	D	Sig
Rectus abdominis	-10.28	2.01	48	-62.22	0.001*
External oblique	-9.433	2.01	48	-65.28	0.001*
Multifidus	-8.81	2.01	48	-49.94	0.001*
Gluteus maximus	-8.14	2.01	48	-51.13	0.001*
Gluteus medius	-10.3	2.01	48	-62.74	0.001*

*Significant p < 0.001

DISCUSSION:

The general result of the present study has indicated that the STTP is effective in the improvement of the selected muscles of the participants. The evidence provided in Table 2 and 3 has suggested that trunk and hip muscles of the females’ participants in the study have responded to the training programme implemented. The results further indicated that STTP could be useful as rehabilitation exercises in females subjects.

The results obtained from this study agrees to that of the previous researcher who explained that back extensors serve as the crucial muscles during raising and bending actions. These muscles act both to stretch the spine and to stabilise the flexion motion created by the trunk when weightis being raised¹⁷. Muscular strength is perceived to be the ability of a muscle or group of muscles to produce force and hence muscular strength is enhanced with STTP. Moreover, research has shown that STTP is applied in physical fitness as well as in the prevention and restoration of musculoskeletal impairments¹⁸. For example, low back extensor muscle strength is a significant determinant of low back health and consequently STTP serve as means for rehabilitation of the lower back, avoidance of injury, and as a constituent of physical fitness exercise programmes to improve performance standards^15,19. The finding of the current study has further indicated that STTP intervention is effective in increasing the muscles activations among healthy females subject. An increase in muscles activations is associated with the capacity of the muscles to respond effectively to the demands placed upon them. This explanation could be comprehended because many people with LBP possessed weak low back muscles which hinder or restricts higher muscle activations^20,21. As such the current findings could be extended to cater for the LBP patients in enhancing the strength of their activities. In another perspective, some researchers examined the value of specific trunk, hip, muscles strengthening and back training for the prevention of injuries²². It was concluded from their findings that strength training is vital in reducing the prevalence of injury occurrence of the LBP patients. It has also been reported that weakness and poor stamina from the lumbar and gluteus muscle tissue in people with lower extremity accidental injuries and LBP could be effectively improved through STTP interventions ^23,24. These investigations are in agreement with the findings of the present study in determining that the STTP is efficient in enhancing the muscles activities among healthy females’ subjects which could likewise be alluded in the rehabilitation of LBP patients.

CONCLUSION:

The outcomes of the present research have indicated that the strength training programme adopted in the study was useful in increasing the muscles activations of the participants within the five weeks interventions period. The strength intervention programme is shown to be capable of stimulating the rectus abdominis, external oblique, multifidus, gluteus maximus and gluteus medius muscles. Furthermore, the study reveals that the utilisation of surface electromyography signals in detecting muscles activations is nontrivial as it allows the researchers to establish that STTP intervention programme could improve the activations of the lumber muscles amongst healthy female’s subjects which would, consequently, be useful to the female’s patients with history of LBP as well as prevent its occurrence to those at risk. Trainers and physiotherapist could consider STTP as a practical measure for rehabilitation and prevention of LBP.

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Received on 22.06.2017 Modified on 21.07.2017

Research J. Pharm. and Tech. 2017; 10(9): 2845-2850.

DOI: 10.5958/0974-360X.2017.00501.7